Research activity information

• Differential centiloid scale normalization techniques: comparison between hybrid PET/MRI and independently acquired MRI.

  Ryo Yamakuni, Takenobu Murakami, Naoyuki Ukon, Takeyasu Kakamu, Wataru Toda, Kasumi Hattori, Hirofumi Sekino, Shiro Ishii, Kenji Fukushima, Hiroshi Matsuda, Yoshikazu Ugawa, Noritaka Wakasugi, Mitsunari Abe, Hiroshi Ito

  OBJECTIVE: Centiloid (CL) scales play an important role in semiquantitative analyses of amyloid-β (Aβ) PET. CLs are derived from the standardized uptake value ratio (SUVR), which needs Aβ positron emission tomography (PET) normalization processing. There are two methods to collect the T1-weighted imaging (T1WI) for normalization: (i) anatomical standardization using simultaneously acquired T1WI (PET/MRI), usually adapted to PET images from PET/MRI scanners, and (ii) T1WI from a separate examination (PET + MRI), usually adapted to PET images from PET/CT scanners. This study aimed to elucidate the correlations and differences in CLs between when using the above two T1WI collection methods. METHODS: Among patients who underwent Aβ PET/MRI (using 11C-Pittuberg compound B (11C-PiB) or 18F-flutemetamol (18F-FMM)) at our institution from 2015 to 2023, we selected 49 patients who also underwent other additional MRI examinations, including T1WI for anatomic standardization within 3 years. Thirty-one of them underwent 11C-PiB PET/MRI, and 18 participants underwent 18F-FMM PET/MRI. Twenty-five of them, additional MRI acquisition parameters were identical to simultaneous MRI during PET, and 24 participants were different. After normalization using PET/MRI or PET + MRI method each, SUVR was measured using the Global Alzheimer's Association Initiative Network cerebral cortical and striatum Volume of Interest templates (VOI) and whole cerebellum VOI. Subsequently, CLs were calculated using the previously established equations for each Aβ PET tracer. RESULTS: Between PET/MRI and PET + MRI methods, CLs correlated linearly in 11C-PiB PET (y = 1.00x - 0.11, R2 = 0.999), 18F-FMM PET (y = 0.97x - 0.12, 0.997), identical additional MRI acquisition (y = 1.00x + 0.33, 0.999), different acquisition (y = 0.98x - 0.43, 0.997), and entire study group (y = 1.00x - 0.24, 0.999). Wilcoxon signed-rank test revealed no significant differences: 11C-PiB (p = 0.49), 18F-FMM (0.08), and whole PET (0.46). However, significant differences were identified in identical acquisition (p = 0.04) and different acquisition (p = 0.02). Bland-Altman analysis documented only a small bias between PET/MRI and PET + MRI in 11C-PiB PET, 18F-FMM PET, identical additional MRI acquisition, different acquisition, and whole PET (- 0.05, 0.67, - 0.30, 0.78, and 0.21, respectively). CONCLUSIONS: Anatomical standardizations using PET/MRI and using PET + MRI can lead to almost equivalent CL. The CL values obtained using PET/MRI or PET + MRI normalization methods are consistent and comparable in clinical studies.

  Oct. 2024, Annals of nuclear medicine, 38(10) (10), 835 - 846, English, Domestic magazine

  Scientific journal


• Comparison of laparoscopic liver resection for the ventral versus the dorsal areas of segment 8.

  Kentaro Oji, Takeshi Urade, Masahiro Kido, Shohei Komatsu, Hidetoshi Gon, Nobuaki Yamasaki, Kenji Fukushima, Shinichi So, Toshihiko Yoshida, Keisuke Arai, Masayuki Akita, Jun Ishida, Yoshihide Nanno, Daisuke Tsugawa, Sadaki Asari, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  PURPOSE: The technical difficulties of laparoscopic liver resection (LLR) are greatly associated with the location of liver tumors. Since segment 8 (S8) contains a wide area, the difficulty of LLR for S8 tumors may vary depending on the location within the segment, such as the ventral (S8v) and dorsal (S8d) area, but the difference is unclear. METHODS: We retrospectively investigated 30 patients who underwent primary laparoscopic partial liver resection for liver tumors in S8 at Kobe University Hospital between January 2018 and June 2023. RESULTS: Thirteen and 17 patients underwent LLR for S8v and S8d, respectively. The operation time was significantly longer (S8v 203[135-259] vs. S8d 261[186-415] min, P = 0.002) and the amount of blood loss was significantly higher (10[10-150] vs. 10[10-200] mL, P = 0.034) in the S8d group than in the S8v group. No significant differences were observed in postoperative complications or postoperative length of hospital stay. Additionally, intraoperative findings revealed that the rate at which the case performed partial liver mobilization in the S8d group was higher (2[15.4%] vs. 8[47.1%], P = 0.060) and the median parenchymal transection time of the S8d group was longer (102[27-148] vs. 129[37-175] min, P = 0.097) than those in the S8v group, but there were no significant differences. CONCLUSION: The safety of LLR for the S8d was comparable to that of LLR for S8v, although LLR for S8d resulted in longer operative time and more blood loss. THE TRIAL REGISTRATION NUMBER: B230165 (approved at December 26, 2023).

  Aug. 2024, Langenbeck's archives of surgery, 409(1) (1), 243 - 243, English, International magazine

  Scientific journal


• Association between tumor morphology and efficacy of atezolizumab plus bevacizumab for advanced hepatocellular carcinoma.

  Nobuaki Ishihara, Shohei Komatsu, Keitaro Sofue, Eisuke Ueshima, Yoshihiko Yano, Yoshimi Fujishima, Jun Ishida, Masahiro Kido, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Hiroaki Yanagimoto, Hirochika Toyama, Yoshihide Ueda, Yuzo Kodama, Takamichi Murakami, Takumi Fukumoto

  AIM: The IMbrave150 trial revealed that atezolizumab plus bevacizumab (AtezoBv) showed a higher objective response rate (ORR) in patients with advanced hepatocellular carcinoma (HCC). Although conversion therapy after AtezoBv has been recently reported, markers predictive of its efficacy, particularly radiological imaging markers, have not yet been identified. The present study focused on tumor morphological appearance on radiological imaging and evaluated whether it could be associated with AtezoBv efficacy. METHODS: Ninety-five intrahepatic lesions in 74 patients who were given AtezoBv for advanced HCC were recruited for evaluation. The lesions were divided into two groups, simple nodular (SN group) and non-simple nodular (non-SN group), based on the gross morphology on pretreatment imaging, and retrospectively evaluated for treatment response and other relevant clinical outcomes. RESULTS: Assessing the size of individual tumors after treatment, waterfall plots showed that tumor shrinkage in the non-SN group including 56 lesions was higher than that in the SN group comprising 39 lesions. The ORR was significantly higher in the non-SN group (39.3% vs. 15.4%, p = 0.012). Additionally, the median time to nodular progression was longer in the non-SN group (21.0 months vs. 8.1 months, p = 0.119) compared to the SN group. Six patients with non-SN lesions underwent sequential local therapy. CONCLUSIONS: Atezolizumab plus bevacizumab may show increased therapeutic efficacy in patients with tumors with a higher potential for aggressive oncological behavior, such as non-SN lesions. Treatment strategies focusing on conversion therapy may be crucial in patients with non-SN lesions.

  Aug. 2024, Hepatology research : the official journal of the Japan Society of Hepatology, 54(8) (8), 773 - 780, English, International magazine

  Scientific journal


• Impact of bile leak on the prognosis of patients with hepatocellular carcinoma who have undergone liver resection.

  Hidetoshi Gon, Shohei Komatsu, Hirotoshi Soyama, Motofumi Tanaka, Kenji Fukushima, Takeshi Urade, Shinichi So, Toshihiko Yoshida, Keisuke Arai, Jun Ishida, Yoshihide Nanno, Daisuke Tsugawa, Hiroaki Yanagimoto, Hirochika Toyama, Masahiro Kido, Takumi Fukumoto

  PURPOSE: The impact of postoperative bile leak on the prognosis of patients with hepatocellular carcinoma who underwent liver resection is controversial. This study aimed to investigate the prognostic impact of bile leak for patients with hepatocellular carcinoma who underwent liver resection. METHODS: Patients with hepatocellular carcinoma who underwent liver resection between 2009 and 2019 at Kobe University Hospital and Hyogo Cancer Center were included. After propensity score matching between the bile leak and no bile leak groups, differences in 5-year recurrence-free and overall survival rates were evaluated using the Kaplan-Meier method. RESULTS: A total of 781 patients, including 43 with postoperative bile leak, were analyzed. In the matched cohort, 40 patients were included in each group. The 5-year recurrence-free survival rates after liver resection were 35% and 32% for the bile leak and no bile leak groups, respectively (P = 0.857). The 5-year overall survival rates were 44% and 54% for the bile leak and no bile leak groups, respectively (P = 0.216). CONCLUSION: Overall, bile leak may not have a profound negative impact on the prognosis of patients with hepatocellular carcinoma who have undergone liver resection.

  Jul. 2024, Langenbeck's archives of surgery, 409(1) (1), 233 - 233, English, International magazine

  Scientific journal


• Impact of iodine contrast media on gamma camera-based GFR and factors affecting the difference between serum creatinine-based estimated GFR and Gate's GFR.

  Shiro Ishii, Shigeyasu Sugawara, Yumi Tanaka, Natsumi Kawamoto, Junko Hara, Ryo Yamakuni, Hiroki Suenaga, Kenji Fukushima, Hiroshi Ito

  OBJECTIVE: We aimed to elucidate the factors underlying the difference between estimated glomerular filtration rate (eGFR) calculated from serum creatinine and Gate's GFR (gGFR) measured using technetium-99m diethylene triamine pentaacetic acid ( 99m Tc-DTPA) scintigraphy. METHODS: This study was based on consecutive patients who underwent 99m Tc-DTPA scintigraphy at our hospital between January 2021 and December 2022 and whose blood serum creatinine data were obtained on the same day as the 99m Tc-DTPA scintigraphy. Relationships between the ratio of gGFR and eGFR (gGFR/eGFR) and age, sex, BMI, visceral fat, psoas muscle index (PMI), serum blood urea nitrogen, and creatinine level were investigated based on 75 patients. Additionally, for 44 patients who had two or more follow-up DTPA studies, we compared gGFR values for studies that used iodine contrast media (ICM) for computed tomography before same-day 99m Tc-DTPA studies and those that did not in the same patients. RESULTS: Weak correlations were observed between gGFR/eGFR and PMI ( r  = 0.30), BMI ( r  = 0.24), and the visceral fat area ( r  = 0.33). Multi-regression analyses showed that gGFR/eGFR was correlated with PMI ( β  = 0.34, P  < 0.01) and approached significance with the visceral fat area ( β  = 0.24, P  = 0.05). A significant difference was observed in gGFR between patients who received ICM before the 99m Tc-DTPA renogram and those who did not ( P  < 0.001, eGFR 80.5 ± 19.0 vs. 91.7 ± 27.8 ml/min). CONCLUSION: ICM administration temporarily decreased gGFR, and increased muscle mass increased the difference between eGFR and gGFR values.

  Jul. 2024, Nuclear medicine communications, 45(7) (7), 573 - 580, English, International magazine

  Scientific journal


• Complete response to tremelimumab plus durvalumab treatment in hepatocellular carcinoma with a bile duct tumor thrombus: A case report.

  Nobuaki Ishihara, Shohei Komatsu, Masahiro Kido, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Toshihiko Yoshida, Keisuke Arai, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  Tremelimumab plus durvalumab (Dur/Tre) is the first-line treatment for advanced hepatocellular carcinoma (HCC) worldwide. The present report describes the case of a 68-year-old man diagnosed with advanced HCC and a bile duct tumor thrombus (BDTT) who achieved a complete response to Dur/Tre therapy. The BDTT progressed to the bifurcation of the left and right hepatic ducts. Over time, both the tumors and BDTT progressively decreased in size, and a complete response was confirmed using the Response Evaluation Criteria in Solid Tumors (version 1.1.) 6 months after treatment administration. Subsequently, immune-related adverse events, including type 1 diabetes mellitus and diabetic ketoacidosis, emerged, leading to treatment discontinuation. The patient was undergoing outpatient follow-up in a drug-free state with no signs of recurrence 290 days after the initial administration of Dur/Tre. Although long-term and meticulous observations are required, the present findings could influence the choice of systemic chemotherapy for advanced HCC.

  Jul. 2024, Oncology letters, 28(1) (1), 332 - 332, English, International magazine

  Link to Kobe Univ. Repository (Kernel)


• Efficacy of S-1 Adjuvant Chemotherapy for Resected Biliary Tract Cancer: A Retrospective Propensity-Matched Analysis.

  Michihiko Yoshida, Hiroaki Yanagimoto, Daisuke Tsugawa, Masayuki Akita, Takeshi Urade, Yoshihide Nanno, Kenji Fukushima, Hidetoshi Gon, Shohei Komatsu, Sadaki Asari, Masahiro Kido, Hirochika Toyama, Tetsuo Ajiki, Takumi Fukumoto

  INTRODUCTION: Surgical resection is considered an effective cure for biliary tract cancer (BTC); however, the prognosis is unsatisfactory despite improved surgical techniques and perioperative management. The recurrence rate remains high even after curative resection. The efficacy of adjuvant chemotherapy in pancreatic and gastric cancers has been previously reported, and the feasibility of adjuvant therapy with S-1 has recently been reported in patients with resected BTC. We aimed to retrospectively investigate the effects of adjuvant chemotherapy with S-1 on resected advanced BTC. METHODS: We included data from 438 BTC patients who underwent resection between 2001 and 2020. After excluding patients with pTis-pT1 (n = 112) and other exclusion criteria, 266 patients were included in the analysis. RESULTS: After propensity score matching, 48 patients received S-1 adjuvant chemotherapy (S-1 group), and 48 patients received non-S1 adjuvant chemotherapy or underwent surgery alone (Non-S-1 group). The patients in the S-1 group had significantly better overall survival (OS) than those in the non-S-1 group (MST 51 vs 37 months, hazard ratio [HR]:.54, 95% confidence interval [CI]:.30-.98, P = .04). The S-1 group had a significantly better recurrence-free survival (RFS) than the non-S-1 group (94 vs 21 months, HR: .57, 95% CI: .33-.97, P = .03). Subgroup analyses for OS and RFS exhibited the benefits of S-1 in patients aged <75 years and in patients with primary sites of extrahepatic and perineural invasion and curability of R0. DISCUSSION: S-1 adjuvant therapy is promising for improving the postoperative survival of patients with resected advanced BTC, positive nerve invasion, and R0 resection.

  Jun. 2024, The American surgeon, 90(6) (6), 1279 - 1289, English, International magazine

  Scientific journal


• Spontaneous rupture of splenic hilar lymph node metastasis from hepatocellular carcinoma.

  Ryosuke Fujinaka, Takeshi Urade, Masahiro Kido, Shohei Komatsu, Hidetoshi Gon, Kenji Fukushima, Masato Komatsu, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  Spontaneous rupture of a primary hepatocellular carcinoma (HCC) is a frequently observed and fatal complication. However, the rupture of lymph node (LN) metastases from HCC is rare. A 79 year-old male with hepatitis B underwent three liver resections for HCC. Two years and 6 months after the last liver resection, enhanced computed tomography (CT) revealed a nodule with a diameter of 3 cm in the lower pole of the spleen. Splenic metastasis of HCC was suspected, and splenectomy was scheduled. During our hospital stay for a urinary tract infection before the scheduled operation, he complained of acute left-sided abdominal pain, and CT showed intra-abdominal hemorrhage due to rupture of the splenic tumor. Emergency splenectomy was performed, and the postoperative course was uneventful. Histopathological examination revealed a poorly differentiated HCC in the lower splenic pole lesion, which contained LN structures. The ruptured lesion was diagnosed as splenic hilar LN metastasis of HCC. Although laparoscopic partial liver resection was performed for intrahepatic recurrence, and atezolizumab plus bevacizumab therapy was administered for peritoneal metastases, the patient was alive 25 months after the splenectomy. Our case suggests that emergency surgery for LN metastatic rupture can achieve hemostasis and lead to improved survival outcomes.

  Jun. 2024, Clinical journal of gastroenterology, 17(3) (3), 557 - 562, English, Domestic magazine

  Scientific journal


• Risk Stratification Using Right Ventricular Longitudinal Strain Ratio Derived from 13N-Ammonia PET in Patients with Ischemic Heart Disease.

