128 results on '"Shibagaki, K."'
Search Results
2. Enhancement of the synthesis efficiency of carbon cluster ions by the irradiation of two laser pulses to polymers in vacuum
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Shibagaki, K., Kamiya, Y., and Sasaki, K.
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- 2004
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3. Possible Protective Mechanisms of Heme Oxygenase-1 in the Brain
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TAKATA, K., KITAMURA, Y., KAKIMURA, J., SHIBAGAKI, K., TANIGUCHI, T., GEBICKE-HAERTER, P. J., SMITH, M. A., PERRY, G., and SHIMOHAMA, S.
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- 2002
4. Synthesis efficiency of heavy carbon clusters from ETFE ablated by different numbers of laser pulse in vacuum
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Shibagaki, K, Takada, N, Sasaki, K, and Kadota, K
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- 2002
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5. Spatial distribution of the velocity distribution function of Fe atoms in a magnetron sputtering plasma source.
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Shibagaki, K., Nafarizal, N., and Sasaki, K.
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MAGNETRONS , *ELECTRIC oscillators , *IRON , *FLUORESCENCE , *LASERS - Abstract
We examined the spatial distribution of the velocity distribution function of Fe atoms in a conventional dc magnetron sputtering source by laser-induced fluorescence (LIF) imaging spectroscopy. By measuring the Doppler broadening of the excitation spectrum of LIF, we evaluated the velocity distribution function of Fe at many positions in the discharge space. By calculating the first- and second-order moments of the velocity distribution function, we obtained two-dimensional maps of the average velocity and the effective temperature in the r-z plane of the cylindrically symmetric magnetron discharge. The map of the average velocity clearly indicates that Fe atoms have fast velocity in the region adjacent to the target at a low discharge pressure such as 3 mTorr, while at a high gas pressure such as 20 mTorr, the average velocity of Fe atoms is almost zero in the entire discharge space. On the other hand, it has been found from the map of the effective temperature that the velocity distribution function observed at 3 mTorr has a broad width corresponding to approximately 8×104 K in the bright plasma near the target. [ABSTRACT FROM AUTHOR]
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- 2005
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6. Synthetic characteristics of large carbon cluster ions by laser ablation of polymers in vacuum.
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Shibagaki, K., Takada, N., Sasaki, K., and Kadota, K.
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COMPLEX ions , *CARBON , *TIME-of-flight mass spectrometry - Abstract
The synthetic characteristics of large carbon cluster ions by laser ablation of polymers in vacuum were investigated. Time-of-flight mass spectrometry was used for analyzing the masses of ionic species produced by laser ablation. We found that large carbon cluster ions C[sup +, sub n] with n up to 400 were synthesized in vacuum when copolymer of ethylene and tetrafluoroethylene, polyvinyliden fluoride, and chlorotrifluoroethylene were employed as the target material. Since the synthesis of large cluster ions in vacuum is a surprising phenomenon, we examined the synthesis efficiency in various experimental conditions. By comparing mass spectra obtained from various polymers containing hydrogen and/or halogen atoms, the existence of both hydrogen and halogen atoms in polymers do not directly contribute to enhance the synthesis efficiency of large carbon clusters. In addition, microscopic observations of surface morphologies of laser-ablated polymers revealed that the clustering reactions in eroded craters had little correlation with the synthesis efficiency of large carbon clusters. [ABSTRACT FROM AUTHOR]
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- 2003
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7. Production of carbon clusters by laser ablation of polymers in vacuum.
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Shibagaki, K., Takada, N., Sasaki, K., and Kadota, K.
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LASER ablation , *POLYMERS - Abstract
Time-of-flight mass spectrometry was used for analyzing ionic species produced by Nd:YAG laser ablation of polymers [polypropylene (PP), polyethylene (PE), and polytetrafluoroethylene] in vacuum. The temporal variation of the mass distribution after the laser irradiation was investigated. The target polymers were decomposed to almost atomic species by the laser irradiation. After the laser irradiation, significant temporal evolution of carbon cluster ions (C[sub n]H[sub m][sup +], C[sub n]H[sub m][sup -], and C[sub n]F[sub m][sup -]) was observed. This result indicates that the cluster ions are produced from atomic species via gas-phase reactions in the ablation plume with no ambient gases. The mass spectra of C[sub n][sup -] and C[sub n]H[sub m][sup -] obtained from the PP and PE targets suggest that even carbon clusters (C[sub 2k]) are hydrogenated more efficiently than odd ones (C[sub 2k+1]) to produce C[sub 2k]H[sub m]. © 2001 American Institute of Physics. [ABSTRACT FROM AUTHOR]
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- 2002
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8. Spatial distribution of the velocity distribution function of Fe atoms in magnetron sputtering plasma source
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Shibagaki, K., Nafarizal, N., and Sasaki, K.
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Magnetrons -- Properties ,Iron -- Atomic properties ,Fluorescence spectroscopy -- Analysis ,Physics - Abstract
The study was conducted to measure the spatial distribution of the velocity distribution functions of Fe atoms in a dc magnetron sputtering plasma source by Doppler-shifted laser-induced fluorescence imaging spectroscopy. These results represents the relaxation process of the energy of sputtered Fe atoms and during the transport toward the downstream plasma, the energy of Fe atoms is reduced and the velocity distribution function is thermalized by collision with ambient Ar gas.