  Atsushi Yamamoto, Michinobu Nagao, Masateru Kawakubo, Risako Nakao, Yuka Matsuo, Akiko Sakai, Koichiro Kaneko, Kenji Fukushima, Mitsuru Momose, Shuji Sakai, Junichi Yamaguchi

  Purpose To investigate whether right ventricular (RV) myocardial strain ratio (RVMSR) assessed using nitrogen 13 ammonia (13N-NH3) PET can predict cardiovascular events in patients with ischemic heart disease (IHD). Materials and Methods This retrospective study included 480 consecutive patients (mean age, 66 years ± 12 [SD]; 334 males and 146 females) with IHD who underwent 13N-NH3 PET. RVMSR was defined as the ratio of RV strain during stress to that at rest. The primary end point was major adverse cardiac events (MACEs), defined as cardiac death or heart failure hospitalization. The ability of RVMSR to predict MACE was assessed using receiver operating characteristic (ROC) curve and Kaplan-Meier analyses. Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) with 95% CIs. Results ROC curve analysis identified a sensitivity and specificity of 84% and 82%, respectively, for predicting MACE from RVMSR. Patients with reduced RVMSR (<110.2) displayed a significantly higher rate of MACE than those with a preserved RVMSR (34 of 240 vs four of 240; P < .001). Cox proportional hazards regression analysis of imaging parameters, including myocardial flow reserve, indicated that RVMSR was an independent predictor of MACE (HR, 0.94 [95% CI: 0.92, 0.97]; P < .001). Conclusion RVMSR was an independent predictor of MACE and has potential to aid in the risk stratification of patients with IHD. Keywords: Right Ventricular Myocardial Strain Ratio, Myocardial Flow Reserve, Ischemic Heart Disease, 13N-Ammonia Positron Emission Tomography Supplemental material is available for this article. © RSNA, 2024.

  Jun. 2024, Radiology. Cardiothoracic imaging, 6(3) (3), e230298, English, International magazine

  Scientific journal


• Prognostic significance of left atrial strain combined with left ventricular strain using cardiac magnetic resonance feature tracking in patients with heart failure with preserved ejection fraction.

  Masataka Katahira, Kenji Fukushima, Takatoyo Kiko, Ryo Yamakuni, Keiichiro Endo, Akiomi Yoshihisa, Shiro Ishii, Hiroshi Ito, Yasuchika Takeishi

  We aimed to evaluate the prognostic value of left ventricular global longitudinal strain (LVGLS) and left atrial strain (LAS) obtained from magnetic resonance imaging (MRI) feature tracking in patients with heart failure with preserved ejection fraction (HFpEF). We retrospectively enrolled consecutive patients with HFpEF admitted to our hospital who underwent cardiac MRI. LVGLS and LAS were obtained from cine MRI by feature tracking. The end point was defined as a composite of all-cause death, myocardial infarction, and hospitalization due to decompensated HF. One-hundred patients with HFpEF were enrolled. Mean LVGLS and LAS were - 13.7 ± 3.7% and 22.5 ± 11.6%, respectively. During follow-up of 4.4 ± 1.9 years, 24 events occurred. Multivariate Cox proportional hazards model analysis demonstrated LAS was independently associated with adverse cardiac events. Kaplan-Meier curve analysis revealed that the patients with both LVGLS and LAS worse than the median (LVGLS ≥ - 12.2% and LAS ≤ 13.8%) had a significantly lower event-free rate compared to those with preserved strain (Log-rank P < 0.001). Simultaneous assessment of LVGLS and LAS using MRI was useful for risk stratification in the patients with HFpEF.

  May 2024, Heart and vessels, 39(5) (5), 404 - 411, English, Domestic magazine

  Scientific journal


• Optimal cutoff values of drain amylase for predicting pancreatic fistula are different between open and laparoscopic distal pancreatectomy.

  Jun Ishida, Hirochika Toyama, Sadaki Asari, Tadahiro Goto, Yoshihide Nanno, Toshihiko Yoshida, Shinichi So, Takeshi Urade, Kenji Fukushima, Hidetoshi Gon, Daisuke Tsugawa, Shohei Komatsu, Hiroaki Yanagimoto, Masahiro Kido, Takumi Fukumoto

  BACKGROUND: Drainage fluid amylase (DFA) is useful for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP). However, difference in optimal cutoff value of DFA for predicting CR-POPF between open DP (ODP) and laparoscopic DP (LDP) has not been investigated. This study aimed to identify the optimal cutoff values of DFA for predicting CR-POPF after ODP and LDP. METHODS: Data for 294 patients (ODP, n = 127; LDP, n = 167) undergoing DP at Kobe University Hospital between 2010 and 2021 were reviewed. Propensity score matching was performed to minimize treatment selection bias. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff values of DFA for predicting CR-POPF for ODP and LDP. Logistic regression analysis for CR-POPF was performed to investigate the diagnostic value of DFA on postoperative day (POD) three with identified cutoff value. RESULTS: In the matched cohort, CR-POPF rates were 24.7% and 7.9% after ODP and LDP, respectively. DFA on POD one was significantly lower after ODP than after LDP (2263 U/L vs 4243 U/L, p < 0.001), while the difference was not significant on POD three (543 U/L vs 1221 U/L, p = 0.171). ROC analysis revealed that the optimal cutoff value of DFA on POD one and three for predicting CR-POPF were different between ODP and LDP (ODP, 3697 U/L on POD one, 1114 U/L on POD three; LDP, 10564 U/L on POD one, 6020 U/L on POD three). Multivariate analysis showed that DFA on POD three with identified cutoff value was the independent predictor for CR-POPF both for ODP and LDP. CONCLUSIONS: DFA on POD three is an independent predictor for CR-POPF after both ODP and LDP. However, the optimal cutoff value for it is significantly higher after LDP than after ODP. Optimal threshold of DFA for drain removal may be different between ODP and LDP.

  May 2024, Surgical endoscopy, 38(5) (5), 2699 - 2708, English, International magazine

  Scientific journal


• Current Roles of Ramucirumab in the Sequential Treatment of Unresectable Hepatocellular Carcinoma.

  Akira Koizumi, Shohei Komatsu, Satoshi Omiya, Yoshihiko Yano, Yoshimi Fujishima, Jun Ishida, Masahiro Kido, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Shinichi So, Toshihiko Yoshida, Keisuke Arai, Ryosuke Fujinaka, Yuhi Shimura, Hiroaki Yanagimoto, Hirochika Toyama, Yoshihide Ueda, Yuzo Kodama, Takumi Fukumoto

  BACKGROUND/AIM: The treatment algorithm for systemic therapies for advanced hepatocellular carcinoma (HCC) has changed dramatically; however, the therapeutic landscape for sequential second-line or later-line treatments, including ramucirumab, remains controversial. This study aimed to investigate the role of ramucirumab for treating HCC. PATIENTS AND METHODS: We retrospectively analyzed data from 17 patients with advanced HCC who received ramucirumab, and 8 of them who received lenvatinib re-administration after ramucirumab treatment failure. RESULTS: The median overall survival of 17 patients treated with ramucirumab was 11.5 months. The median ratios of the 1-month post-treatment α-fetoprotein (AFP) levels and albumin-bilirubin (ALBI) scores to the pre-treatment AFP levels and ALBI scores following ramucirumab treatment were 0.880 and 0.965, respectively. The median ratios of the 1-month post-treatment AFP and ALBI levels to the pre-treatment levels were 1.587 and 0.970 for mALBI grade 1/2a, and 1.313 and 0.936 for mALBI grade 2b/3, respectively. Six of the eight patients who received lenvatinib rechallenge treatment exhibited a decrease in AFP levels one month post-lenvatinib treatment. Deterioration of liver function 3 months post-lenvatinib treatment was noted in five of the eight patients who received lenvatinib rechallenge treatment after ramucirumab. CONCLUSION: Ramucirumab may be equally useful in patients with unresectable HCC who have poor liver function or whose liver function is aggravated by other therapies. Rechallenge treatment with lenvatinib after ramucirumab may be a valid treatment option for HCC.

  May 2024, Anticancer research, 44(5) (5), 2055 - 2061, English, International magazine

  Scientific journal


• The Albumin-bilirubin Grade as Prognostic Indicator for Recurrent Hepatocellular Carcinoma Needing Repeat Liver Resection.

  Hidetoshi Gon, Shohei Komatsu, Satoshi Omiya, Masahiro Kido, Kenji Fukushima, Takeshi Urade, Toshihiko Yoshida, Keisuke Arai, Jun Ishida, Yoshihide Nanno, Daisuke Tsugawa, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  BACKGROUND/AIM: This study aimed to evaluate the utility of the albumin-bilirubin grade for predicting the prognosis after repeat liver resection for patients with recurrent hepatocellular carcinoma. PATIENTS AND METHODS: Ninety patients with intrahepatic recurrent hepatocellular carcinoma who underwent repeat liver resection at our institution between 2005 and 2019 were retrospectively analyzed. Cox proportional-hazards regression models evaluated independent preoperative prognostic factors, including the albumin-bilirubin grade. Prognosis differences between patients with albumin-bilirubin grades 1 and 2 were analyzed using the Kaplan-Meier method. RESULTS: Cox proportional-hazards regression analysis revealed that albumin-bilirubin grade 2 (p=0.003) and early recurrence within one year from the initial surgery (p=0.001) were independently associated with poor recurrence-free survival, and albumin-bilirubin grade 2 (p=0.020) was independently associated with poor overall survival. The five-year recurrence-free (31% and 17%, respectively) and overall (86% and 60%, respectively) survival rates after repeat liver resection for patients with albumin-bilirubin grades 1 and 2 were significantly different between groups (both p=0.003). CONCLUSION: The albumin-bilirubin grade is useful for preoperatively predicting favorable survival rates after repeat liver resection for patients with recurrent hepatocellular carcinoma. Patients with an albumin-bilirubin grade 1 are better candidates for surgical treatment of recurrent hepatocellular carcinoma.

  May 2024, Anticancer research, 44(5) (5), 2031 - 2038, English, International magazine

  Scientific journal


• Collagen Triple Helix Repeat-Containing Protein 1 Is a Novel Biomarker of Right Ventricular Involvement in Pulmonary Hypertension.

  Tetsuro Yokokawa, Kazuto Nishiura, Masataka Katahira, Yu Sato, Shunsuke Miura, Akihiko Sato, Takeshi Shimizu, Tomofumi Misaka, Takamasa Sato, Takashi Kaneshiro, Masayoshi Oikawa, Akiomi Yoshihisa, Koichi Sugimoto, Kenji Fukushima, Kazuhiko Nakazato, Yasuchika Takeishi

  BACKGROUND: Pulmonary hypertension leads to right ventricular failure, which is a major determinant of prognosis. Circulating biomarkers for right ventricular function are poorly explored in pulmonary hypertension. This study aimed to clarify the significance of collagen triple helix repeat-containing protein 1 (CTHRC1) as a biomarker of right ventricular failure in pulmonary hypertension. METHODS: A monocrotaline-induced pulmonary hypertension rat model was used to evaluate right ventricular CTHRC1 expression and its relationship with fibrosis. Next, human plasma CTHRC1 levels were measured in controls (n = 20), pulmonary arterial hypertension (n = 46), and patients with chronic thromboembolic pulmonary hypertension (CTEPH) (n = 64) before the first and after the final balloon pulmonary angioplasty. RESULTS: CTHRC1 expression was higher in the right ventricles of rats with monocrotaline-induced pulmonary hypertension than in those of controls. CTHRC1 was colocalized with vimentin and associated with fibrosis in the right ventricles. Plasma CTHRC1 levels were higher in human patients with pulmonary arterial hypertension (P = 0.006) and CTEPH (P = 0.011) than in controls. Plasma CTHRC levels were correlated with B-type natriuretic peptide (R = 0.355, P < 0.001), tricuspid lateral annular peak systolic velocity (R = -0.213, P = 0.029), and right ventricular fractional area change (R = -0.225, P = 0.017). Finally, plasma CTHRC1 levels were decreased after the final balloon pulmonary angioplasty (P < 0.001) in CTEPH. CONCLUSIONS: CTHRC1 can be a circulating biomarker associated with right ventricular function and fibrosis in pulmonary hypertension and might reflect the therapeutic efficacy of balloon pulmonary angioplasty in CTEPH.

  Apr. 2024, The Canadian journal of cardiology, English, International magazine

  Scientific journal


• Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy.

  Taiichiro Miyake, Hiroaki Yanagimoto, Daisuke Tsugawa, Masayuki Akita, Riki Asakura, Keisuke Arai, Toshihiko Yoshida, Shinichi So, Jun Ishida, Takeshi Urade, Yoshihide Nanno, Kenji Fukushima, Hidetoshi Gon, Shohei Komatsu, Sadaki Asari, Hirochika Toyama, Masahiro Kido, Tetsuo Ajiki, Takumi Fukumoto

  BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication of hepatectomy. The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding. Therefore, we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy. AIM: To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy. METHODS: The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed. Patients were divided into two groups according to whether or not they developed VTE after hepatectomy, as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities. Clinicopathological factors, including demographic data and perioperative D-dimer values, were compared between the two groups. Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value. Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors. RESULTS: In total, 234 patients who underwent hepatectomy were, of whom (5.6%) were diagnosed with VTE following hepatectomy. A comparison between the two groups showed significant differences in operative time (529 vs 403 min, P = 0.0274) and blood loss (530 vs 138 mL, P = 0.0067). The D-dimer levels on postoperative days (POD) 1, 3, 5, 7 were significantly higher in the VTE group than in the non-VTE group. In the multivariate analysis, intraoperative blood loss of > 275 mL [odds ratio (OR) = 5.32, 95% confidence interval (CI): 1.05-27.0, P = 0.044] and plasma D-dimer levels on POD 5 ≥ 21 μg/mL (OR = 10.1, 95%CI: 2.04-50.1, P = 0.0046) were independent risk factors for VTE after hepatectomy. CONCLUSION: Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

  Jan. 2024, World journal of clinical cases, 12(2) (2), 276 - 284, English, International magazine

  Scientific journal


• A Novel Method Using Gadolinium-Ethoxybenzyl Diethylenetriamine Pentaacetate Acid-Enhanced Magnetic Resonance Imaging for Predicting Post-Hepatectomy Liver Failure in Hepatocellular Carcinoma Patients with a Major Portal Vein Tumor Thrombus.

  Kosuke Nishio, Shohei Komatsu, Keitaro Sofue, Masahiro Kido, Kaori Kuramitsu, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  INTRODUCTION: The usefulness of gadolinium-ethoxybenzyl diethylenetriamine pentaacetate acid-enhanced magnetic resonance imaging (EOB-MRI) in assessing the functional future remnant liver volume (fFRLV) to predict post-hepatectomy liver failure (PHLF) has been previously reported. Herein, we evaluated the efficacy of this technique in patients with hepatocellular carcinoma (HCC) with a major portal vein tumor thrombus (PVTT). METHODS: This study included 21 patients with PVTT in the ipsilateral first-order branch (Vp3) and 30 patients with PVTT in the main trunk/contralateral branch (Vp4). To evaluate fFRLV, the signal intensity (SI) of the remnant liver was determined on T1-weighted images, using both conventional and newly developed methods. The fFRLV was calculated using the SI of the remnant liver and muscle, remnant liver volume, and body surface area. Preoperative factors predicting PHLF (≥grade B) in HCC patients with Vp3/4 PVTT were evaluated. RESULTS: In the Vp3 group, we found fFRLV area under the receiver-operating characteristic curves (AUCs) above 0.70 (AUC = 0.875, 0.750) using EOB-MRI results calculated using either the plot or whole method. None of the parameters in the Vp4 group had an AUC greater than 0.70. CONCLUSION: The fFRLV calculated by EOB-MRI using the whole method can be as useful as the conventional method in predicting PHLF (≥grade B) for HCC patients with Vp3 PVTT.

  2024, Digestive surgery, 41(1) (1), 30 - 36, English, International magazine

  Scientific journal


• Predictive Value of Aortic Valve Calcium Volume Measured by Computed Tomography for Paravalvular Leakage After Transcatheter Aortic Valve Implantation.

  Daisuke Isomatsu, Akihiko Sato, Yuuki Muto, Yu Sato, Takeshi Shimizu, Tomofumi Misaka, Takashi Kaneshiro, Masayoshi Oikawa, Atsushi Kobayashi, Akiomi Yoshihisa, Takayoshi Yamaki, Hiroyuki Kunii, Kazuhiko Nakazato, Takafumi Ishida, Hirofumi Sekino, Kenji Fukushima, Hiroshi Ito, Yasuchika Takeishi

  Paravalvular leakage (PVL) is a complication of transcatheter aortic valve implantation (TAVI) for aortic stenosis, leading to an adverse prognosis. We investigated whether aortic valve calcium volume (Ca-Vol) measured by preoperative cardiac computed tomography had a predictive value for PVL after TAVI using a third-generation self-expandable valve.We retrospectively analyzed 59 consecutive patients who underwent TAVI using a third-generation self-expandable valve. We measured Ca-Vol in the aortic valve and each cusp (non-coronary cusp [NCC], right-coronary cusp [RCC], and left-coronary cusp [LCC]). We divided the patients into 2 groups: a PVL group (32.2%) and a non-PVL group (67.8%). Total Ca-Vol was significantly higher in the PVL group than in the non-PVL group (P < 0.001). Ca-Vol in each cusp was also significantly higher in the PVL group ([NCC] P < 0.001, [RCC] P = 0.001, [LCC] P < 0.001). Univariate logistic regression analysis for PVL indicated that the total and per-cusp Ca-Vols were predictors for PVL (total, odds ratio [OR] 4.0, P < 0.001; NCC, OR 12.5, P = 0.002; RCC, OR 16.0, P = 0.008; LCC, OR 44.5, P < 0.001).Receiver operating characteristic curve analysis of Ca-Vol for predicting PVL revealed the optimal cut-off values of Ca-Vol were 2.4 cm3 for the total, 0.74 cm3 for NCC, 0.73 cm3 for RCC, and 0.56 cm3 for LCC (area under the curve, 0.85, 0.79, 0.76, and 0.83, respectively).Preoperative total, NCC, RCC, and LCC calcium volumes were significant predictors for PVL after TAVI using third-generation self-expandable valves.

  2024, International heart journal, 65(1) (1), 63 - 70, English, Domestic magazine

  Scientific journal


• Investigation of factors affecting CT attenuation and glucose metabolism of bone marrow as seen on PET/CT scans.

  Shiro Ishii, Ryo Yamakuni, Shigeyasu Sugawara, Junko Hara, Yoshiki Endo, Hirotoshi Hotsumi, Mahori Hiruta, Honami Kobiyama, Yuki Yaginuma, Kenji Fukushima, Hiroshi Ito

  The aim of this study is to determine the factors affecting the CT attenuation of bone marrow, and its correlation with 18F-FDG uptake. The mean standardized uptake value (SUV) of vertebral bone marrow (Vertebral-SUV) and femoral bone marrow (Femoral-SUV) as well as CT number of bone marrow (BM-CT number) were measured in 243 patients who had undergone 18F-FDG PET/CT. The correlations among BM-CT number, Femoral-SUV, and Vertebral-SUV were investigated. The relationships of Femoral-SUV, Vertebral-SUV, and BM-CT number with blood parameters, age, blood sugar, and body weight were analyzed by correlation and multi-regression analyses. The Mann-Whitney U test and chi-square test and Binomial logistic analysis were used to examine the relationships between high BM-CT number (≥ 0 HU) and the above parameters. Significant correlations were observed between: BM-CT number and Femoral-SUV (r = 0.73, P < 0.01); Vertebral-SUV and Femoral-SUV (r = 0.78, P < 0.01); and BM-CT number and Vertebral-SUV (r = 0.52, P < 0.01). BM-CT number was correlated with patients' age in both univariable (r = -0.27) and multivariable analyses (β = -0.20). Positive BM-CT number correlated with WBC in both univariable (P = 0.04) and multivariable (P < 0.01) analyses. Bone marrow glucose metabolism had a tendency to decrease with age, was increased in patients with elevated CRP. In conclusion, CT attenuation of bone marrow correlated well with bone marrow metabolism and also tended to decrease with age. High bone marrow attenuation (≥ 0 HU) could predict elevated serum WBC.

  2024, American journal of nuclear medicine and molecular imaging, 14(1) (1), 22 - 30, English, International magazine

  Scientific journal


• Complete response of glottic cancer to intra-arterial infusion chemotherapy combined with radiotherapy: A report of 4 cases.

  Ryo Yamakuni, Hirofumi Sekino, Masakazu Ikeda, Yoshiki Endo, Masamitsu Ikeda, Shiro Ishii, Kenji Fukushima, Shigeyuki Murono, Yoshiyuki Suzuki, Hiroshi Ito

  Surgical resection is recommended for advanced-stage, resectable glottic cancer. However, total laryngectomy results in the loss of vocal function and reduces patients' quality of life. At our institution, patients with cT3N0M0 stage III resectable glottic cancer who wish to preserve their larynx are treated with super-selective cisplatin infusion with concomitant radiotherapy (RADPLAT) to improve local control over systemic chemotherapy. Herein, we present 4 patients with glottic cancer who underwent biweekly intra-arterial infusion chemotherapy combined with radiation therapy 3 times. For intra-arterial infusion chemotherapy, 100 mg cis-diaminodichloroplatinum was infused into the superior thyroid artery, including the superior laryngeal artery branch. Thereafter, intensity-modulated radiation therapy was administered at doses of 70 Gy in 35 fractions for 3 patients and 66 Gy in 33 fractions for 1 patient. These patients showed complete response after chemoradiotherapy with no recurrence or metastases during the follow-up period to date (mean follow-up period: 56 months, range: 39-76 months).

  Dec. 2023, Radiology case reports, 18(12) (12), 4514 - 4521, English, International magazine


• Subgenome dominance shapes novel gene evolution in the decaploid pitcher plant Nepenthes gracilis.

  Franziska Saul, Mathias Scharmann, Takanori Wakatake, Sitaram Rajaraman, André Marques, Matthias Freund, Gerhard Bringmann, Louisa Channon, Dirk Becker, Emily Carroll, Yee Wen Low, Charlotte Lindqvist, Kadeem J Gilbert, Tanya Renner, Sachiko Masuda, Michaela Richter, Gerd Vogg, Ken Shirasu, Todd P Michael, Rainer Hedrich, Victor A Albert, Kenji Fukushima

  Subgenome dominance after whole-genome duplication generates distinction in gene number and expression at the level of chromosome sets, but it remains unclear how this process may be involved in evolutionary novelty. Here we generated a chromosome-scale genome assembly of the Asian pitcher plant Nepenthes gracilis to analyse how its novel traits (dioecy and carnivorous pitcher leaves) are linked to genomic evolution. We found a decaploid karyotype and a clear indication of subgenome dominance. A male-linked and pericentromerically located region on the putative sex chromosome was identified in a recessive subgenome and was found to harbour three transcription factors involved in flower and pollen development, including a likely neofunctionalized LEAFY duplicate. Transcriptomic and syntenic analyses of carnivory-related genes suggested that the paleopolyploidization events seeded genes that subsequently formed tandem clusters in recessive subgenomes with specific expression in the digestive zone of the pitcher, where specialized cells digest prey and absorb derived nutrients. A genome-scale analysis suggested that subgenome dominance likely contributed to evolutionary innovation by permitting recessive subgenomes to diversify functions of novel tissue-specific duplicates. Our results provide insight into how polyploidy can give rise to novel traits in divergent and successful high-ploidy lineages.

  Dec. 2023, Nature plants, 9(12) (12), 2000 - 2015, English, International magazine

  Scientific journal


• Carnivorous plants: Unlocking the secrets of peristome geometry in pitcher plants.

  Kenji Fukushima

  A recent study employs computational models to explore the functional morphology of carnivorous trapping pitchers in Nepenthes. Focusing on the peristome, the study uncovers new dimensions in form-function relationships, offering theoretical insights into the role of complex trap morphology.

  Nov. 2023, Current biology : CB, 33(21) (21), R1155-R1157, English, International magazine

  Scientific journal


• Oxygen extraction fraction is not uniform in human brain: a positron emission tomography study.

  Hiroshi Ito, Masanobu Ibaraki, Ryo Yamakuni, Motoharu Hakozaki, Naoyuki Ukon, Shiro Ishii, Kenji Fukushima, Hitoshi Kubo, Kazuhiro Takahashi

  The regional differences in cerebral oxygen extraction fraction (OEF) in brain were investigated using positron emission tomography (PET) in detail with consideration of systemic errors in PET measurement estimated by simulation studies. The cerebral blood flow (CBF), cerebral blood volume (CBV), OEF, and cerebral metabolic rate of oxygen (CMRO2) were measured on healthy men by PET with 15O-labeled gases. The OEF values in the pons and the parahippocampal gyrus were significantly smaller than in the other brain regions. The OEF value in the lateral side of the occipital cortex was largest among the cerebral cortical regions. Simulation studies have revealed that errors in OEF caused by regional differences in the distribution volume of 15O-labeled water, as well as errors in OEF caused by a mixture of gray and white matter, must be negligible. The regional differences in OEF in brain must exist which might be related to physiological meanings.Article title: Kindly check and confirm the edit made in the article title.I have checked the article title and it is OK as is. Trial registration: The UMIN clinical trial number: UMIN000033382, https://www.umin.ac.jp/ctr/index.htm.

  Oct. 2023, The journal of physiological sciences : JPS, 73(1) (1), 25 - 25, English, Domestic magazine

  Scientific journal


• Comprehensive assessment of molecular function, tissue characterization, and hemodynamic performance by non-invasive hybrid imaging: Potential role of cardiac PETMR.

  Kenji Fukushima, Hiroshi Ito, Yasuchika Takeishi

  Noninvasive cardiovascular imaging plays a key role in diagnosis and patient management including monitoring treatment efficacy. The usefulness of noninvasive cardiovascular imaging has been extensively studied and shown to have high diagnostic reliability and prognostic significance, while the nondiagnostic results frequently encountered with single imaging modality require complementary or alternative imaging techniques. Hybrid cardiac imaging was initially introduced to integrate anatomical and functional information to enhance the diagnostic performance, and lately employed as a strategy for comprehensive assessment of the underlying pathophysiology of diseases. More recently, the utility of computed tomography has grown in diversity, and emerged from being an exploratory technique allowing functional measurement such as stress dynamic perfusion. Cardiac magnetic resonance imaging (CMR) is widely accepted as a robust tool for evaluation of cardiac function, fibrosis, and edema, yielding high spatial resolution and soft-tissue contrast. However, the use of intravenous contrast materials is typically required for accurate diagnosis with these imaging modalities, despite the associated risk of renal toxicity. Nuclear cardiology, established as a molecular imaging technique, has advantages in visualization of the disease-specific biological process at cellular level using numerous probes without requiring contrast materials. Various imaging modalities should be appropriately used sequentially to assess concomitant disease and the progression over time. Therefore, simultaneous evaluation combining high spatial resolution and disease-specific imaging probe is a useful approach to identify the regional activity and the stage of the disease. Given the recent advance and potential of multiparametric CMR and novel nuclide tracers, hybrid positron emission tomography MR is becoming an ideal tool for disease-specific imaging.

  Oct. 2023, Journal of cardiology, 82(4) (4), 286 - 292, English, International magazine

  Scientific journal


• Risk Factors for Recurrence of Cholangitis After Pancreaticoduodenectomy and Comparison of Stents in Hepaticojejunostomy.

  Hirotaka Fukuoka, Hirochika Toyama, Takuya Mizumoto, Jun Ishida, Sadaki Asari, Tadahiro Goto, Yoshihide Nanno, Takeshi Urade, Kenji Fukushima, Hidetoshi Gon, Daisuke Tsugawa, Shohei Komatsu, Kaori Kuramitsu, Hiroaki Yanagimoto, Masahiro Kido, Tetsuo Ajiki, Takumi Fukumoto

  BACKGROUND: Postoperative cholangitis is a common complication of pancreaticoduodenectomy. Frequent cholangitis impairs patients' quality of life after pancreaticoduodenectomy. However, the risk factors for recurrence of cholangitis remain unclear. Hence, this retrospective study aimed to identify risk factors for recurrence of cholangitis after pancreaticoduodenectomy. METHODS: The medical records of patients who underwent pancreaticoduodenectomy between 2015 and 2019 in our institution were retrospectively reviewed. At least two episodes of cholangitis a year after pancreaticoduodenectomy were defined as 'recurrence of cholangitis' in the present study. Univariate and multivariate analyses were performed. RESULTS: The recurrence of cholangitis occurred in 40 of 207 patients (19.3%). Multivariate analysis revealed that internal stent (external, RR: 2.16, P = 0.026; none, RR: 4.76, P = 0.011), firm pancreas (RR: 2.61, P = 0.021), constipation (RR: 3.49, P = 0.008), and postoperative total bilirubin>1.7 mg/dL (RR: 2.94, P = 0.006) were risk factors of recurrence of cholangitis. Among patients with internal stents (n = 54), those with remnant stents beyond 5 months had more frequent recurrence of cholangitis (≥5 months, 75%; <5 months, 30%). CONCLUSIONS: Internal stents, firm pancreas, constipation, and postoperative high bilirubin levels are risk factors for cholangitis recurrence after pancreaticoduodenectomy. In addition, the long-term implantation of internal stents may trigger cholangitis recurrence.

  Oct. 2023, World journal of surgery, 47(10) (10), 2499 - 2506, English, International magazine

  Scientific journal


• Progression of coronary artery calcification after radiation therapy for esophageal cancer.

  Keisuke Matsuo, Kenji Fukushima, Takanori Abe, Satoshi Saito, Shingo Kato, Takahide Arai, Shintaro Nakano

  BACKGROUND: Advances in cancer treatment have resulted in increased attention toward potential cardiac complications, especially following treatment for esophageal cancer, which is associated with a risk of coronary artery disease. As the heart is directly irradiated during radiotherapy, coronary artery calcification (CAC) may progress in the short term. Therefore, we aimed to investigate the characteristics of patients with esophageal cancer that predispose them to coronary artery disease, CAC progression on PET-computed tomography and the associated factors, and the impact of CAC progression on clinical outcomes. METHODS: We retrospectively screened 517 consecutive patients who received radiation therapy for esophageal cancer from our institutional cancer treatment database between May 2007 and August 2019. CAC scores were analyzed clinically for 187 patients who remained by exclusion criteria. RESULTS: A significant increase in the Agatston score was observed in all patients (1 year: P  = 0.001*, 2 years: P  < 0.001*). Specifically for patients receiving middle-lower chest irradiation (1 year: P  = 0.001*, 2 years: P  < 0.001*) and those with CAC at baseline (1 year: P  = 0.001*, 2 years: P  < 0.001*), a significant increase in the Agatston score was observed. There was a trend for a difference in all-cause mortality between patients who had irradiation of the middle-lower chest ( P  = 0.053) and those who did not. CONCLUSION: CAC can progress within 2 years after the initiation of radiotherapy to the middle or lower chest for esophageal cancer, particularly in patients with detectable CAC before radiotherapy initiation.

  Sep. 2023, Coronary artery disease, 34(6) (6), 453 - 461, English, International magazine

  Scientific journal


• Lumbar intradural space reduction during the Valsalva maneuver observed using cine MRI and MR myelography: a single-case experimental study.

  Ryo Yamakuni, Shinya Seino, Shiro Ishii, Hironobu Ishikawa, Katsuyuki Kikori, Tatsuya Ando, Takeyasu Kakamu, Kenji Fukushima, Koji Otani, Hiroshi Ito

  BACKGROUND: Previous studies have shown that the Valsalva maneuver (VM) causes spinal canal object movements. We hypothesized that this occurs because of cerebrospinal fluid (CSF) flow generated from intradural space reduction. Previous studies using myelograms reported lumbar CSF space changes during inspiration. However, no similar studies have been conducted using modern MRI. Therefore, this study analyzed intradural space reduction during the VM using cine magnetic resonance imaging (MRI). METHODS: The participant was a 39-year-old, healthy, male volunteer. Cine MRI involved fast imaging employing steady-state acquisition cine sequence during three resting and VM sets for 60 s each. The axial plane was at the intervertebral disc and vertebral body levels between Th12 and S1 during cine MRI. This examination was performed on 3 separate days; hence, data from nine resting and VM sets were available. Additionally, two-dimensional myelography was performed during rest and the VM. RESULTS: Intradural space reduction was observed during the VM using cine MRI and myelography. The intradural space cross-sectional area during the VM (mean: 129.3 mm2; standard deviation [SD]: 27.4 mm2) was significantly lower than that during the resting period (mean: 169.8; SD: 24.8; Wilcoxon signed-rank test, P < 0.001). The reduction rate of the vertebral body level (mean: 26.7%; SD: 9.4%) was larger than that of the disc level (mean: 21.4%; SD: 9.5%; Wilcoxon rank sum test, P = 0.0014). Furthermore, the reduction was mainly observed on the ventral and bilateral intervertebral foramina sides at the vertebral body and intervertebral disc levels, respectively. CONCLUSION: The intradural space was reduced during the VM, possibly because of venous dilatation. This phenomenon may be associated with CSF flow, intradural object movement, and nerve compression, potentially leading to back pain.

  Aug. 2023, Acta neurochirurgica, 165(8) (8), 2111 - 2120, English, International magazine

  Scientific journal


• The Usefulness of Total Tumor Volume as a Prognostic Factor and in Selecting the Optimal Treatment Strategy of Chemotherapeutic Intervention in Patients with Colorectal Liver Metastases.

  Yuhi Shimura, Shohei Komatsu, Yoshiaki Nagatani, Yohei Funakoshi, Keitaro Sofue, Masahiro Kido, Kaori Kuramitsu, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Shinichi So, Hiroaki Yanagimoto, Hirochika Toyama, Hironobu Minami, Takumi Fukumoto

  BACKGROUND: Few reports have discussed the association between total tumor volume (TTV) and prognosis in patients with colorectal liver metastases (CRLM). The present study aimed to evaluate the usefulness of TTV for predicting recurrence-free survival and overall survival (OS) in patients receiving initial hepatic resection or chemotherapy, and to investigate the value of TTV as an indicator for optimal treatment selection for patients with CRLM. PATIENTS AND METHODS: This retrospective cohort study included patients with CRLM who underwent hepatic resection (n = 93) or chemotherapy (n = 78) at the Kobe University Hospital. TTV was measured using 3D construction software and computed tomography images. RESULTS: A TTV of 100 cm3 has been previously reported as a significant cut-off value for predicting OS of CRLM patients receiving initial hepatic resection. For patients receiving hepatic resection, the OS for those with a TTV ≥ 100 cm3 was significantly reduced compared with those with a TTV < 100 cm3. For patients receiving initial chemotherapy, there were no significant differences between the groups divided according to TTV cut-offs. Regarding OS of patients with TTV ≥ 100 cm3, there was no significant difference between hepatic resection and chemotherapy (p = 0.160). CONCLUSIONS: TTV can be a predictive factor of OS for hepatic resection, unlike for initial chemotherapy treatment. The lack of significant difference in OS for CRLM patients with TTV ≥ 100 cm3, regardless of initial treatment, suggests that chemotherapeutic intervention preceding hepatic resection may be indicated for such patients.