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- 2005
9. Negative ion densities in high-density, low-temperature recombining hydrogen plasmas
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Shibagaki, K, primary and Sasaki, K, additional
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- 2008
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10. Chemical bonds of fluorocarbon films which can be a source of CFx radicals
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Takada, N., primary, Iida, T., additional, Shibagaki, K., additional, and Sasaki, K., additional
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- 2004
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11. Laser desorption time-of-flight mass spectrometry of fluorocarbon films synthesized by C4F8/H2 plasmas
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Shibagaki, K., primary, Maeda, T., additional, Takada, N., additional, Sasaki, K., additional, and Kadota, K., additional
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- 2003
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12. Analysis of the molecular structure of fluorocarbon deposits produced by C4F8 and C4F8–H2 plasmas
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Takada, N., primary, Shibagaki, K., additional, Sasaki, K., additional, Kadota, K., additional, and Oyama, K.-I., additional
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- 2001
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13. Implementation of a multi-pulse speech codec with pitch prediction on a single chip floating-point signal processor.
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Fukui, A. and Shibagaki, K.
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- 1987
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14. Chemical bonds of fluorocarbon films which can be a source of CFx radicals.
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Takada, N., Iida, T., Shibagaki, K., and Sasaki, K.
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- 2004
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15. Laser desorption time-of-flight mass spectrometry of fluorocarbon films synthesized by C4F8/H2 plasmas.
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Shibagaki, K., Maeda, T., Takada, N., Sasaki, K., and Kadota, K.
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- 2003
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16. Analysis of the molecular structure of fluorocarbon deposits produced by C4F8 and C4F8-H2 plasmas.
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Takada, N., Shibagaki, K., Sasaki, K., Kadota, K., and Oyama, K.-I.
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- 2001
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17. Outermost surface microstructure of as-grown, heat-treated and partially oxidized carbon microcoils
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Shibagaki, K., Motojima, S., Umemoto, Y., and Nishitani, Y.
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- 2001
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18. Thermal behavior and effect of heat treatment in an inert gas on oxidized carbon microcoils
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Shibagaki, K. and Motojima, S.
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- 2001
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19. Surface properties of carbon micro-coils oxidized by a low concentration of oxygen gas
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Shibagaki, K. and Motojima, S.
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- 2000
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20. Distribution of sulfur in bulk carbon microcoils
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Shibagaki, K. and Motojima, S.
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- 2001
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21. The kinetics of Na +-H + antiporter activity in platelets of Dahl-Iwai salt sensitive rats.
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Otsuka, K, Shibagaki, K, Ohno, Y, Hayashi, M, and Saruta, T
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- 1999
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22. J003: The kinetics of Na+-H+ antiporter activity in platelets of Dahl-Iwai salt sensitive rats.
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Otsuka, K., Shibagaki, K., Ohno, Y., Hayashi, M., and Saruta*, T.
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- 1999
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23. J003: The kinetics of Na+-H+ antiporter activity in platelets of Dahl-Iwai salt sensitive rats.
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Otsuka, K., Shibagaki, K., Ohno, Y., Hayashi, M., and Saruta, T.
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- 1999
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24. Multiple intraductal papillary neoplasms of bile duct diagnosed based on endoscopic ultrasonography and peroral cholangioscopy findings.
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Onoe M, Fukuba N, Kodama Y, Oka A, Kawashima K, Shibagaki K, Ishimura N, Kushiyama Y, Uchida Y, Furukawa T, and Ishihara S
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- Humans, Male, Adult, Bile Ducts, Intrahepatic diagnostic imaging, Cholangiopancreatography, Magnetic Resonance, Neoplasms, Multiple Primary diagnostic imaging, Neoplasms, Multiple Primary pathology, Endosonography, Bile Duct Neoplasms diagnostic imaging, Bile Duct Neoplasms surgery, Endoscopy, Digestive System
- Abstract
A man in his 30s was referred to our department for evaluation of bile duct stricture and removal of an intrahepatic bile duct stone. Five years before his presentation, he underwent left hepatectomy for a giant hepatic hemangioma. There were no abnormalities in blood biochemical tests. Magnetic resonance cholangiopancreatography showed one 5 mm oval defect in region B6 and two 8 mm semicircular defects in the hilar bile duct. Endoscopic ultrasound revealed a 3.5 mm hypoechoic focal raised lesion in the hilar bile duct. Oral cholangioscopy revealed his two lesions in the hilar bile duct as white papillary elevations with mucus production. The pathological diagnosis of intraductal papillary neoplasm was determined (low-grade dysplasia, type 1, gastric type). After 1 and a half years, no expansion of the bile duct lesion was observed. Initially, it was thought to be a benign stenosis after liver resection, but based on the results of endoscopic ultrasound, we suspected a tumorous lesion, and we were able to make an accurate diagnosis, including histological type, using transoral cholangioscopy., (© 2024. The Author(s).)
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- 2024
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25. Gastric dysplastic lesions in Helicobacter pylori-naïve stomach: Foveolar-type adenoma and intestinal-type dysplasia.