  Jun. 2023, Annals of surgical oncology, 30(11) (11), 6603 - 6610, English, International magazine

  Scientific journal


• Transarterial chemoembolization for liver metastases of a pancreatic neuroendocrine neoplasm: a single-center experience.

  Yoshihide Nanno, Hirochika Toyama, Eisuke Ueshima, Keitaro Sofue, Ippei Matsumoto, Jun Ishida, Takeshi Urade, Kenji Fukushima, Hidetoshi Gon, Daisuke Tsugawa, Shohei Komatsu, Kaori Kuramitsu, Tadahiro Goto, Sadaki Asari, Hiroaki Yanagimoto, Masahiro Kido, Tetsuo Ajiki, Takumi Fukumoto

  Transarterial chemoembolization (TACE) is performed for pancreatic neuroendocrine tumor (PanNEN) liver metastases; however, the safety and efficacy of TACE procedures, especially for patients who have undergone previous pancreatic surgery, have not been established. We reviewed 48 TACE procedures (1-6 procedures/patient) performed on 11 patients with PanNEN liver metastases, including 16 TACE procedures (4-6 procedures/patient) for 3 patients with a history of biliary-enteric anastomosis. The overall tumor objective response rate was 94%. The incidence of Clavien‒Dindo grade ≥ 2 complications was 1/16 (6%) and 1/32 (3%), and the median time to untreatable progression was 31 (14-41) and 27 (2-60) months among patients with and without a history of biliary-enteric anastomosis, respectively. Although validation is needed in future studies, our experiences have shown that TACE treatment is a viable treatment option for PanNEN liver metastases, even after biliary-enteric anastomosis with experienced teams and careful patient follow-up.

  Jun. 2023, Surgery today, 53(12) (12), 1396 - 1400, English, Domestic magazine

  Scientific journal


• Advantages of the Laparoscopic Approach for the Initial Operation in Patients who Underwent Repeat Hepatectomy.

  Hidetoshi Gon, Shohei Komatsu, Masahiro Kido, Kenji Fukushima, Takeshi Urade, Shinichi So, Toshihiko Yoshida, Keisuke Arai, Jun Ishida, Yoshihide Nanno, Daisuke Tsugawa, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  BACKGROUND: Less intra-abdominal adhesions are expected following laparoscopic surgery. Although an initial laparoscopic approach for primary liver tumors may have advantages in patients who require repeat hepatectomies for recurrent liver tumors, this has not been sufficiently investigated. METHODS: Patients who underwent repeat hepatectomies for recurrent liver tumors at our hospital between 2010 and 2022 were retrospectively analyzed. Of 127 patients, 76 underwent laparoscopic repeat hepatectomy (LRH), of whom 34 patients initially underwent laparoscopic hepatectomy (L-LRH) and 42, open hepatectomy (O-LRH). Fifty-one patients underwent open hepatectomy as both the initial and second operation (O-ORH). We analyzed surgical outcomes between L-LRH and O-LRH groups and between L-LRH and O-ORH groups using propensity-matching analysis for each pattern. RESULTS: Twenty-one patients each were included in L-LRH and O-LRH propensity-matched cohorts. The L-LRH group had a lower rate of postoperative complications than the O-LRH group (0 vs 19%, P = 0.036). When we compared surgical outcomes between L-LRH and O-ORH groups in another matched cohort with 18 patients in each group, in addition to the lower rate of postoperative complications, the L-LRH group had additional favorable surgical outcomes including shorter operation time and lower blood loss volume than the O-ORH group (291 vs 368 min, P = 0.037 and 10 vs 485 mL, P < 0.0001). CONCLUSIONS: An initial laparoscopic approach would be favorable for patients undergoing repeat hepatectomies, as it leads to lower risk of postoperative complications. Compared with O-ORH, the advantage of the laparoscopic approach may be enhanced when it is repeatedly adopted.

  Jun. 2023, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 27(8) (8), 1621 - 1631, English, International magazine

  Scientific journal


• Non-prey biotic interactions in carnivorous plants.

  Héctor Montero, Kenji Fukushima

  Carnivorous plants often spark broad interest due to their specialized adaptations for trapping and consuming animals. These notable organisms not only fix carbon through photosynthesis, but they also obtain essential nutrients such as nitrogen and phosphate from their captured prey. In typical angiosperms, interactions with animals are usually confined to such processes as pollination and herbivory, but another layer of complexity in these interactions is added for carnivorous plants. Here, we introduce carnivorous plants and their associated organisms - ranging from their prey to their symbionts - and highlight biotic interactions beyond carnivory to discuss how the 'default' interactions typical for flowering plants have changed in the case of the carnivorous plants (Figure 1).

  Jun. 2023, Current biology : CB, 33(11) (11), R497-R500, English, International magazine

  Scientific journal


• Conventional versus aspiration-type needles in CT-guided biopsy for chest pathologies/lesions: A comparative study.

  Hirofumi Sekino, Shiro Ishii, Ryo Yamakuni, Hiroki Suenaga, Daichi Kuroiwa, Kenji Fukushima, Hiroshi Ito

  BACKGROUND: Larger sample volume can be obtained in one needle pass using an aspiration-type semi-automatic cutting biopsy needle (STARCUT® aspiration-type needle; TSK Laboratory, Tochigi, Japan) in comparison to the conventional semi-automatic cutting biopsy needle. OBJECTIVE: To evaluate and compare the safety and effectiveness of aspiration-type semi-automatic cutting biopsy needles and non-aspiration-type biopsy needles when performing computed tomography (CT)-guided core needle biopsies (CNBs). METHODS: A total of 106 patients underwent CT-guided CNB for chest lesions between June 2013 and March 2020 at our hospital. Non-aspiration-type cutting biopsy needles were used in 47 of these patients, while aspiration-type needles were used in the remaining 59 patients. All needles used were 18- or 20-gauge biopsy needles. Parameters, like forced expiratory volume in 1-second percent (FEV1.0%), the maximum size of the target lesion, puncture pathway distance in the lung, number of needle passes, procedure time, diagnostic accuracy, and incidence of complications, were measured. Comparisons were made between the needle-type groups. RESULTS: No significant difference was observed in terms of diagnostic accuracy. However, the procedure time was shorter and a lesser number of needle passes were required with the aspiration-type cutting biopsy needle compared to the non-aspiration-type needle. Pneumothorax and pulmonary hemorrhage were the complications encountered, however, their incidence was not significantly different between the two types of needles. CONCLUSIONS: The aspiration-type semi-automatic cutting biopsy needle had similar diagnostic accuracy as the non-aspiration-type biopsy needle, with added advantages of a lesser number of needle passes and shorter procedure time.

  May 2023, Current medical imaging, English, International magazine

  Scientific journal


• Prognostic Impact of Malnutrition Diagnosed by the GLIM Criteria for Resected Extrahepatic Cholangiocarcinoma.

  Yuki Okazoe, Hiroaki Yanagimoto, Daisuke Tsugawa, Masayuki Akita, Riki Asakura, Satoshi Omiya, Takeshi Urade, Yoshihide Nanno, Kenji Fukushima, Hidetoshi Gon, Shohei Komatsu, Kaori Kuramitsu, Tadahiro Goto, Sadaki Asari, Hirochika Toyama, Masahiro Kido, Tetsuo Ajiki, Takumi Fukumoto

  BACKGROUND/AIM: Recently, the Global Leadership Initiative on Malnutrition (GLIM), which includes the world's leading clinical nutrition societies, proposed the first global diagnostic criteria for malnutrition. However, the association between malnutrition diagnosed by the GLIM criteria and prognosis in patients with resected extrahepatic cholangiocarcinoma (ECC) remains unknown. This study aimed to investigate the predictive validity of the GLIM criteria for the prognosis of patients with resected ECC. PATIENTS AND METHODS: Between 2000 and 2020, 166 patients who underwent curative-intent resection for ECC were retrospectively analyzed. Prognostic significance of preoperative malnutrition diagnosed by the GLIM criteria was investigated using a multivariate Cox proportional hazards model. RESULTS: Eighty-five (51.2%) and 46 (27.7%) patients were diagnosed with moderate and severe malnutrition, respectively. Increased malnutrition severity tended to be correlated with increased lymph node metastasis rate (p-for-trend=0.0381). The severe malnutrition group had worse 1-, 3-, and 5-year overall survival rates than the normal (without malnutrition) group (82.2% vs. 91.2%, 45.6% vs. 65.1%, 29.3% vs. 61.5%, respectively, p=0.0159). In multivariate analysis, preoperative severe malnutrition was an independent predictor for poor prognosis (hazard ratio=1.68, 95% confidence interval=1.06-2.66, p=0.0282), along with intraoperative blood loss >1,000 ml, lymph node metastasis, perineural invasion, and curability. CONCLUSION: Severe preoperative malnutrition diagnosed by the GLIM criteria was associated with poor prognosis in patients who underwent curative-intent resection for ECC.

  May 2023, Anticancer research, 43(5) (5), 2299 - 2308, English, International magazine

  Scientific journal


• Factors Predicting Over-Time Weight Increase After Liver Transplantation: A Retrospective Study.

  Yuhi Shimura, Kaori Kuramitsu, Masahiro Kido, Shohei Komatsu, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Shinichi So, Toshihiko Yoshida, Keisuke Arai, Daisuke Tsugawa, Tadahiro Goto, Sadaki Asari, Hiroaki Yanagimoto, Hirochika Toyama, Tetsuo Ajiki, Takumi Fukumoto

  BACKGROUND: Post-transplantation weight control is important for long-term outcomes; however, few reports have examined postoperative weight change. This study aimed to identify perioperative factors contributing to post-transplantation weight change. METHODS: Twenty-nine patients who underwent liver transplantation between 2015 and 2019 with an overall survival of >3 years were analyzed. RESULTS: The median age, model for end-stage liver disease score, and preoperative body mass index (BMI) of the recipients were 57, 25, and 23.7, respectively. Although all but one recipient lost weight, the percentage of recipients who gained weight increased to 55% (1 month), 72% (6 months), and 83% (12 months). Among perioperative factors, recipient age ≤50 years and BMI ≤25 were identified as risk factors for weight gain within 12 months (P < .05), and patients with age ≤50 years or BMI ≤25 recipients gained weight more rapidly (P < .05). The recovery time of serum albumin level ≥4.0 mg/dL was not statistically different between the 2 groups. The weight change during the first 3 years after discharge was represented by an approximately straight line, with 18 and 11 recipients showing a positive and negative slope, respectively. Body mass index ≤23 was identified as a risk factor for a positive slope of weight gain (P <.05). CONCLUSIONS: Although postoperative weight gain implies recovery after transplantation, recipients with a lower preoperative BMI should strictly manage body weight as they may be at higher risk of rapid weight increase.

  Apr. 2023, Transplantation proceedings, 55(4) (4), 924 - 929, English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• 横隔膜腹腔側に発生したsolitary fibrous tumorの1例

  上田 泰弘, 味木 徹夫, 浅利 貞毅, 柳本 泰明, 津川 大介, 秋田 真之, 朝倉 力, 三宅 泰一郎, 南野 佳英, 浦出 剛史, 福島 健司, 権 英寿, 小松 昇平, 蔵満 薫, 後藤 直大, 外山 博近, 木戸 正浩, 福本 巧

  兵庫県外科医会, Mar. 2023, 兵庫県外科医会会誌, 57, 13 - 15, Japanese


• Assessment of serum and drain fluid bilirubin concentrations in liver transplantation patients.

  Hirotoshi Soyama, Kaori Kuramitsu, Masahiro Kido, Shohei Komatsu, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Shinichi So, Yoshihide Nanno, Daisuke Tsugawa, Tadahiro Goto, Hiroaki Yanagimoto, Sadaki Asari, Hirochika Toyama, Tetsuo Ajiki, Takumi Fukumoto

  BACKGROUND: Bile leakage is a major complication after liver transplantation and remains as a significant source of morbidity and mortality. In 2011, the International Study Group of Liver Surgery (ISGLS) defined bile leakage as a drain/serum bilirubin ratio ≥3. However, to our knowledge there is no literature assessing serum and drain bilirubin concentrations after liver transplantation. The aim of this study was to describe the natural postoperative changes in serum and drain fluid bilirubin concentrations in patients after liver transplantation. METHODS: We included 32 patients who underwent liver transplantation at Kobe University Hospital from January 2007 to December 2020. We enrolled 34 living donors who had no complications as the control group. RESULTS: The recipient serum total/direct bilirubin concentration were higher compared with the donors from postoperative day (POD) 1 to 5 with a statistical difference (P < .05). The recipient drain/serum total bilirubin ratio was lower than donors on POD 3 (0.89 ± 0.07 vs 1.53 ± 0.07: P < .0001), which was also confirmed by the recipient drain/serum direct bilirubin ratio (0.64 ± 0.10 vs 1.18 ± 0.09: P < .0001). On POD 3, the drain fluid volume (647.38 ± 89.47 vs 113.43 ± 86.8 mL: P < .001) and serum total bilirubin concentration (6.73 ± 0.61 vs 1.23 ± 0.60 mg/dL: P < .001) was higher in the recipients than in donors. Categorized in 2 groups, the higher drain fluid volume and bilirubin concentration recipients showed lower drain/serum total bilirubin ratio compared with the other group (P = .03) CONCLUSION: The drain/serum bilirubin ratio in the transplanted patients could be calculated lower compared with the hepatectomy patients because of high drain fluid volume and hyperbilirubinemia. Great care should be taken when assessing the bile leakage in liver transplant recipients using the ISGLS definition.

  Jan. 2023, Transplantation proceedings, 55(1) (1), 184 - 190, English, International magazine

  Scientific journal


• Investigation of tumor assessment between two PET systems using various indices: comparison between PET/CT and PET/MRI systems.

  Hirotoshi Hotsumi, Shirou Ishii, Hiroki Suenaga, Shigeyasu Sugawara, Kenji Fukushima, Hiroshi Ito

  This study aimed to determine the comparability of tumor-uptake indices of 18F-FDG in positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MRI). 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) PET/CT and PET/MRI were performed on 55 patients with confirmed primary malignancies. PET/CT preceded PET/MRI in all examinations. Accumulation of 18F-FDG in lesions and normal organs (brain, liver) was measured. Maximum and peak standardized uptake values (SUVs; SUVmax and SUVpeak, respectively), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) with margin thresholds of SUV of 50% (MTV50%; TLG50%, respectively) were measured as indices for comparison of measurements in tumors. Comparative indices with tumor SUVmax and liver ratio (TLRmax), brain ratio (TBRmax) were calculated. These indices were compared between PET/CT and PET/MRI examinations. The data measured using PET/CT and PET/MRI showed significant correlations for all tumor indices. The correlation was strongest for SUVpeak (r = 0.933), followed by TBRmax (r = 0.929); and the index ratio of (PET/CT)/(PET/MRI) data was close to 1.0 for TLRmax (1.00 ± 0.22) and TBRmax (1.01 ± 0.21), followed by MTV50% (0.82 ± 0.33) and TLG50% (1.18 ± 0.45). The values of all indices showed strong correlations between PET/CT and PET/MRI examinations. Among them, TLRmax, TBRmax, MTV50%, and TLG50% showed a close value and may be useful for comparison of tumor evaluation between two PET systems.

  2023, American journal of nuclear medicine and molecular imaging, 13(4) (4), 156 - 163, English, International magazine

  Scientific journal


• Optimization of Intraventricular Radioactive Concentration for 13N ammonia PET with Time-of-Flight Scanner: Simplified Phantom Study with Noise Equivalent Count Rate Analysis.

  Yoko Kaimoto, Kenji Fukushima, Kazuko Kanaya, Masayasu Asanuma, Kaoru Aoba, Atsushi Yamamoto, Risako Nakao, Koichiro Kaneko, Michinobu Nagao, Koichi Chida

  Background: Myocardial blood flow quantification (MBF) is one of the distinctive features for cardiac positron emission tomography. The MBF calculation is mostly obtained by estimating the input function from the time activity curve in dynamic scan. However, there is a substantial risk of count-loss because the high radioactivity pass through the left ventricular (LV) cavity within a short period. We aimed to determine the optimal intraventricular activity using the noise equivalent count rate (NECR) analysis with simplified phantom model. Methods: Positron emission tomography computed tomography scanner with LYSO crystal and time of flight was used for phantom study. 150 MBq/mL of 13N was filled in 10 mL of syringe, placed in neck phantom to imitate end-systolic small LV. 3D list-mode acquisition was repeatedly performed along radioactive decay. Net true and random count rate were calculated and compared to the theoretical activity in the syringe. NECR curve analysis was used to determine the optimal radioactive concentration. Result: The attenuation curves showed good correlation to the theoretical activity between 20 to 370, and 370 to 740 MBq (r2=1.0 ± 0.0001, p<0.0001; r2=0.99 ± 0.0001, p<0.0001 for 20 to 370, and 370 to 740, respectively), while did not over 740 MBq (p=0.62). NECR analysis revealed that the peak rate was at 2.9 Mcps, there at the true counts were significantly suppressed. The optimal radioactive concentration was determined as 36 MBq/mL. Conclusion: Simulative analysis for high-dose of 13N using the phantom imitating small LV confirmed that the risk of count-loss was increased. The result can be useful information in assessing the feasibility of MBF quantification in clinical routine.