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Shibagaki K, Kushima R, Mishiro T, Araki A, Niino D, Ishimura N, and Ishihara S
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- Humans, Helicobacter Infections pathology, Helicobacter Infections complications, Helicobacter Infections microbiology, Precancerous Conditions pathology, Precancerous Conditions microbiology, Proto-Oncogene Proteins p21(ras) genetics, Mutation, Stomach pathology, Stomach microbiology, Stomach Neoplasms pathology, Stomach Neoplasms microbiology, Kruppel-Like Factor 4, Adenoma pathology, Adenoma microbiology, Gastric Mucosa pathology, Gastric Mucosa microbiology, Helicobacter pylori isolation & purification
- Abstract
Reports of Helicobacter pylori (Hp)-naïve gastric neoplasm (HpNGN) cases have been rapidly increasing due to the recent increase in the Hp-naïve population in Japan. Most HpNGNs exhibit the gastric immunophenotype and a low malignant potential regardless of histological type. Especially, foveolar-type gastric adenoma (FGA) and intestinal-type gastric dysplasia (IGD) rarely progress to invasive carcinoma. FGA is a foveolar epithelial neoplasm that occurs in the fundic gland (oxyntic gland) mucosa and is classified as the flat type or raspberry type (FGA-RA). The flat type is a large, whitish flatly elevated lesion while FGA-RA is a small reddish polyp. Genomically, the flat type is characterized by APC and KRAS gene mutations and FGA-RA by a common single nucleotide variant in the KLF4 gene. This KLF4 single-nucleotide variant reportedly induces gastric foveolar epithelial tumorigenesis and activates both cell proliferation and apoptosis, leading to its slow-growing nature. IGD consists of an intestinalized epithelial dysplasia that develops in the pyloric gland mucosa, characterized as a superficial depressed lesion surrounded by raised mucosa showing a gastritis-like appearance. Immunohistochemically, it exhibits an intestinal or gastrointestinal phenotype and, frequently, p53 overexpression. Thus, IGD shows unique characteristics in HpNGNs and a potential multistep tumorigenic process., (© 2024 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.)
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- 2024
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26. Multicenter study of invasive gastric cancer detected after 10 years of Helicobacter pylori eradication in Japan: Clinical, endoscopic, and histopathologic characteristics.
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Kobayashi M, Fujisaki J, Namikawa K, Hoteya S, Sasaki A, Shibagaki K, Yao K, Abe S, Oda I, Ueyama H, Isomoto H, Ito M, Sugimoto M, Kawai T, Kodama M, Murakami K, Adachi K, Matsuhashi N, Ohata K, Ushijima T, Kato M, Miyamoto S, Yoshimura D, Yao T, Yagi K, Iwaizumi M, and Uemura N
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Objectives: Gastric cancer can be diagnosed even in patients long after Helicobacter pylori eradication. Most cases involve intramucosal lesions; however, some are invasive and require surgery. To clarify appropriate long-term surveillance methods, this study compared invasive gastric cancer diagnosed ≥10 and <10 years after eradication., Methods: This retrospective multicenter study included 14 institutions. We included 377 patients with gastric cancer with submucosal or deep invasion after surgical or endoscopic resection. Ordered logistic regression analysis was used to explore the factors contributing to the pathological stage and histological type., Results: Invasive gastric cancer was detected in 84 patients (Group L) and 293 patients (Group S) ≥10 and <10 years after H. pylori eradication, respectively. Endoscopic mucosal atrophy at the time of cancer detection was similar in both groups; 50% of the patients had severe atrophy. Annual endoscopy correlated with early pathological stage (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.14-0.54, p < 0.001). Group L exhibited an independent correlation with the advanced pathological stage (OR 2.27, 95% CI 1.06-4.88, p = 0.035) and the undifferentiated type (OR 2.12, 95% CI 1.16-3.90, p = 0.015). The pure differentiated type and early pathological stage significantly ( p = 0.001) correlated with severe mucosal atrophy in Group S but not in Group L., Conclusions: Invasive cancers diagnosed ≥10 years after H. pylori eradication were likely to be more malignant in histological type and pathological stage. Gastric cancer surveillance should continue regardless of endoscopic atrophy, particularly ≥10 years after eradication., Competing Interests: Seiichiro Abe is an associate editor of DEN Open. The other authors declare no conflict of interest., (© 2024 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)
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- 2024
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27. Gastric Metastasis from Salivary Duct Carcinoma Mimicking Scirrhous Gastric Cancer.
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Kishimoto K, Shibagaki K, Araki A, Murakami K, Takahashi Y, Kotani S, Oka A, Yazaki T, Fukuba N, Mishima Y, Oshima N, Kawashima K, Ishimura N, Kadota K, and Ishihara S
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- Male, Humans, Middle Aged, Salivary Ducts metabolism, Salivary Ducts pathology, Biomarkers, Tumor, Stomach Neoplasms diagnosis, Stomach Neoplasms pathology, Salivary Gland Neoplasms diagnosis, Salivary Gland Neoplasms metabolism, Salivary Gland Neoplasms pathology, Carcinoma, Ductal pathology
- Abstract
A 59-year-old man underwent submandibular gland excision for salivary duct carcinoma (SDC). One year later, esophagogastroduodenoscopy indicated gastric diffuse mucosal thickening with luminal contraction, mimicking scirrhous gastric carcinoma. Biopsy specimens showed dense proliferation of neoplastic cells expressing androgen receptor and human epidermal growth factor 2, indicating SDC. Gastric diffuse infiltrative metastasis is generally characteristic of gastric metastasis from invasive ductal carcinoma, which shows histologic features similar to SDC. This is the first known report of gastric diffusely infiltrating metastasis in an SDC patient. Rapidly progressing, diffuse gastric wall thickening should also be considered indicative of salivary tumor-associated gastric metastasis.
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- 2024
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28. Clinicopathologic differences of gastric neoplasms between Helicobacter pylori-infected and -naïve patients: a multicenter retrospective analysis.
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Kotani S, Shibagaki K, Hirahara N, Hasegawa N, Tanabe R, Ebisutani Y, Nonomura S, Kishimoto K, Kodama Y, Takahashi Y, Kataoka M, Oka A, Fukuba N, Mishima Y, Oshima N, Kawashima K, Ishimura N, Araki A, Kadota K, Itawaki A, Nagasaki M, Miyaoka Y, Onuma H, and Ishihara S
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- Humans, Female, Retrospective Studies, Gastric Mucosa pathology, Endoscopy, Stomach Neoplasms pathology, Helicobacter pylori, Helicobacter Infections complications, Helicobacter Infections epidemiology, Helicobacter Infections diagnosis
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Background: The incidence of gastric neoplasms in Helicobacter pylori (Hp)-naïve patients has recently increased due to a remarkable decrease in the Hp-infected population in Japan. We investigated the clinicopathologic differences between Hp-infected gastric neoplasms (HpIGNs) and Hp-naïve gastric neoplasms (HpNGNs) that have not been fully elucidated so far., Methods: This retrospective multicenter study investigated 966 consecutive patients with 1131 gastric dysplasia or cancers who underwent endoscopic or surgical treatment for the recent decade. Clinicopathologic features were compared between HpIGN and HpNGN cases., Results: One thousand and sixty-eight HpIGNs in 916 patients included 877 differentiated types and 191 undifferentiated types. Sixty-three HpNGNs in 50 patients included 57 differentiated types (35 foveolar types, 15 intestinal types, 6 fundic-gland types, and 1 other differentiated type) and 6 undifferentiated types. HpNGNs occurred in younger (59.5 vs. 71.8 years, p < 0.05) and female patients (40.0% vs. 26.5%, p < 0.05), were found more frequently in the proximal compartment (p < 0.05), and had smaller size (median 4.0 vs. 20.0 mm, p < 0.05). Histologically, HpNGNs and HpIGNs both primarily consisted of differentiated type (90.5% vs. 82.1%, p = 0.089) and HpNGNs showed lower prevalence of invasive cancer (11.1% vs. 37.6%, p < 0.05) and lymphovascular invasion (1.6% vs. 31.6%, p < 0.05). Nearly all HpNGNs (62/63, 98.4%) were diagnosed in early pathological stage, while 16.1% (172/1068) of HpIGNs were diagnosed in advanced stage (p < 0.05)., Conclusions: HpNGNs is recently on the increase but shows lower malignant nature regardless of histologic type than HpIGN. Endoscopic gastric cancer screening will be reviewed via cost effectiveness for Hp-naïve individuals in future., (© 2023. Japanese Society of Gastroenterology.)
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- 2024
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29. Long-term outcomes of functional single ventricles associated with heterotaxy syndrome†.
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Tanimoto K, Hoashi T, Shibagaki K, Ono Y, Komori M, Okuda N, Imai K, Iwai S, and Ichikawa H
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- Infant, Newborn, Humans, Treatment Outcome, Retrospective Studies, Heart Ventricles surgery, Heart Ventricles abnormalities, Heterotaxy Syndrome surgery, Fontan Procedure methods, Univentricular Heart, Scimitar Syndrome surgery, Heart Defects, Congenital surgery
- Abstract
Objectives: The goal of this study was to determine the long-term surgical outcomes of patients with functional single ventricles associated with heterotaxy syndrome, risk factors for mortality and factors associated with Fontan stage completion., Methods: Overall, 279 patients with a functional single ventricle associated with heterotaxy syndrome who underwent an initial surgical procedure at our institute between 1978 and 2021 were grouped into 4 "eras" based on the surgical year during which the initial procedure was performed: era 1 (1978-1989, n = 71), era 2 (1990-1999, n = 98), era 3 (2000-2009, n = 64) and era 4 (2010-2021, n = 46). Neonatal surgery was more frequent in eras 3 and 4 than in eras 1 and 2., Results: Overall, 228 patients had right atrial isomerism; 120 patients (43.0%) had a total anomalous pulmonary venous connection; and 58 patients (20.8%) underwent an initial procedure as neonates. Overall survival rates at 10, 20 and 30 years after the initial procedure were 47.1%, 40.6% and 36.1%, respectively. Neonatal surgery (P < 0.001), total anomalous pulmonary venous connection repair at the initial procedure (P < 0.001) and early era (P < 0.001) were identified as risk factors for mortality, with the last 2 variables being negatively associated with Fontan stage completion (P < 0.001 for both)., Conclusions: Although era had a favourable effect on survival, total anomalous pulmonary venous connection with intrinsic pulmonary vein obstruction was associated with both mortality and Fontan stage completion., Clinical Registration Number: R19092., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2023
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30. Endoscopic fenestration treatment for pneumatosis cystoides intestinalis in patient with recurrent colonic intussusception.