  2023, Annals of nuclear cardiology, 9(1) (1), 33 - 39, English, Domestic magazine

  Scientific journal


• Myocardial Strain Derived from 13N-ammonia Positron Emission Tomography: Detection of Ischemia-Related Wall Motion Abnormality.

  Michinobu Nagao, Masateru Kawakubo, Atsushi Yamamoto, Risako Nakao, Yuka Matsuo, Kenji Fukushima, Akiko Sakai, Mitsuru Momose, Shuji Sakai

  Background: Due to the limitation of spatial resolution, cardiac nuclear medicine images have not been applied to feature-tracking method to automatic extraction of myocardial contours. We have successfully applied the feature-tracking method to high-resolution cine 13N-ammonia positron emission tomography (PET) images to calculate the regional myocardial strains. Here, we investigate the potential of 13N-ammonia PET-derived strain to detect ischemia-related wall motion abnormality. Methods: Data of adenosine-stress/rest 13N-ammonia PET for 95 coronary artery disease patients was retrospectively analyzed. Using an original algorithm dedicated to 13N-ammonia PET, the longitudinal strain (LS) corresponding to the three main coronary artery territories [right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex coronary artery (LCX)] was calculated from semi-automatic endocardial contours extraction on cine 13N-ammonia PET images of the left ventricular long-axis. The presence of ischemia in three main territories was determined from rest and stress-perfusion images. Results: In all three coronary territories, LS at stress was significantly smaller at rest in the ischemic region RCA: -19.2±8.0% vs. -22.7±6.1%, LAD: -19.0±6.9% vs. -24.4±6.4%, LCX: -20.5%±7.6% vs. -22.6±6.9%). In contrast, in the non-ischemic region, there was no significant difference between the LS at stress and at rest. Receiver-operating-characteristic analysis revealed that using the optimal cutoff of the LS ratio of stress to rest, ischemia could be diagnosed with area under the curve of 0.82 in the RCA, 0.86 in the LAD, and 0.69 in the LCX. Conclusions: Myocardial strain derived from endocardial feature-tracking of 13N-ammonia PET cine imaging is reduced in the ischemia induced by adenosine-stress. The LS ratio of stress to rest may detect wall motion abnormality related to ischemia.

  2023, Annals of nuclear cardiology, 9(1) (1), 26 - 32, English, Domestic magazine

  Scientific journal


• Laparoscopic Medial-to-Lateral Approach for the Resection of Hepatocellular Carcinoma Located at the Spiegel Lobe of the Liver.

  Hidetoshi Gon, Masahiro Kido, Shohei Komatsu, Kenji Fukushima, Takeshi Urade, Yoshihide Nanno, Daisuke Tsugawa, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  BACKGROUND: Laparoscopic caudate lobe resection is a challenging procedure. Several researchers have reported the safety of laparoscopic liver resections;1.Transl Gastroenterol Hepatol. 1:56;2.Asian J Endosc Surg. 12:232-236;3.Ann Surg Oncol. 26:2980; however, a standardized procedure has not yet been established. Herein, we present a video showing laparoscopic Spiegel lobectomy in a patient with 6-cm hepatocellular carcinoma (HCC) using a novel approach. PATIENT AND METHODS: A 63-year-old man with a caudate lobe HCC was referred to our hospital. Computed tomography showed a 5 × 6 cm2 HCC located in the Spiegel lobe, which profoundly displaced the inferior vena cava (IVC) to the lower right side, and mobilization of the Spiegel lobe was considered difficult. To perform the dissection between the Siegel lobe and IVC safely, we performed parenchymal transection along the ventral side of the IVC initially. The Spiegel lobe was then dislocated to the left side of the IVC. We dissected the left lateral side of the IVC, including the proper hepatic vein draining the caudate lobe and the left IVC ligament with a safe operative field, and successfully removed the Spiegel lobe with large HCC. RESULTS: The operation time was 383 min. The blood loss was 10 mL. The patient was discharged on the seventh postoperative day without any complications. Histopathological examination revealed well-differentiated HCC with a negative surgical margin. CONCLUSIONS: Laparoscopic medial-to-lateral approach with initial parenchymal transection at the medial side of the Spiegel lobe followed by dissection of the left lateral side of the IVC is considered as a safe and effective procedure for large tumors in the Spiegel lobe.

  Jan. 2023, Annals of surgical oncology, 30(1) (1), 381 - 382, English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Safe Laparoscopic Resection of Hepatocellular Carcinoma in the Spiegel Lobe of the Liver Using a Medial-to-Lateral Approach.

  Hidetoshi Gon, Masahiro Kido, Shohei Komatsu, Kenji Fukushima, Takeshi Urade, Yoshihide Nanno, Daisuke Tsugawa, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  Jan. 2023, Annals of surgical oncology, 30(1) (1), 383 - 383, English, International magazine

  Scientific journal


• Potential Role of Surgical Resection for Gallbladder Cancer in Elderly Patients.

  Yasuhiro Ueda, Hiroaki Yanagimoto, Tetsuo Ajiki, Daisuke Tsugawa, Riki Asakura, Takeshi Urade, Yoshihide Nanno, Kenji Fukushima, Hidetoshi Gon, Shohei Komatsu, Kaori Kuramitsu, Tadahiro Goto, Sadaki Asari, Hirochika Toyama, Masahiro Kido, Takumi Fukumoto

  INTRODUCTION: With the aging of the population in Japan, gallbladder cancer (GBC) in the elderly is increasing. However, the available clinical data are limited, and the optimal treatment is still controversial. The aim of this study was to evaluate the benefit of surgical resection in GBC patients ≥75 years of age. METHODS: A retrospective single center analysis of patients who had undergone surgical resection for GBC between 2000 and 2019 was carried out. Patients aged ≥75 years (elderly group, n = 24) or <75 years (younger group, n = 50) were compared. RESULTS: Both younger and elderly patients exhibited similar clinicopathological characteristics, but comorbidity in the latter was significantly greater, as was the frequency of less invasive surgery. Nonetheless, the incidence of postoperative complications was similar in elderly and younger patients. The proportion of patients receiving adjuvant chemotherapy was lower in the elderly. Overall survival of elderly and younger patients was not significantly different (65.0 vs 62.4% at 5 years, P = .600). In multivariate analysis, residual tumor status but not age was an independent prognostic factor. DISCUSSION: This study demonstrated that appropriate surgical treatment of elderly GBC patients was safe and effective, despite their having more comorbidities and lower rates of adjuvant chemotherapy than younger patients.

  Nov. 2022, The American surgeon, 31348221136570 - 31348221136570, English, International magazine

  Scientific journal


• 進行肝細胞癌におけるconversion surgeryの妥当性

  石原 伸朗, 小松 昇平, 矢野 嘉彦, 木戸 正浩, 蔵満 薫, 権 英寿, 福島 健司, 浦出 剛史, 宗 慎一, 山本 淳史, 藤島 佳未, 石田 淳, 津川 大介, 後藤 直大, 浅利 貞毅, 柳本 泰明, 外山 博近, 上田 佳秀, 味木 徹夫, 福本 巧

  (株)医薬情報研究所, Nov. 2022, 新薬と臨牀, 71(11) (11), 1234 - 1234, Japanese


• 進行肝細胞癌におけるconversion surgeryの妥当性

  石原 伸朗, 小松 昇平, 矢野 嘉彦, 木戸 正浩, 蔵満 薫, 権 英寿, 福島 健司, 浦出 剛史, 宗 慎一, 山本 淳史, 藤島 佳未, 石田 淳, 津川 大介, 後藤 直大, 浅利 貞毅, 柳本 泰明, 外山 博近, 上田 佳秀, 味木 徹夫, 福本 巧

  (株)医薬情報研究所, Nov. 2022, 新薬と臨牀, 71(11) (11), 1234 - 1234, Japanese


• Standardization of laparoscopic anatomic liver resection of segment 2 by the Glissonean approach.

  Takeshi Urade, Masahiro Kido, Kaori Kuramitsu, Shohei Komatsu, Hidetoshi Gon, Kenji Fukushima, Shinichi So, Takuya Mizumoto, Yoshihide Nanno, Daisuke Tsugawa, Tadahiro Goto, Sadaki Asari, Hiroaki Yanagimoto, Hirochika Toyama, Tetsuo Ajiki, Takumi Fukumoto

  BACKGROUND: Anatomic liver resection (ALR) has been established to eliminate the tumor-bearing hepatic region with preservation of the remnant liver volume for liver malignancies. Recently, laparoscopic ALR has been widely applied; however, there are few reports on laparoscopic segmentectomy 2. This study aimed to present the standardization of laparoscopic segmentectomy 2 with surgical outcomes. METHODS: This study included seven patients who underwent pure laparoscopic segmentectomy 2 by the Glissonean approach from January 2020 to December 2021. Four of them had hepatocellular carcinoma, two had colorectal liver metastasis, and one had hepatic angiomyolipoma, which was preoperatively diagnosed with hepatocellular carcinoma. In all patients, preoperative three-dimensional (3D) simulation images from dynamic CT were reconstructed using a 3D workstation. The layer between the hepatic parenchyma and the Glissonean pedicle of segment 2 (G2) was dissected to encircle the root of G2. After clamping or ligation of the G2, 2.5 mg of indocyanine green was injected intravenously to identify the boundaries between segments 2 and 3 with a negative staining method under near-infrared light. Parenchymal transection was performed from the caudal side to the cranial side according to the demarcation on the liver surface, and the left hepatic vein was exposed on the cut surface if possible. RESULTS: The mean operative time for all patients was 281 min. The mean blood loss was 37 mL, and no transfusion was necessary. Estimated liver resection volumes significantly correlated with actual liver resection volumes (r = 0.61, P = 0.035). After the operation, one patient presented with asymptomatic deep venous and pulmonary thrombosis, which was treated with anticoagulant therapy. The mean length of hospital stay was 8.9 days. CONCLUSION: Laparoscopic segmentectomy 2 by the Glissonean approach is a feasible and safe procedure with the preservation of the nontumor-bearing segment 3 for liver tumors in segment 2.

  Nov. 2022, Surgical endoscopy, 36(11) (11), 8600 - 8606, English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Rechallenge With Lenvatinib After Atezolizumab Plus Bevacizumab Treatment for Hepatocellular Carcinoma.

  Shohei Komatsu, Yoshihiko Yano, Masahiro Kido, Kaori Kuramitsu, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Shinichi So, Atsushi Yamamoto, Tadahiro Goto, Hiroaki Yanagimoto, Hirochika Toyama, Yoshihide Ueda, Yuzo Kodama, Takumi Fukumoto

  BACKGROUND/AIM: Atezolizumab plus bevacizumab and lenvatinib are the key drugs in the current systemic chemotherapeutic regimen for hepatocellular carcinoma (HCC). Studies have reported the potential effectiveness of lenvatinib introduction after an atezolizumab plus bevacizumab treatment; however, the therapeutic effectiveness of a lenvatinib rechallenge after an atezolizumab plus bevacizumab treatment remains unclear. PATIENTS AND METHODS: Thirteen consecutive patients who were rechallenged with lenvatinib after clinical failure following treatments with lenvatinib and atezolizumab plus bevacizumab were included. A comparative study was conducted on the duration and treatment efficacy of the first and second lenvatinib treatments and on the pre- and post-treatment liver function. RESULTS: The median ratios of the 1-month post-treatment alpha-fetoprotein (AFP) levels to the pretreatment AFP levels were 0.750 and 0.667 for the first and second lenvatinib treatments, respectively, without significant difference (p=0.9327). Meanwhile, the median ratios of the 1-month post-treatment albumin-bilirubin (ALBI) scores to the pretreatment ALBI scores were 1.063 and 0.827 for the first and second lenvatinib treatments, respectively, with significant difference (p=0.015). The median duration of the second lenvatinib treatment was significantly shorter than that of the first lenvatinib treatment [2.8 months (range=0.9-4.7 months) vs. 8.7 months (range=3.1-29.7 months)]. CONCLUSION: Lenvatinib re-administration after atezolizumab plus bevacizumab treatment can act as a double-edged sword, as it exerts an anti-tumor effect while being associated with potential liver function deterioration. However, this treatment sequence can be useful, and requires careful monitoring of the transitions in the liver function and the patient's performance status.

  Nov. 2022, Anticancer research, 42(11) (11), 5479 - 5486, English, International magazine

  Scientific journal

  Link to Kobe Univ. Repository (Kernel)


• Suitability of Laparoscopic Liver Resection of Segment VII: a Retrospective Two-Center Study.

  Hidetoshi Gon, Hisoka Yamane, Toshihiko Yoshida, Masahiro Kido, Motofumi Tanaka, Kaori Kuramitsu, Shohei Komatsu, Kenji Fukushima, Takeshi Urade, Shinichi So, Yoshihide Nanno, Daisuke Tsugawa, Tadahiro Goto, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  BACKGROUND: Resecting liver tumors located in Couinaud's segment VII is challenging; the efficacy and safety of laparoscopic liver resection for segment VII lesions compared to open liver resection remain unclear. METHODS: Medical records of 84 patients who underwent liver resection of segment VII at Kobe University Hospital and Hyogo Cancer Center between 2010 and 2021 were retrospectively analyzed. Surgical outcomes were compared between laparoscopic liver resection and open liver resection groups using propensity matching analysis. RESULTS: Thirty-one and 53 patients underwent laparoscopic liver resection and open liver resection, respectively. After propensity matching, 29 patients were included in each group. The laparoscopic liver resection group had a significantly longer operation time (407 vs. 305 min, P = 0.002), lower blood loss (100 vs. 230 mL, P = 0.004), and higher postoperative alanine aminotransferase levels (436 vs. 252 IU/L, P = 0.008) than the open liver resection group. In patients with liver cirrhosis, the proportion of patients with postoperative liver-specific complications was higher in the laparoscopic liver resection group than in the open liver resection group (57% vs 11%, P = 0.049), although there was no significant difference in postoperative liver-specific complication rates between the groups in patients without liver cirrhosis. CONCLUSIONS: For liver resection of segment VII, laparoscopic liver resection led to higher postoperative liver damage than open liver resection. Open liver resection may be better for patients with liver cirrhosis to avoid postoperative liver-specific complications. Laparoscopic liver resection could be an acceptable procedure for patients without liver cirrhosis, with some merits such as less blood loss.

  Jun. 2022, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 26(11) (11), 2274 - 2281, English, International magazine

  Scientific journal


• Impact of Hepatectomy for Advanced Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombus.

  Shohei Komatsu, Masahiro Kido, Kaori Kuramitsu, Daisuke Tsugawa, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Hiroaki Yanagimoto, Hirochika Toyama, Takumi Fukumoto

  BACKGROUND: Optimal treatment strategies for advanced hepatocellular carcinoma (HCC) with macroscopic portal vein tumor thrombus (PVTT) remain controversial. Therefore, this study aimed to assess the impact and predictive factors of hepatectomy for HCC with macroscopic PVTT. METHODS: This study included 100 patients who presented with intraoperatively confirmed PVTT extending to the first portal branch (Vp3), main portal trunk, or opposite-side portal branch (Vp4) between June 2000 and December 2019. Their postoperative outcomes and predictive factors for survival were evaluated. RESULTS: Of the 100 patients, 37 (37%) and 63 (63%) had Vp3 and Vp4 PVTTs, respectively. Moreover, 42 (42%) and 58 (58%) patients underwent R0/1 and R2 hepatectomies, respectively. The median survival time (MST) of all patients with Vp3/4 PVTT was 14.5 months; the 1- and 3-year overall survival rates were 59.6 and 16.8%, respectively. The MSTs of patients with Vp3 and Vp4 PVTTs were 16.1 and 14.3 months, respectively (P = 0.7098). The MSTs of patients who underwent R0/1 and R2 hepatectomies were 14.3 and 14.9 months, respectively (P = 0.3831). All assessed tumor factors (including the Vp status [Vp3 or Vp4], type of resection [R0/1 or R2], intrahepatic maximal tumor size, intrahepatic tumor number, and the existence of extrahepatic metastasis) did not influence the overall survival significantly. CONCLUSIONS: Tumor factors, such as the presence of a Vp3/4 PVTT, have a strong impact on survival; however, other multiple tumor factors have a limited impact. Hepatectomy can be an effective treatment option for HCC with Vp3/4 PVTT, and its indications should be considered.

  Apr. 2022, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 26(4) (4), 822 - 830, English, International magazine

  Scientific journal


• Prognostic impact of inflammation-based scores for extrahepatic cholangiocarcinoma.

  Riki Asakura, Hiroaki Yanagimoto, Tetsuo Ajiki, Daisuke Tsugawa, Takuya Mizumoto, Shinichi So, Takeshi Urade, Yoshihide Nanno, Kenji Fukushima, Hidetoshi Gon, Syohei Komatsu, Kaori Kuramitsu, Tadahiro Goto, Sadaki Asari, Masahiro Kido, Hirochika Toyama, Takumi Fukumoto

  INTRODUCTION: Although the relationship between systemic inflammatory responses and prognosis has been known in various cancers, it remains unclear which scores are most valuable for determining the prognosis of extrahepatic cholangiocarcinoma. We aimed to verify the usefulness of various inflammation-based scores as prognostic factors in patients with resected extrahepatic cholangiocarcinoma. METHODS: We analyzed consecutive patients undergoing surgical resection for extrahepatic cholangiocarcinoma at our institution between January 2000 and December 2019. The usefulness of the following inflammation-based scores as prognostic factor was investigated: Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), prognostic nutrition index (PNI), C-reactive protein to albumin ratio (CAR), controlling nutritional status (CONUT), and prognostic index (PI). RESULTS: A total of 169 patients were enrolled in this study. Of the nine scores, CAR and CONUT indicated prognostic value. Furthermore, multivariate analysis for overall survival revealed that high CAR (>0.23) was an independent prognostic factor (HR: 1.816, 95%CI: 1.135-2.906, p=0.0129), along with lymph node metastasis and curability. There was no difference in tumor staging and short-term outcomes between the low CAR (≤ 0.23) and high CAR groups. CONCLUSIONS: CAR was the most valuable prognostic score in patients with resected extrahepatic cholangiocarcinoma.

  Jan. 2022, Digestive surgery, 39(2-3) (2-3), 65 - 74, English, International magazine

  Scientific journal


• Standardization of the Side-to-Side Cavo-Caval Anastomosis in Orthotopic Liver Transplantation Based on the Causal Analysis of Outflow Obstruction.

  Kaori Kuramitsu, Masahiro Kido, Shohei Komatsu, Daisuke Tsugawa, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Shinichi So, Takuya Mizumoto, Yoshihide Nanno, Hironori Yamashita, Tadahiro Goto, Hiroaki Yanagimoto, Sadaki Asari, Tetsuo Ajiki, Hirochika Toyama, Takumi Fukumoto

  BACKGROUND: Although liver transplantation is widely accepted as the therapeutic strategy for end-stage liver failure, complication of hepatic venous outflow obstruction remains lethal. Currently, ensuring a single wide orifice in both the graft and recipient inferior vena cava has been proposed to avoid hepatic venous outflow obstruction with no theoretical concept. METHODS: We herein report a standardization technique for the reconstruction of the hepatic vein based on the causal analysis. RESULTS: During the put-in process, the graft must be positioned in contact with the recipient diaphragm and slightly pushed to the cranial direction to simulate the state after abdominal closure. Because there is no extra space between the graft and diaphragm, the graft could not rotate about the anastomotic site of the inferior vena cava toward the diaphragm after abdominal closure as the intestinal pressure increases, and accordingly hepatic venous outflow obstruction does not develop. CONCLUSIONS: With this concept, all transplant surgeons can successfully and easily perform hepatic vein reconstruction without total clamping of the inferior vena cava and without outflow block.

  Dec. 2021, Transplantation proceedings, 53(10) (10), 2934 - 2938, English, International magazine

  Scientific journal


• Impact of Sarcopenia as a Prognostic Factor on Reductive Hepatectomy for Advanced Hepatocellular Carcinoma.

  Satoshi Omiya, Shohei Komatsu, Masahiro Kido, Kaori Kuramitsu, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Shinichi So, Keitaro Sofue, Yoshihiko Yano, Yoshitada Sakai, Hiroaki Yanagimoto, Hirochika Toyama, Tetsuo Ajiki, Takumi Fukumoto

  BACKGROUND/AIM: Sarcopenia has been reported to be a significant prognostic factor in patients with hepatocellular carcinoma in recent years. This study aimed to clarify the prognostic significance of sarcopenia in advanced hepatocellular carcinoma treated with reductive hepatectomy. PATIENTS AND METHODS: We retrospectively analyzed 93 patients who underwent reductive hepatectomy for advanced hepatocellular carcinoma. RESULTS: Median survival time of the sarcopenia group (16.4 months) was significantly shorter than that of the non-sarcopenia group (20.4 months). The overall survival rates at 1, 3, and 5 years of the sarcopenia group were significantly lower than those of the non-sarcopenia group (57.9%, 8.6%, and 2.9% vs. 67.3%, 29.2%, and 15.7%, respectively; p=0.035). On multivariate analysis, sarcopenia was a significant risk factor of overall survival (hazard ratio=1.60, 95% confidence interval=1.00-2.56, p=0.049). CONCLUSION: Sarcopenia was a significant prognostic factor of survival after reductive hepatectomy in advanced hepatocellular carcinoma.

  Nov. 2021, Anticancer research, 41(11) (11), 5775 - 5783, English, International magazine

  Scientific journal


• Lenvatinib Rechallenge After Ramucirumab Treatment Failure for Hepatocellular Carcinoma.

  Shohei Komatsu, Yoshihiko Yano, Masahiro Kido, Kaori Kuramitsu, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Shinichi So, Hiroaki Yanagimoto, Hirochika Toyama, Yuzo Kodama, Takumi Fukumoto

  BACKGROUND/AIM: While there is increasing evidence supporting the role of several first- and second-line treatment regimens for advanced hepatocellular carcinomas (HCC), the clinical relevance of rechallenge treatment with previously administered drugs, however, remains to be explored. PATIENTS AND METHODS: Five consecutive patients with advanced HCC who received lenvatinib rechallenge treatment after ramucirumab were assessed. RESULTS: All patients were clinically diagnosed with failure after ramucirumab treatment, and the frequencies of ramucirumab administration before lenvatinib re-administration ranged from 3 to 11. The alfa-fetoprotein level in four of five patients decreased 1 month after the lenvatinib rechallenge. Radiological findings via the modified Response Evaluation Criteria in Solid Tumors showed stable diseases in four patients and a partial response in one. CONCLUSION: Rechallenge treatment with lenvatinib after ramucirumab can be effective, and may be a treatment option for HCC in cases wherein the disease progressed after an initial response to lenvatinib treatment.

  Sep. 2021, Anticancer research, 41(9) (9), 4555 - 4562, English, International magazine

  Scientific journal


• A case of peripancreatic plexiform schwannoma.

  Kenji Fukushima, Makoto Shinzeki, Kentaro Tai, Masaki Omori, Natsuko Yamauchi, Tomoko Tanaka, Yasunori Matsuda, Hiroshi Ashitani, Kenichi Tanaka

  BACKGROUND: Plexiform schwannoma is one of the least common variants of schwannoma, accounting for only 5% of all schwannoma cases. It generally occurs in the skin and subcutaneous tissues and is uncommon in deep soft tissue or viscera. We present an extremely rare case of plexiform schwannoma arising from the peripancreatic plexus. CASE PRESENTATION: A 29-year-old man presented with hyperglycemia detected during a medical checkup. He was diagnosed with type 1 diabetes based on the clinical findings and laboratory tests. During the diagnostic process for diabetes, a 2.5 cm mass was incidentally detected in the pancreas by abdominal ultrasound. Contrast-enhanced computed tomography revealed a mass that was gradually enhanced at the body and tail of the pancreas. Magnetic resonance imaging revealed low signal intensity of the mass on T1-weighted images and high signal intensity on T2-weighted and diffusion-weighted images. Magnetic resonance cholangiopancreatography showed no abnormal findings in the main pancreatic duct. Endoscopic ultrasonography (EUS) showed a lobulated, low-echoic mass with a clear boundary. EUS-guided fine needle biopsy was performed, and spindle-shaped cells that were diffusely immunopositive for S-100 and negative for c-kit and desmin were detected, resulting in a diagnosis of a neurogenic tumor arising from the pancreas or the peripancreatic nerve plexus. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. Although the tumor was connected to the splenic plexus, the splenic artery could be divided along its adventitial plane. Macroscopic findings of the excised tumor consisted of multiple yellowish-white nodules, and its histopathological features were consistent with plexiform schwannoma. There was no pancreatic tissue on the dorsal surface of the tumor, which suggested that the tumor arose from the peripancreatic nerve plexus. CONCLUSIONS: The findings documented herein can aid in the differential diagnosis of peripancreatic schwannoma and in planning appropriate treatment.

  Aug. 2021, Surgical case reports, 7(1) (1), 199 - 199, English, International magazine

  Scientific journal


• Severity assessment in pigs after partial liver resection: evaluation of a score sheet.

  Kerstin Hagemeister, Lisa Ernst, Pramod Kadaba Srinivasan, Hirokazu Tanaka, Kenji Fukushima, René Tolba

  Severity assessment in biomedical research is required by the European authorities. Therefore, a variety of score sheets are available. The first score sheets were designed and introduced by Morton and Griffith (M&G) in 1985, to assess pain and distress in animals. Score sheets are an important part of the 3R principles to evaluate the degree of severity in different studies. Here, we used a modified score sheet from M&G for severity assessment of 12 Aachen minipigs after partial liver resection for safety testing of a novel synthetic sealant (VIVO-107). The control group was treated with the clinical standard fibrin. Estimation of recovery status of both groups was performed from the day of surgery to postoperative day 7 using a score sheet. Included parameters were blood loss during the surgical procedure, general state, spontaneous behaviour and clinical results. Values from 0 to 20 were graded for each category and resulted in the degree of strain (DS) from DS0 to DS4. An increasing DS indicated higher severity. Suitability of the implemented score sheet was evaluated. Higher score points were documented almost exclusively as an outcome of the clinical results, influenced mainly by increased temperature in the fibrin treated control group, whereas, spontaneous behaviour had only slight influence and general state had no influence. The average score seven days after surgery was <2. The laparotomy, where the partial liver resection is a part, is rated as moderate severity in the EU Directive 2010/63, while the assessment done in the present study hints to a mild severity of the model in our hands.

  Jun. 2020, Laboratory animals, 54(3) (3), 251 - 260, English, International magazine

  Scientific journal


• Hemostatic Efficacy and Safety of the Novel Medical Adhesive, MAR VIVO-107, in a Rabbit Liver Resection Model.

  Kenji Fukushima, Hirokazu Tanaka, Pramod Kadaba Srinivasan, Kerstin Pawlowsky, Babette Kögel, Shinji Uemoto, Yonson Ku, René H Tolba

  BACKGROUND: Topical hemostatic agents are useful when hepatic hemorrhage is difficult to control. The aim of this study was to evaluate the hemostatic efficacy and safety of a biodegradable polyurethane-based adhesive, MAR VIVO-107 (MAR), in comparison with a clinically used fibrin glue. METHODS: Thirty female New Zealand white rabbits were randomly assigned to 3 study groups as follows: MAR (n = 10), fibrin glue (n = 10), and saline groups (n = 10). After standardized partial liver resection was performed, each agent was immediately applied to the wound area. Bleeding time until hemostasis and blood loss were recorded. After 7 days, body weight, hematology parameters, and serum levels of aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase were measured. Simultaneously, the severity of intra-abdominal adhesion was evaluated. RESULTS: The mean bleeding time in the MAR (38 ± 10 s) and fibrin glue groups (65 ± 17 s) was significantly shorter than that in the saline group (186 ± 12 s). Similarly, the mean blood loss in the MAR (9 ± 3 g) and fibrin glue groups (9 ± 3 g) was significantly less than that in the saline group (23 ± 4 g). No significant differences in bleeding time and blood loss were found between the MAR and fibrin glue groups. The postoperative survival rate was 100% in all the groups. Body weight as well as hematological and serum biochemical values on day 7 were within the small and physiological range when compared with the preoperative baseline values, and significant differences were not detected among the MAR, fibrin glue, and saline groups. The severities of adhesion were similar between the 3 groups. CONCLUSION: Our data demonstrated that MAR was not inferior to fibrin glue in terms of hemostatic efficacy and safety.

  2018, European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes, 59(1-2) (1-2), 48 - 57, English, International magazine

  Scientific journal


• Efficacy of the Novel Medical Adhesive, MAR-VIVO-107, in an Acute Porcine Liver Resection Model.

  Hirokazu Tanaka, Kenji Fukushima, Pramod Kadaba Srinivasan, Kerstin Pawlowsky, Babette Koegel, Koichiro Hata, Yonson Ku, Shinji Uemoto, René H Tolba

  BACKGROUND: Despite modern surgical techniques, insufficient hemostasis after liver trauma is still a major cause of morbidity and mortality after injury. Therefore, efficient hemostatic agents are indicated. In this study, we evaluated the hemostatic efficacy of a novel synthetic wound adhesive (MAR-VIVO-107) based on polyurethane/polyurea, compared with a widely used fibrin adhesive (Tisseel). MATERIALS AND METHODS: Twelve German Landrace pigs were randomly assigned to 2 groups. The animals were operated under sterile conditions. A midline laparotomy was performed and the left liver lobe was isolated and resected, using a surgical scissor, in order to induce hepatic trauma. MAR-VIVO-107 or Tisseel was applied to the resected area. The animals were monitored for 60 minutes; thereafter, they were sacrificed under anesthesia. Blood and tissue samples were collected pre- and postresection for biochemical and hematological analyses. RESULTS: MAR-VIVO-107 versus Tisseel (mean ± SD, P value)-postsurgical survival rate was 100% in both groups. Bleeding time was significantly higher in Tisseel compared with MAR-VIVO-107 (10.3 ± 5.0 vs 3.7 ± 1.5 minutes, P = .0124). In trend, blood loss was less in the MAR-VIVO-107 group (54.3 ± 34.9 vs 105.5 ± 65.8 g, P = .222). Aspartate transaminase levels were significantly lower in the MAR-VIVO-107 group when compared with the Tisseel group (39.0 ± 10.0 vs 72.4 ± 23.4 U/L, P = .0459). CONCLUSION: The efficacy of MAR-VIVO-107 and comparable performance to the gold standard fibrin have been shown under pre-clinical conditions. MAR-VIVO-107 permits hemorrhage control within seconds, even in wet environment.

  Oct. 2017, Surgical innovation, 24(5) (5), 423 - 431, English, International magazine

  Scientific journal


• Novel synthetic adhesive as an effective alternative to Fibrin based adhesives.

  Pramod Kadaba Srinivasan, Vera Sperber, Mamdouh Afify, Hirokazu Tanaka, Kenji Fukushima, Babette Kögel, Felix Gremse, René Tolba

  AIM: To compare a novel, fully synthetic, polyurethane based glue (MAR-1) to fibrin sealant in a partial liver resection rat model. METHODS: After 50% resection of the lateral left liver lobe in male Wistar rats (n = 7/group/time point), MAR-1, Fibrin or NaCl was applied. After 14, 21 and 90 postoperative days, sealant degradation, intra-abdominal adhesions were scored, and histological examination of liver tissue was performed. RESULTS: (Mean ± SEM) (MAR-1 vs Fibrin vs NaCl). Bleeding mass was significantly higher in NaCl (3.36 ± 0.51 g) compared to MAR-1 (1.44 ± 0.40 g) and Fibrin (1.16 ± 0.32 g). At 14 and 90 d, bleeding time was significantly lower in MAR-1 (6.00 ± 0.9 s; 13.57 ± 3.22 s) and Fibrin (3.00 ± 0.44 s; 22.2 ± 9.75 s) compared to NaCl (158.16 ± 11.36 s; 127.5 ± 23.3 s). ALT levels were significantly higher in MAR-1 (27.66 ± 1 U/L) compared to Fibrin (24.16 ± 0.98 U/L) and NaCl (23.85 ± 0.80 U/L). Intrabdominal adhesions were significantly lower in MAR-1 (11.22% ± 5.5%) compared to NaCl (58.57% ± 11.83%). Degradation of the glue was observed and MAR-1 showed almost no traces of glue in the abdominal cavity as compared to the Fibrin (10% ± 5% 14 d; 7% ± 3% 21 d). Survival showed no significant differences between the groups. CONCLUSION: Compared to Fibrin, MAR-1 showed similar hemostatic properties, no adverse effects, and is biocompatible. Further studies on adhesion strength and biodegradability of synthetic sealants are warranted.

  Aug. 2017, World journal of hepatology, 9(24) (24), 1030 - 1039, English, International magazine

  Scientific journal


• Recommendation for severity assessment following liver resection and liver transplantation in rats: Part I.

  S Kanzler, A Rix, Z Czigany, H Tanaka, K Fukushima, B Kögel, K Pawlowsky, R H Tolba

  Score sheets were first introduced 30 years ago to assess pain, distress and suffering in animals. To date, however, there is still no general agreement on their use in research practice, and only a few publications can be found on this topic. In the present work, we demonstrate the use of a special score sheet for severity assessment in the first three postoperative days in two showcased studies performed on Wistar and Lewis rats undergoing liver resection or orthotopic liver transplantation, respectively. Scoring of different criteria and the total score were evaluated within each intervention. Additionally, both procedures were compared regarding their degree of severity. Suitability of these score sheets was evaluated for assessing severity of the procedures and these showed a minor severity within each investigated study. A comparison of both studies showed slightly higher scores involving liver transplantation. In contradiction to the common classification of these procedures as a moderate severity grade the score sheets applied here indicates a minor severity grade within each investigated study. Also, limitations and possible improvements in the design of our score sheets for defined interventions are reconsidered.