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Takahashi Y, Shibagaki K, Fukuyama C, Kawashima K, Ishimura N, Kinoshita Y, and Ishihara S
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- Humans, Endoscopy, Pneumatosis Cystoides Intestinalis, Intussusception, Colonic Diseases
- Abstract
Competing Interests: The authors declare that they have no conflict of interest.
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- 2023
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31. Endoscopic differential diagnosis between foveolar-type gastric adenoma and gastric hyperplastic polyps in Helicobacter pylori-naïve patients.
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Shibagaki K, Ishimura N, Kotani S, Fukuyama C, Takahashi Y, Kishimoto K, Yazaki T, Kataoka M, Omachi T, Kinoshita Y, Hasegawa N, Oka A, Mishima Y, Mishiro T, Oshima N, Kawashima K, Nagase M, Araki A, Kadota K, and Ishihara S
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- Humans, Diagnosis, Differential, Retrospective Studies, Gastroscopy methods, Stomach Neoplasms diagnosis, Stomach Neoplasms pathology, Helicobacter pylori, Adenomatous Polyps diagnosis
- Abstract
Background: Foveolar-type gastric adenoma (FGA) occurs in Helicobacter pylori (Hp)-naïve individuals and morphologically mimics Hp-naïve gastric hyperplastic polyp (HpN-GHP). FGA is often difficult to distinguish from HpN-GHP even by biopsy, due to its low-grade histologic atypia. We conducted a retrospective study to create an endoscopic diagnostic index., Methods: We analyzed 51 FGAs in 41 patients and 36 HpN-GHPs in 24 patients. All lesions were photographed by white-light endoscopy (WLE) and narrow-band imaging with magnification endoscopy (NBIME). Three experts and three non-experts reviewed the WLE and WLE+NBIME images to assess six items for lesion diagnosis. We analyzed correlations between the diagnostic items and histologic features and compared the diagnostic accuracy between modalities. We created a composite diagnostic index and calculated its accuracy and consistency., Results: FGAs more frequently showed the following features vs. HpN-GHPs: bright-red color (94.1% vs. 44.4%), peripheral hyperplasia (58.8% vs. 8.3%), papillary/gyrus-like microstructure (96.1% vs. 33.3%), visible capillaries (70.6% vs. 38.9%), and demarcation line (98.0% vs. 41.7%) (P < 0.05). White-zone thickening was seen only in HpN-GHPs (52.8%). Diagnostic accuracy (mean, WLE vs. WLE+NBIME) was 90.8 ± 1.1% vs. 93.5 ± 2.4% (P = 0.15) for experts and 88.5 ± 3.0% vs. 86.6 ± 3.5% (P = 0.51) for non-experts. When satisfying the four criteria (bright-red color, papillary/gyrus-like microstructure, demarcation line, and absent white-zone thickening), sensitivity and specificity for FGA were 90.2% and 94.4%, respectively, with a kappa value of ≥ 0.6 for interobserver diagnostic agreement., Conclusions: Composite diagnostic index contributes to the reproducible, accurate, preoperative differential diagnosis of FGA and HpN-GHP., (© 2023. The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.)
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- 2023
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32. Seasonal variation in predialysis systolic blood pressure and cardiovascular events in patients on maintenance hemodialysis.
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Takahashi R, Maruki T, Uchiyama K, Washida N, Shibagaki K, Yanai A, Nakayama T, Hayashi K, Kanda T, and Itoh H
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- Humans, Blood Pressure, Renal Dialysis, Retrospective Studies, Seasons, Male, Female, Heart Failure complications, Kidney Failure, Chronic complications
- Abstract
Predialysis systolic blood pressure (SBP) in patients on hemodialysis (HD) consistently followed a seasonal pattern, reaching a peak in winter and nadir in summer, similar to blood pressure in the general population. However, the relationship between seasonal variations in predialysis SBP and clinical outcomes is still under-investigated in Japanese patients on HD. This retrospective cohort study included 307 Japanese patients undergoing HD for >1 year in three dialysis clinics and evaluated the association between the standard deviation (SD) of predialysis SBP and clinical outcomes, including major adverse cardiovascular events (MACEs; cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization) with 2.5 years follow-up. The SD of predialysis SBP was 8.2 (6.4-10.9) mmHg. In the model fully adjusted for the SD of predialysis SBP, predialysis SBP, age, sex, HD vintage, Charlson comorbidity index, ultrafiltration rate, renin-angiotensin system inhibitors, corrected calcium, phosphorus, human atrial natriuretic peptide, C-reactive protein, albumin, hemoglobin, body mass index, normalized protein catabolism rate, and intradialytic SBP decline, Cox regression analyses showed that a higher SD of predialysis SBP (per 10 mmHg) was significantly associated with increased MACE risk (hazard ratio [HR], 1.89; 95% confidence interval [95% CI], 1.07-3.36) and all-cause hospitalization (HR, 1.57; 95% CI, 1.07-2.30). Therefore, greater seasonal variations in predialysis SBP were associated with worse clinical outcomes, including MACEs and all-cause hospitalization. Whether interventions to reduce seasonal variations in predialysis SBP will improve the prognosis of Japanese patients on HD must be investigated further., (© 2023. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)
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- 2023
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33. Mean annual intradialytic blood pressure decline and cardiovascular events in Japanese patients on maintenance hemodialysis.