  Dec. 2016, Laboratory animals, 50(6) (6), 459 - 467, English, International magazine

  Scientific journal


• Severity assessment in rabbits after partial hepatectomy: Part II.

  N Drude, K Pawlowsky, H Tanaka, K Fukushima, B Kögel, R H Tolba

  Although the recognition of pain, distress and discomfort has already been described in 1985 by Morton and Griffiths there is still very little known about the establishment of score sheets especially, regarding post-surgical pain and severity assessment for laboratory animals such as rabbits. In this paper we describe the estimation of severity and recovery status of 36 female New Zealand White rabbits (NZW) in a standardized liver resection model using two different adhesive treatments and one control group. Welfare was assessed at 3-4 consecutive days after surgery using a scoring system which included the following criteria: body weight, general state, clinical results, spontaneous behavior and clinical examination. Values could range from 0 to 20 where increasing values indicated increasing severity with a predefined humane endpoint for a score ≥20 points. Documented score points were almost exclusively a result of body weight loss, whereas clinical signs and general health status had no influence on the overall sum of points scored. Behavioral variation was solely observed postoperatively, within the first 24 h, with an average score ≤1. In contrast to the classification of a laparotomy as a moderate procedure in the EU Directive 2010/63 (annex VIII) the assessment herein presented showed a mild burden in all groups according to the scoring system used. The partial hepatectomy itself, as well as the adhesive treatment using either synthetic glue VIVO-107 or fibrin glue, were well tolerated.

  Dec. 2016, Laboratory animals, 50(6) (6), 468 - 475, English, International magazine

  Scientific journal


• The Incidence of Posthepatectomy Liver Failure Defined by the International Study Group of Liver Surgery among Living Donors.

  Kaori Kuramitsu, Takumi Fukumoto, Tsuyoshi Kobayashi, Kenji Fukushima, Sho Okimoto, Takeshi Iwasaki, Masahiro Tominaga, Yoh Zen, Hideki Ohdan, Yonson Ku

  BACKGROUND: Although several publications have reported donor morbidities, deterioration of liver function, which may cause posthepatectomy liver failure (PHLF), was not assessed specifically. METHODS: The incidence of PHLF proposed by the International Study Group of Liver Surgery (ISGLS-PHLF) was analyzed among 257 living donors. ISGLS-PHLF was defined by an increased international normalized ratio and hyperbilirubinemia on or after postoperative day 5. RESULTS: ISGLS-PHLF was identified in 21 donors (8%), of which 18 (85.7%) were grade A, 2 (9.5%) were grade B, and 1 (4.8%) was grade C. The average hospital stay without ISGLS-PHLF was 15 ± 1 days, which extended along with increasing grades (p = 0.03). In univariate analysis, right hepatectomy was significantly associated with the incidence of ISGLS-PHLF (p = 0.02), and right hepatectomy (p = 0.002) and operation time (p = 0.01) in multivariate analysis. Of 176 right lobe donors, 19 (10.8%) developed ISGLS-PHLF, of which 16 (84.2%) were grade A, 2 (10.5%) were grade B, and 1 (5.3%) was grade C. Operation time was significantly associated with the incidence of ISGLS-PHLF in univariate (p = 0.002) and multivariate (p = 0.003) analyses. CONCLUSIONS: Right lobe donation surgery is associated with a higher incidence of ISGLS-PHLF.

  Apr. 2016, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 20(4) (4), 757 - 64, English, International magazine

  Scientific journal


• Fabrication of a magnesium alloy with excellent ductility for biodegradable clips.

  Naoko Ikeo, Ryota Nakamura, Kosuke Naka, Toshiaki Hashimoto, Toshihiko Yoshida, Takeshi Urade, Kenji Fukushima, Hikaru Yabuuchi, Takumi Fukumoto, Yonson Ku, Toshiji Mukai

  UNLABELLED: To develop a biodegradable clip, the equivalent plastic strain distribution during occlusion was evaluated by the finite element analysis (FEA) using the material data of pure Mg. Since the FEA suggested that a maximum plastic strain of 0.40 is required to allow the Mg clips, the alloying of magnesium with essential elements and the control of microstructure by hot extrusion and annealing were conducted. Mechanical characterization revealed that the Mg-Zn-Ca alloy obtained by double extrusion followed by annealing at 673K for 2h possessed a fracture strain over 0.40. The biocompatibility of the alloy was confirmed here by investigating its degradation behavior and the response of extraperitoneal tissue around the Mg-Zn-Ca alloy. Small gas cavity due to degradation was observed following implantation of the developed Mg-Zn-Ca clip by in vivo micro-CT. Histological analysis, minimal observed inflammation, and an only small decrease in the volume of the implanted Mg-Zn-Ca clip confirmed its excellent biocompatibility. FEA using the material data for ductile Mg-Zn-Ca also showed that the clip could occlude the simulated vessel without fracture. In addition, the Mg-Zn-Ca alloy clip successfully occluded the renal vein. Microstructural observations using electron backscattering diffraction confirmed that dynamic recovery occurred during the later stage of plastic deformation of the ductile Mg-Zn-Ca alloy. These results suggest that the developed Mg-Zn-Ca alloy is a suitable material for biodegradable clips. STATEMENT OF SIGNIFICANCE: Since conventional magnesium alloys have not exhibited significant ductility for applying the occlusion of vessels, the alloying of magnesium with essential elements and the control of microstructure by hot extrusion and annealing were conducted. Mechanical characterization revealed that the Mg-Zn-Ca alloy obtained by double extrusion followed by annealing at 673K for 2h possessed a fracture strain over 0.40. The biocompatibility of the alloy was confirmed by investigating its degradation behavior and the response of extraperitoneal tissue around the Mg-Zn-Ca alloy. Finite element analysis using the material data for the ductile Mg-Zn-Ca alloy also showed that the clip could occlude the simulated vessel without fracture. In addition, the Mg-Zn-Ca alloy clip successfully occluded the renal vein. Microstructural observations using electron backscattering diffraction confirmed that dynamic recovery occurred during the later stage of plastic deformation of the ductile Mg-Zn-Ca alloy.

  Jan. 2016, Acta biomaterialia, 29, 468 - 476, English, International magazine

  Scientific journal


• INCIDENCE OF POSTHEPATECTOMY LIVER FAILURE AS DEFINED BY ISGLS AMONG LIVING LIVER DONORS

  Kaori Kuramitsu, Takumi Fukumoto, Masahiro Kido, Atsushi Takebe, Motofumi Tanaka, Hisoka Kinoshita, Kenji Fukushima, Taku Matsumoto, Tadahiro Gotoh, Sadaki Asari, Hirochika Toyama, Yonson Ku

  Nov. 2015, TRANSPLANT INTERNATIONAL, 28, 138 - 138, English


• 肝細胞癌肝外転移巣に対し集学的治療を行い長期生存した1例

  権 英寿, 木戸 正浩, 福本 巧, 武部 敦志, 田中 基文, 蔵満 薫, 木下 秘我, 福島 健司, 浦出 剛史, 宗 慎一, 新関 亮, 松本 逸平, 味木 徹夫, 具 英成

  (株)癌と化学療法社, Sep. 2015, 癌と化学療法, 42(9) (9), 1111 - 1114, Japanese


• Severe post-transplant lymphoproliferative disorder after living donor liver transplantation.

  Kaori Kuramitsu, Takumi Fukumoto, Kenji Fukushima, Takeshi Iwasaki, Masahiro Tominaga, Toshimitsu Matsui, Fumi Kawakami, Tomoo Itoh, Yonson Ku

  Post-transplant lymphoproliferative disorder (PTLD) is a well-known complication after transplantation. A living donor liver transplantation was performed on a 31-year-old man for fulminant hepatitis. He again developed liver dysfunction after 7 months. He was diagnosed as having acute cellular rejection and the steroid pulse therapy introduced resulted in little improvement. He gradually developed a high fever and right axillary lymphadenopathy appeared. Chest computed tomography (CT) was performed revealing small lung nodules and axillary lymphadenopathy. Because his serological status for Epstein-Barr virus was positive, PTLD was highly suspected and immunosuppression treatment was withdrawn with little improvement. One week later, he developed tachycardia. Chest CT was re-performed revealing an infiltration to the left cardiac chamber. For diagnosis, axillary lymph node biopsy was performed and during the procedure, he developed ventricular tachycardia (VT). Immunohistological staining revealed PTLD of T lymphocytes, and chemotherapy was introduced on the same day he developed VT. After two cycles of tetrahydropyranyl, adriamycin, cyclophosphamide, vincristine, prednisolone and etoposide treatment, he completely recovered. This is a first case report of severe PTLD with VT, and our case implies the feasibility of chemotherapy after the appearance of dissemination symptoms.

  Mar. 2015, Hepatology research : the official journal of the Japan Society of Hepatology, 45(3) (3), 356 - 62, English, International magazine

  Scientific journal


• 粒子線治療後に局所再発した転移性肝癌の1切除例

  吉田 俊彦, 武部 敦志, 福本 巧, 木戸 正浩, 田中 基文, 蔵満 薫, 木下 秘我, 津川 大介, 福島 健司, 浦出 剛史, 宗 慎一, 味木 徹夫, 松本 逸平, 新関 亮, 岡崎 太郎, 浅利 貞毅, 後藤 直大, 松本 拓, 具 英成

  (株)癌と化学療法社, Nov. 2014, 癌と化学療法, 41(12) (12), 2071 - 2073, Japanese


• 同時性腸骨転移を伴う肝細胞癌に対し集学的治療を行い長期生存を得た1例

  宗 慎一, 木戸 正浩, 福本 巧, 武部 敦志, 田中 基文, 木下 秘我, 蔵満 薫, 津川 大介, 福島 健司, 浦出 剛史, 吉田 俊彦, 浅利 貞毅, 岡崎 太郎, 新関 亮, 松本 逸平, 味木 徹夫, 具 英成

  (株)癌と化学療法社, Nov. 2014, 癌と化学療法, 41(12) (12), 2107 - 2109, Japanese


• Assessment of ISGLS definition of posthepatectomy liver failure and its effect on outcome in patients with hepatocellular carcinoma.

  Kenji Fukushima, Takumi Fukumoto, Kaori Kuramitsu, Masahiro Kido, Atsushi Takebe, Motofumi Tanaka, Tomoo Itoh, Yonson Ku

  BACKGROUND: Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy. As there was no standardized definition, the International Study Group of Liver Surgery (ISGLS) defined PHLF as increased international normalized ratio and hyperbilirubinemia on or after postoperative day 5 in 2010. We evaluated the impact of the ISGLS definition of PHLF on hepatocellular carcinoma (HCC) patients. METHODS: We retrospectively analyzed 210 consecutive HCC patients who underwent curative hepatectomy at our facility from 2005 to 2010. The median follow-up period after hepatectomy was 35.2 months. RESULTS: Thirty-nine (18.6%) patients fulfilled the ISGLS definition of PHLF. Overall survival (OS) rates at 1, 3, and 5 years in patients with/without PHLF were 69.1/93.5, 45.1/72.5, and 45.1/57.8%, respectively (P = 0.002). Recurrence-free survival (RFS) rates at 1, 3, and 5 years in patients with/without PHLF were 40.9/65.9, 15.7/38.3, and 15.7/20.3%, respectively (P = 0.003). Multivariate analysis revealed that PHLF was significantly associated with both OS (P = 0.047) and RFS (P = 0.019). Extent of resection (P < 0.001), intraoperative blood loss (P = 0.002), and fibrosis stage (P = 0.040) were identified as independent risk factors for developing PHLF. CONCLUSION: The ISGLS definition of PHLF was associated with OS and RFS in HCC patients, and long-term survival will be improved by reducing the incidence of PHLF.

  Apr. 2014, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 18(4) (4), 729 - 36, English, International magazine

  Scientific journal


• 肝細胞癌vp1症例術後再発形式の検討

  小松 昇平, 福本 巧, 木戸 正浩, 武部 敦志, 田中 基文, 蔵満 薫, 木下 秘我, 福島 健司, 浦出 剛史, 宗 慎一, 松本 逸平, 味木 徹夫, 千堂 宏義, 杉本 武巳, 藤野 泰宏, 富永 正寛, 具 英成

  (株)医薬情報研究所, Mar. 2014, 新薬と臨牀, 63(3) (3), 479 - 479, Japanese


• 進行肝細胞癌に対する粒子線治療後にPIHPを施行した症例の検討

  田中 基文, 福本 巧, 木戸 正浩, 武部 敦志, 蔵満 薫, 木下 秘我, 小松 昇平, 福島 健司, 浦出 剛史, 宗 慎一, 新関 亮, 松本 逸平, 味木 徹夫, 寺嶋 千貴, 藤井 收, 出水 祐介, 不破 信和, 具 英成

  (株)癌と化学療法社, Nov. 2013, 癌と化学療法, 40(12) (12), 1681 - 1683, Japanese


• Dual Treatment; A Novel Strategy for Highly-Advanced Hepatocellular carcinoma

  Shinichi So, Takumi Fukumoto, Masahiro Kido, Atsushi Takebe, Motofumi Tanaka, Kaori Kuramitsu, Hisoka Kinoshita, Shohei Komatsu, Kenji Fukushima, Takeshi Urade, Yonson Ku

  Oct. 2013, HEPATOLOGY, 58, 230A - 230A, English


• Usefulness of 99mTc-GSA scintigraphy on preoperative evaluation of liver function for hepatectomy

  Motofumi Tanaka, Takumi Fukumoto, Masahiro Kido, Atsushi Takebe, Kaori Kuramitsu, Hisoka Kinoshita, Shohei Komatsu, Kenji Fukushima, Takeshi Urade, Shinichi So, Yonson Ku

  Oct. 2013, HEPATOLOGY, 58, 781A - 781A, English


• Graft Type Significantly Associates with the Incidence of Posthepatectomy Liver Failure Defined by ISGLS in Living Donors after Hepatectomy

  Kaori Kuramitsu, Takumi Fukumoto, Kenji Fukushima, Ippei Matsumoto, Tetsuo Ajiki, Yonson Ku

  Oct. 2013, HEPATOLOGY, 58, 775A - 775A, English


• 術前経皮的肝灌流と肝切除で完全奏効した両葉多発肝細胞癌の1例

  武部 敦志, 福本 巧, 木戸 正浩, 土田 忍, 高橋 応典, 田中 基文, 蔵満 薫, 中馬 正志, 福島 健司, 浦出 剛史, 外山 博近, 新関 亮, 松本 逸平, 味木 徹夫, 具 英成

  (株)医薬情報研究所, Dec. 2012, 新薬と臨牀, 61(12) (12), 2677 - 2677, Japanese


• 術前経皮的肝灌流化学療法と肝切除にて完全奏効した両葉多発肝細胞癌の1例

  浦出 剛史, 田中 基文, 福本 巧, 木戸 正浩, 土田 忍, 高橋 応典, 武部 敦志, 蔵満 薫, 粟津 正英, 中馬 正志, 福島 健司, 宗 慎一, 田井 謙太郎, 藤本 将人, 外山 博近, 新関 亮, 松本 逸平, 味木 徹夫, 具 英成

  (株)癌と化学療法社, Nov. 2012, 癌と化学療法, 39(12) (12), 1825 - 1827, Japanese


• Long-Term Outcomes and Prognostic Factors with Reductive Hepatectomy and Sequential Percutaneous Isolated Hepatic Perfusion for Multiple Bilobar Hepatocellular Carcinoma

  Takumi Fukumoto, Masahiro Kido, Masanori Takahashi, Atsushi Takebe, Motofumi Tanaka, Kaori Kuramitsu, Kenji Fukushima, Takeshi Urade, Ippei Matsumoto, Tetsuo Ajiki, Yonson Ku

  Oct. 2012, HEPATOLOGY, 56, 518A - 519A, English


• Fragility Index, a Novel Predictor to Assess Deterioration Speed of Renal Function after Living Donor Liver Transplantation

  Kaori Kuramitsu, Takumi Fukumoto, Kenji Fukushima, Ippei Matsumoto, Tetsuo Ajiki, Yonson Ku

  Oct. 2012, HEPATOLOGY, 56, 519A - 519A, English


• 肺癌肝転移の診断でRFAを施行した肝内胆管癌の1例

  福島 健司, 木戸 正浩, 福本 巧, 堀 裕一, 楠 信也, 土田 忍, 高橋 応典, 田中 基文, 蔵満 薫, 津川 大介, 権 英寿, 中馬 正志, 浦出 剛史, 松本 逸平, 味木 徹夫, 具 英成, 神澤 真紀, 伊藤 智雄

  (株)癌と化学療法社, Nov. 2011, 癌と化学療法, 38(12) (12), 2030 - 2032, Japanese


• 肝切除および粒子線治療併用にて治療効果を認めた両葉多発肝細胞癌の1例

  浦出 剛史, 木戸 正浩, 福本 巧, 堀 裕一, 楠 信也, 土田 忍, 高橋 応典, 田中 基文, 蔵満 薫, 津川 大介, 権 英寿, 中馬 正志, 福島 健司, 松本 逸平, 味木 徹夫, 寺嶋 千貴, 出水 祐介, 村上 昌雄, 具 英成

  (株)癌と化学療法社, Nov. 2011, 癌と化学療法, 38(12) (12), 2065 - 2067, Japanese


• RENAL FUNCTION DETERIORATES AFTER LIVING DONOR LIVER TRANSPLANTATION; HOW TO PREDICT CHRONIC DYSFUNCTION?