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Takahashi R, Uchiyama K, Washida N, Shibagaki K, Yanai A, Nakayama T, Nagashima K, Sato Y, Kanda T, and Itoh H
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- Humans, Blood Pressure physiology, East Asian People, Renal Dialysis adverse effects, Retrospective Studies, Hypotension etiology, Kidney Failure, Chronic complications
- Abstract
An intradialytic systolic blood pressure (SBP) decline, which defines intradialytic hypotension, may be associated with higher all-cause mortality. However, in Japanese patients on hemodialysis (HD), the association between intradialytic SBP decline and patient outcomes is unclear. This retrospective cohort study included 307 Japanese patients undergoing HD over 1 year in three dialysis clinics and evaluated the association between the mean annual intradialytic SBP decline (predialysis SBP-nadir intradialytic SBP) and clinical outcomes, including major adverse cardiovascular events (MACEs; cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization) by following up for 2 years. The mean annual intradialytic SBP decline was 24.2 (25-75th percentile, 18.3-35.0) mmHg. In the model fully adjusted for intradialytic SBP decline tertile group (T1, <20.4 mmHg; T2, 20.4 to <29.9 mmHg; T3, ≥29.9 mmHg), predialysis SBP, age, sex, HD vintage, Charlson comorbidity index, ultrafiltration rate, use of renin-angiotensin system inhibitors, corrected calcium, phosphorus, human atrial natriuretic peptide, geriatric nutritional risk index, normalized protein catabolism rate, C-reactive protein, hemoglobin, and use of pressor agents, Cox regression analyses showed that the hazard ratio (HR) was significantly higher for T3 than for T1 for MACEs (HR, 2.38; 95% confidence interval 1.12-5.09) and all-cause hospitalization (HR, 1.68; 95% confidence interval 1.03-2.74). Therefore, in Japanese patients on HD, a greater intradialytic SBP decline was associated with worse clinical outcomes. Further studies are warranted to investigate whether interventions to attenuate the intradialytic SBP decline will improve the prognosis of Japanese patients on HD., (© 2023. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)
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- 2023
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34. Changes of biomarkers for erythropoiesis, iron metabolism, and FGF23 by supplementation with roxadustat in patients on hemodialysis.
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Yoshida S, Saito T, Shibagaki K, Hirao K, Yuza T, Tomosugi N, and Honda H
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- Humans, Biomarkers, Darbepoetin alfa therapeutic use, Dietary Supplements, Erythropoiesis, Ferritins, Glycine, Hepcidins metabolism, Iron metabolism, Isoquinolines therapeutic use, Renal Dialysis adverse effects, Anemia, Erythropoietin metabolism
- Abstract
This study aimed to confirm changes in biomarkers of erythropoiesis and iron metabolism and serum fibroblast growth factor 23 (FGF-23) during darbepoetin-α treatment and then switching to the hypoxia-inducible factor prolyl hydroxylase inhibitor roxadustat. A total of 28 patients on hemodialysis who received weekly doses of darbepoetin-α were switched to roxadustat. Biomarkers for erythropoiesis and iron metabolism and intact and C-terminal FGF-23 were measured in blood samples collected before the HD session on days - 7 (darbepoetin-α injection), - 4, and - 2, and days 0 (switch to roxadustat treatment, three times weekly), 3, 5, 7, 14, 21, and 28. Erythropoietin and erythroferrone levels were elevated on day - 4 by darbepoetin-α injection and decreased to baseline levels at day 0. Levels of erythropoietin were not significantly increased by roxadustat supplementation, but erythroferrone levels were continuously elevated, similar to darbepoetin-α treatment. Hepcidin-25 and total iron binding capacity were significantly decreased or increased in patients treated with roxadustat compared with darbepoetin-α. Changes of intact and C-terminal FGF-23 levels were parallel to changes of phosphate levels during roxadustat treatment. However, the actual and percentage changes of intact FGF-23 and C-terminal FGF-23 in patients with low ferritin levels were greater than those in patients with high ferritin levels. Roxadustat might stimulate erythropoiesis by increasing iron usage through hepcidin-25, which was suppressed by erythroferrone in the physiological erythropoietin condition. Changes of intact FGF-23 and C-terminal FGF-23 levels might be affected by roxadustat in patients on hemodialysis, especially those with a low-iron condition., (© 2023. The Author(s).)
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- 2023
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35. A multicenter prospective study of the treatment and outcome of patients with gastroduodenal peptic ulcer bleeding in Japan.
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Kawaguchi K, Yoshida A, Yuki T, Shibagaki K, Tanaka H, Fujishiro H, Miyaoka Y, Yanagitani A, Koda M, Ikuta Y, Hamamoto T, Mukoyama T, Sasaki Y, Kushiyama Y, Yuki M, Noguchi N, Miura M, Ikebuchi Y, Yashima K, Kinoshita Y, Ishihara S, and Isomoto H
- Subjects
- Humans, Prospective Studies, Japan epidemiology, Risk Assessment methods, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy, Gastrointestinal Hemorrhage diagnosis, Prognosis, Endoscopy, Gastrointestinal adverse effects, Treatment Outcome, Severity of Illness Index, Peptic Ulcer Hemorrhage diagnosis, Peptic Ulcer Hemorrhage therapy, Peptic Ulcer complications, Peptic Ulcer therapy
- Abstract
Gastroduodenal peptic ulcers are the main cause of nonvariceal upper gastrointestinal bleeding (UGIB). We believe that recent advances in endoscopic techniques and devices for diagnosing upper gastrointestinal tract tumors have advanced hemostasis for UGIB. However, few prospective multicenter studies have examined how these changes affect the prognosis. This prospective study included 246 patients with gastroduodenal peptic ulcers treated at 14 participating facilities. The primary endpoint was in-hospital mortality within 4 weeks, and the secondary endpoints required intervention and refractory bleeding. Subsequently, risk factors affecting these outcomes were examined using various clinical items. Furthermore, the usefulness of the risk stratification using the Glasgow-Blatchford score, rockall score and AIMS65 based on data from the day of the first urgent endoscopy were examined in 205 cases in which all items were complete there are two periods. Thirteen (5%) patients died within 4 weeks; and only 2 died from bleeding. Significant risk factors for poor outcomes were older age and severe comorbidities. Hemostasis was required in 177 (72%) cases, with 20 cases of refractory bleeding (2 due to unsuccessful endoscopic treatment and 18 due to rebleeding). Soft coagulation was the first choice for endoscopic hemostasis in 57% of the cases and was selected in more than 70% of the cases where combined use was required. Rockall score and AIMS65 predicted mortality equally, and Glasgow-Blatchford score was the most useful in predicting the requirement for intervention. All scores predicted refractory bleeding similarly. Although endoscopic hemostasis for UGIB due to peptic ulcer had a favorable outcome, old age and severe comorbidities were risk factors for poor prognosis. We recommend that patients with UGIB should undergo early risk stratification using a risk scoring system., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2022
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36. Oxaliplatin-related Portal Hypertension Complicated with Esophageal Varices and Refractory Massive Ascites.
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Yazaki T, Kawashima K, Ishimura N, Kataoka M, Fukunaga M, Hyakudomi R, Tajima Y, Moriyama I, Araki A, Kadota K, Shibagaki K, Tobita H, and Ishihara S
- Subjects
- Humans, Oxaliplatin adverse effects, Ascites complications, Gastrointestinal Hemorrhage complications, Esophageal and Gastric Varices complications, Hypertension, Portal chemically induced, Hypertension, Portal complications, Vascular Diseases complications
- Abstract
Oxaliplatin, widely used as a chemotherapy drug for colorectal cancer, is known to cause various adverse reactions. In particular, special attention for the development of portal hypertension associated with porto-sinusoidal vascular disease is necessary, as it is a serious adverse life-threating reaction, although rare. We herein report a case of oxaliplatin-related portal hypertension that developed several years after oxaliplatin administration and led to esophageal varices and refractory massive ascites. Clinical physicians should be aware of the possibility of oxaliplatin-induced portal hypertension and its possible development over a long period after discontinuation of the drug.
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- 2022
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37. Mesenteric Ischemia After Cardiac Surgery in Dialysis Patients: An Overlooked Risk Factor.
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Takeyoshi D, Shirasaka T, Shibagaki K, Okubo R, Kunioka S, Kikuchi Y, and Kamiya H
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- Humans, Renal Dialysis, Risk Factors, Tomography, X-Ray Computed methods, Mesenteric Ischemia complications, Mesenteric Ischemia surgery, Cardiac Surgical Procedures adverse effects
- Abstract
Background: No study has examined the association of the calcification of abdominal artery orifices with nonocclusive mesenteric ischemia (NOMI) in dialysis patients undergoing cardiac surgery. Thus, this study aimed to determine whether calcification of abdominal blood vessel orifices in hemodialysis patients may be a risk factor for NOMI and examine the long-term survival of dialysis patients after undergoing cardiac surgery., Methods: From April 2014 to September 2020, 100 dialysis patients underwent cardiac surgery at our hospital. The calcification of the celiac artery (CA) and superior mesenteric artery (SMA) was evaluated by computed tomography, and the degree of orifice stenosis was graded as follows: patent, 0; partial occlusion, 1; and complete occlusion, 2., Results: Eight patients experienced NOMI, and all of them died. SMA calcification scores were not significantly different between the NOMI and non-NOMI groups (1.38±0.52 vs. 1.13±0.69; P = 0.247). However, the average CA orifice calcification score was significantly greater in the NOMI group than in the non-NOMI group (1.63±0.52 vs. 1.15±0.65; P = 0.039), and the SMA+CA orifice calcification scores were significantly different between the groups (3.00±0.76 vs. [non-NOMI] 2.25±1.18; P = 0.028). In all patients, the 30-day and in-hospital mortality rates were 13% and 18%, respectively. All patients were completely followed up with a mean follow-up period of 604±585 days. Kaplan-Meier survival curves showed that patients with SMA and CA calcification tended to have a shorter overall survival than patients without calcification; however, no significant difference was noted., Conclusions: The calcification of CA and/or SMA orifices was associated with postoperative NOMI and poor long-term survival among dialysis patients undergoing cardiac surgery.