  Kaori Kuramitsu, Takumi Fukumoto, Shinobu Tuchida, Masahiro Kido, Masanori Takahashi, Motofumi Tanaka, Daisuke Tsugawa, Kenji Fukushima, Masashi Chuma, Takeshi Urade, Yonson Ku

  Oct. 2011, HEPATOLOGY, 54, 681A - 681A, English


• PERCUTANEOUS ISOLATED HEPATIC PERFUSION (PIHP) FOR ADVANCED HEPATOCELLULAR CARCINOMA: TWO DECADES EXPERIENCE OF KOBE PROGRAM

  Takumi Fukumoto, Nobuya Kusunoki, Masahiro Kido, Shinobu Tuchida, Masanori Takahashi, Motofumi Tanaka, Daisuke Tsugawa, Masashi Chuma, Kenji Fukushima, Takeshi Urade, Yonson Ku

  Oct. 2011, HEPATOLOGY, 54, 1385A - 1386A, English

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  -, Dec. 2024, Japanese, Domestic conference

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  -, Dec. 2024, Japanese, Domestic conference

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  -, Nov. 2024, Japanese, Domestic conference

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  -, Nov. 2024, Japanese, Domestic conference

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  -, Oct. 2024, English, Domestic conference

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  -, Oct. 2024, Japanese, Domestic conference

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  -, Oct. 2024, English, International conference

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  -, Jul. 2024, Japanese, Domestic conference

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  -, Jul. 2024, Japanese, Domestic conference

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  -, Jul. 2024, Japanese, Domestic conference

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  -, Jul. 2024, Japanese, Domestic conference

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  -, Jul. 2024, Japanese, Domestic conference

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  -, Jun. 2024, English, Domestic conference

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  -, Mar. 2024, Japanese, International conference

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  -, Mar. 2024, Japanese, Domestic conference

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  -, Feb. 2024, Japanese, Domestic conference

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  -, Feb. 2024, Japanese, Domestic conference

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  -, Jan. 2024, Japanese, Domestic conference

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  -, Dec. 2023, Japanese, Domestic conference

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  -, Nov. 2023, English, International conference

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  -, Oct. 2023, English, International conference

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  -, Sep. 2023, Japanese, Domestic conference

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  -, Sep. 2023, Japanese, Domestic conference

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  -, Sep. 2023, Japanese, Domestic conference

  Public symposium


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  -, Sep. 2023, Japanese, Domestic conference

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  -, Sep. 2023, Japanese, Domestic conference

  Poster presentation


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  -, Sep. 2023, Japanese, Domestic conference

  Poster presentation


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  -, Sep. 2023, Japanese, Domestic conference

  Poster presentation


• A comparative study of laparo-scopic liver resection for the segment 8 dorsal and ventral area

  -

  -, Sep. 2023, English, International conference

  Oral presentation


• Short-term impact of laparoscopic liver resection with 0-mm surgical margin for HCC

  -

  -, Sep. 2023, English, International conference

  Oral presentation


• Acceptability of Laparoscopic Liver Resection of Segment I: A Retrospective Study

  -

  -, Sep. 2023, English, International conference

  Oral presentation


• Laparoscopic segmentectomy2 versus left lateral sectionecto-my for liver tumors in segment2

  -

  -, Sep. 2023, English, International conference

  Oral presentation


• Impact of malnutrition diagnosed by the GLIM criteria on postoperative complications after pancreaticoduodenectomy for biliary tract cancer

  -

  -, Sep. 2023, English, International conference

  Poster presentation


• Impact of malnutrition diagnosed by the GLIM criteria on outcome of elderly patients with hepatocellular carcinoma after liver resection

  -

  -, Sep. 2023, English, International conference

  Poster presentation


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  -, Sep. 2023, Japanese, Domestic conference

  Invited oral presentation


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  -, Aug. 2023, Japanese, Domestic conference

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  -, Jun. 2023, Japanese, Domestic conference

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  -, May 2023, English, International conference

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  -, Apr. 2023, Japanese, Domestic conference

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  -, Apr. 2023, Japanese, Domestic conference

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  -, Apr. 2023, Japanese, Domestic conference

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  -, Apr. 2023, Japanese, Domestic conference

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  -, Apr. 2023, Japanese, Domestic conference

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  -, Apr. 2023, Japanese, Domestic conference

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  -, Apr. 2023, Japanese, Domestic conference

  Public symposium


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  -, Apr. 2023, Japanese, Domestic conference

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  -, Apr. 2023, Japanese, Domestic conference

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  -, Apr. 2023, Japanese, Domestic conference

  Public symposium


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  -, Apr. 2023, Japanese, Domestic conference

  Others


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  -, Apr. 2023, Japanese, Domestic conference

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  -, Mar. 2023, Japanese, Domestic conference

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  -, Dec. 2022, Japanese, Domestic conference

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  -, Dec. 2022, Japanese, Domestic conference

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  -, Dec. 2022, Japanese, Domestic conference

  Public symposium


• The Factors of Predicting Over-Time Weight Increase After Liver Transplantation

  Shimura Y, Kuramitsu K, Kido M, Komatsu S, Gon H, Fukushima K, Urade T, So S, Tsugawa D, Goto T, Asari S, Yanagimoto H, Toyama H, Fukumoto T

  -, Nov. 2022, English, International conference

  Oral presentation


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  -, Nov. 2022, Japanese, Domestic conference

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  -, Nov. 2022, Japanese, Domestic conference

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  -, Nov. 2022, Japanese, Domestic conference

  Oral presentation


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  -, Nov. 2022, Japanese, Domestic conference

  Public symposium


• The usefulness of total tumor volume as a prognostic factor with colorectal cancer liver metastases

  Shimura Y, Komatsu S, Kido M, Kuramitsu K, Gon H, Fukushima K, Urade T, So S, Mizumoto T, Nanno Y, Tsugawa D, Goto T, Asari S, Yanagimoto H, Toyama H, Ajiki T, Fukumoto T

  -, Oct. 2022, Japanese, Domestic conference

  Poster presentation


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  -, Oct. 2022, Japanese, Domestic conference

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  -, Oct. 2022, Japanese, Domestic conference

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  -, Oct. 2022, Japanese, Domestic conference

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  -, Jul. 2022, Japanese, Domestic conference

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  -, Jul. 2022, Japanese, Domestic conference

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  -, Jul. 2022, Japanese, Domestic conference

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  -, Jul. 2022, Japanese, Domestic conference

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  -, Jul. 2022, Japanese, Domestic conference

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  -, Jul. 2022, English, International conference

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  -, Jun. 2022, Japanese, Domestic conference

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  -, Jun. 2022, Japanese, Domestic conference

  Oral presentation


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  -

  -, Jun. 2022, Japanese, Domestic conference

  Invited oral presentation


• -

  -

  -, Jun. 2022, Japanese, Domestic conference

  Public symposium


• Impact of Delayed Gastric Emptying After Pancreatoduodenectomy on Postoperative Nutritional Status

  Mizumoto T, Toyama H, Asari S, Goto T, Nanno Y, So S, Urade T, Fukushima K, Gon H, Tsugawa D, Komatsu S, Kuramitsu K, Yanagimoto H, Kido M, Ajiki T, Fukumoto T

  -, Jun. 2022, Japanese, Domestic conference

  Poster presentation


• Spontaneous rupture of splenic hilar lymph node metastasis from hepatocellular carcinoma: a rare case report

  Fujinaka R, Urade T, Kido M, Kuramitsu K, Komatsu S, Gon H, Fukushima K, So S, Mizumoto T, Nanno Y, Tsugawa D, Goto T, Asari S, Yanagimoto H, Toyama H, Ajiki T, Fukumoto T

  -, Jun. 2022, Japanese, Domestic conference

  Poster presentation


• Laparoscopic anatomic liver resection of segment 2 based on the anatomical variation of the hepatic veins

  Urade T, Kido M, Kuramitsu K, Komatsu S, Gon H, Fukushima K, Mizumoto T, Nanno Y, Tsugawa D, Goto T, Yanagimto H, Asari S, Toyama H, Ajiki T, Fukumoto T

  -, Jun. 2022, Japanese, Domestic conference

  Poster presentation


• Low levels of C-reactive protein on postoperative day 1 are an early predictor for posthepatectomy liver failure in hepatocellular carcinoma patients undergoing right hepatectomy

  Fukushima K, Kido M, Kuramitsu K, Komatsu S, Gon H, Urade T, So S, Mizumoto T, Nanno Y, Tsugawa D, Goto T, Asari S, Yanagimoto H, Toyama H, Ajiki T, Fukumoto T

  -, Jun. 2022, Japanese, Domestic conference

  Poster presentation


• Current role of atezolizumab plus bevacizumab therapy in the sequential treatment of unresectable hepatocellular carcinoma

  Komatsu S, Kido M, Kuramitsu K, Gon H, Fukushima K, Urade T, So S, Mizumoto T, Nanno Y, Tsugawa D, Goto T, Asari S, Yanagimoto H, Toyama H, Ajiki T, Fukumoto T

  -, Jun. 2022, Japanese, Domestic conference

  Poster presentation


• Utility of plasma serum D-dimer for diagnosis of venous thromboembolism after hepatectomy

  Yanagimoto H, Miyake T, Tsugawa D, Urade T, Nanno Y, Fukushima K, Gon H, Komatsu S, Kuramitsu K, Goto T, Asari S, Kido M, Toyama H, Ajiki T, Fukumoto T

  -, Jun. 2022, Japanese, Domestic conference

  Poster presentation


• The usefulness of total tumor volume as a prognostic factor in patients with colorectal cancer liver metastases

  Shimura Y, Komatsu S, Kido M, Kuramitsu K, Gon H, Fukushima K, Urade T, So S, Mizumoto T, Nanno Y, Tsugawa D, Goto T, Asari S, Yanagimoto H, Toyama H, Ajiki T, Fukumoto T

  -, Jun. 2022, Japanese, Domestic conference

  Public symposium


• Multidisciplinary approach for advanced hepatocellular carcinoma

  Kido M, Komatsu S, Kuramitsu K, Gon H, Fukushima K, Urade T, Ajiki T, Yanagimoto H, Goto T, Tsugawa D, Toyama H, Fukumoto T

  -, Jun. 2022, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2022, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jun. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, May 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, May 2022, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2022, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2022, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2022, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2022, Japanese, Domestic conference

  Oral presentation


• Intraoperative Assessment of the Demarcation Line and Intersegmental/Sectional Planes in Liver Surgery

  Urade T, Kido M, Kuramitsu K, Komatsu S, Gon H, Fukushima K, So S, Mizumoto T, Nanno Y, Tsugawa D, Goto T, Asari S, Yanagimoto H, Toyama H, Ajiki T, Fukumoto T

  15th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA), Mar. 2022, English, International conference

  Poster presentation


• Laparoscopic anatomic liver resection of segment 2 by glissonean approach

  Urade T, Kido M, Kuramitsu K, Komatsu S, Gon H, Fukushima K, So S, Mizumoto T, Nanno Y, Goto T, Asari S, Yanagimoto H, Toyama H, Ajiki T, Fukumoto T

  SAGES 2022 Annual Meeting, Mar. 2022, English, International conference

  Poster presentation


• -

  -

  -, Feb. 2022, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2021, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Nov. 2021, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Nov. 2021, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Oct. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Oct. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Sep. 2021, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Sep. 2021, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Oct. 2015, Japanese, Domestic conference

  Poster presentation


• Incidence of posthepatectomy liver failure as defined by ISGLS among living liver donors

  Kuramitsu K, Fukumoto T, Kido M, Takebe A, Tanaka M, Kinoshita H, Fukushima K, Matsumoto T, Goto T, Asari S, Toyama H, Ku Y

  17th Congress of the European Society for Organ Transplantation (ESOT Brussels 2015), Sep. 2015, English, International conference

  Oral presentation


• A case of outflow block requiring metallic stent of inferior vena cava and hepatic vein after orthotopic liver transplantation using piggyback technique

  Arai K, Tanaka M, Fukumoto T, Kuramitsu K, Kido M, Takebe A, Kinoshita H, Fukushima K, Urade T, So S, Yoshida T, Ku Y

  14th Congress of the Asian Society of Transplantation (CAST2015), Aug. 2015, English, International conference

  Poster presentation


• -

  -

  -, Jul. 2015, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2015, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jun. 2015, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jun. 2015, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2015, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2015, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2015, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Apr. 2015, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Nov. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2014, Japanese, Domestic conference

  Public symposium


• Low-dose antiviral treatment for hepatitis C virus following living donor liver transplantation without splenectomy

  Yoshida T, Takebe A, Fukumoto T, Kido M, Tanaka M, Kuramitsu K, Kinoshita H, Fukushima K, Urade T, Ku Y

  The 1st International Congress of Living Donor Liver Transplantation Study Group(ILDLT), Nov. 2014, English, International conference

  Poster presentation


• -

  -

  -, Oct. 2014, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jul. 2014, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jul. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2014, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2014, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2014, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2014, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, May 2014, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Apr. 2014, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Apr. 2014, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Apr. 2014, Japanese, Domestic conference

  Poster presentation


• A novel algorithm for hepatectomy based on the fibrosis stage

  Kuramitsu K, Fukumoto T, Fukushima K, Kido M, Takebe A, Tanaka M, Kinoshita H, Matsumoto I, Ajiki T, Ku Y

  11th World Congress of the International Hepato-Pancreato-Biliary Association(IHPBA), Mar. 2014, English, International conference

  Poster presentation


• Dual treatment; A novel strategy for highly-Advanced hepatocellular carcinoma

  So S, Kido M, Fukumoto T, Takebe A, Tanaka M, Kinoshita H, Kuramitsu K, Tsugawa D, Fukushima K, Ku Y

  11th World Congress of the International Hepato-Pancreato-Biliary Association(IHPBA), Mar. 2014, English, International conference

  Poster presentation


• -

  -

  -, Nov. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Nov. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Nov. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2013, English, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2013, English, International conference

  Poster presentation


• -

  -

  -, Nov. 2013, English, International conference

  Poster presentation


• -

  -

  -, Nov. 2013, English, International conference

  Poster presentation


• -

  -

  -, Nov. 2013, English, International conference

  Poster presentation


• -

  -

  -, Oct. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Oct. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Oct. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Oct. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Sep. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Sep. 2013, Japanese, International conference

  Oral presentation


• -

  -

  -, Jul. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jul. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2013, Japanese, Domestic conference

  Nominated symposium


• -

  -

  -, Jul. 2013, English, International conference

  Poster presentation


• -

  -

  -, Jul. 2013, English, International conference

  Poster presentation


• -

  -

  -, Jul. 2013, English, International conference

  Poster presentation


• -

  -

  -, Jul. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2013, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Apr. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Apr. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Apr. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Apr. 2013, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Apr. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2013, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jan. 2013, English, International conference

  Poster presentation


• -

  -

  -, Dec. 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Nov. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2012, English, International conference

  Poster presentation


• -

  -

  -, Nov. 2012, English, International conference

  Poster presentation


• -

  -

  -, Oct. 2012, English, International conference

  Poster presentation


• -

  -

  -, Oct. 2012, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Sep. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2012, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jun. 2012, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jun. 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, May 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, May 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, May 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, May 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Apr. 2012, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Mar. 2012, English, Domestic conference

  Oral presentation


• -

  -

  -, Mar. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Feb. 2012, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Dec. 2011, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2011, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Nov. 2011, English, International conference

  Poster presentation


• -

  -

  -, Nov. 2011, English, International conference

  Poster presentation


• -

  -

  -, Oct. 2011, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Oct. 2011, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Sep. 2011, English, International conference

  Poster presentation


• -

  -

  -, Sep. 2011, Japanese, Domestic conference

  Public discourse


• -

  -

  -, Sep. 2011, English, International conference

  Poster presentation


• -

  -

  -, Sep. 2011, English, International conference

  Poster presentation


• -

  -

  -, Jul. 2011, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jul. 2011, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jul. 2011, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Jul. 2011, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2011, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2011, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Jul. 2011, English, International conference

  Poster presentation


• -

  -

  -, Jul. 2011, English, International conference

  Poster presentation


• -

  -

  -, Jun. 2011, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2011, Japanese, Domestic conference

  Public symposium


• -

  -

  -, Jun. 2011, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Feb. 2011, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2010, Japanese, Domestic conference

  Oral presentation


• -

  -

  -, Nov. 2007, Japanese, Domestic conference

  Poster presentation


• -

  -

  -, Sep. 2007, Japanese, Domestic conference

  Oral presentation