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- 2022
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38. Heterotopic Gastric Mucosa in Middle Esophagus Complicated with Esophageal Ulcers.
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Kishimoto K, Shibagaki K, Nonomura S, Sumi S, Fukuda N, Takahashi Y, Kotani S, Okimoto E, Oshima N, Kawashima K, Ishimura N, and Ishihara S
- Subjects
- Female, Gastric Mucosa pathology, Humans, Ulcer complications, Choristoma complications, Choristoma pathology, Esophageal Diseases complications, Esophageal Diseases diagnostic imaging, Esophageal Diseases pathology, Peptic Ulcer complications
- Abstract
Heterotopic gastric mucosa (HGM) of esophagus, primarily occurring in cervical esophagus, is usually asymptomatic. A healthy woman (mid-40s) with postprandial heartburn was diagnosed with middle esophageal HGM and esophageal ulcers by esophagogastroduodenoscopy. Using 8-channel pH monitoring, a sensor near the HGM area detected postprandial acid phase (pH 3-4), while areas adjacent to the proximal and distal sensors were neutral, suggesting acid secretion from the HGM. A biopsy showed fundic gland tissue expressing H
+ /K+ -ATPase and pepsinogen-I. Oral vonoprazan improved the clinical symptoms and endoscopic findings. This is the first report using 8-channel pH monitoring to diagnose extremely rare middle esophageal HGM.- Published
- 2022
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39. KLF4 Mutation Shapes Pathologic Characteristics of Foveolar-Type Gastric Adenoma in Helicobacter pylori-Naive Patients.
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Mishiro T, Shibagaki K, Fukuyama C, Kataoka M, Notsu T, Yamashita N, Oka A, Nagase M, Araki A, Kawashima K, Ishimura N, Maruyama R, Kinoshita Y, and Ishihara S
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- Adenomatous Polyps, Gastric Mucosa pathology, Helicobacter Infections, Helicobacter pylori, Humans, Kruppel-Like Factor 4 genetics, Mutation, Adenoma genetics, Adenoma pathology, Stomach Neoplasms genetics, Stomach Neoplasms pathology
- Abstract
Along with a recent remarkable decrease in Helicobacter pylori-infected individuals, reports of gastric neoplasms such as sporadic foveolar-type gastric adenoma (FGA) in H. pylori-naive patients have been increasing. This tumor, with its raspberry-like appearance, is common in H. pylori-naive gastric mucosa. The current study investigated the genomic features of sporadic FGA. Fresh-frozen sporadic FGA tissue samples from H. pylori-naive patients were subjected to whole genome analysis using a next-generation sequencer. Proliferation ability and apoptotic profiles of human gastric epithelial cells, along with plasmid transfection of candidate variants, were examined. A mean of 6.65 × 10
8 total reads were obtained for each sample. Common genetic abnormalities in well-known proliferation driver genes of conventional gastric dysplasia/cancer were not found. However, a common single-nucleotide variation (SNV) was noted within the DNA-binding domain of the tumor suppressor gene KLF4. This novel SNV was located in the zinc finger 2 region. Additional experiments showed that it significantly suppressed proliferation of gastric epithelial cells compared with wild-type KLF4 plasmid-transfected cells, although suppression was reduced in early apoptotic phase-related genes. A novel SNV in the KLF4 zinc finger 2 region was commonly found in sporadic FGA tissue samples, which may explain the slow-growing properties of this neoplasm., (Copyright © 2022 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
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40. Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis.
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Iwatsubo T, Takeuchi T, Hakoda A, Fujiwara Y, Nagami Y, Naito Y, Dohi O, Tatsuta T, Sawaya M, Jin X, Koike T, Sugimoto M, Murata M, Hamada K, Okada H, Kobara H, Chiyo T, Yoshida N, Tomatsuri N, Inaba T, Ishikawa S, Nagahara A, Ueyama H, Koizumi E, Iwakiri K, Mizukami K, Murakami K, Furuta T, Suzuki T, Ogasawara N, Kasugai K, Isomoto H, Kawaguchi K, Shibagaki K, Kataoka H, Shimura T, Suzuki H, Nishizawa T, and Higuchi K
- Subjects
- Fibrinolytic Agents adverse effects, Gastric Mucosa surgery, Humans, Postoperative Hemorrhage epidemiology, Postoperative Hemorrhage etiology, Postoperative Hemorrhage prevention & control, Propensity Score, Prospective Studies, Retrospective Studies, Risk Factors, Endoscopic Mucosal Resection adverse effects, Stomach Neoplasms complications, Stomach Neoplasms surgery
- Abstract
Background: The risk of bleeding after gastric endoscopic submucosal dissection (ESD) in antithrombotic agent users has increased, and its management remains a problem. Second-look endoscopy (SLE) following gastric ESD in antithrombotic agent users may be effective in preventing delayed bleeding, but this requires elucidation. Therefore, this study aimed to investigate the efficacy of SLE in reducing bleeding after gastric ESD in patients receiving antithrombotic agents., Methods: This retrospective cohort study was conducted at 19 referral hospitals in Japan. A total of 1,245 patients who were receiving antithrombotic agents underwent gastric ESD between January 2013 and July 2018. The incidence of delayed bleeding was compared between SLE and non-SLE groups using propensity score matching analysis., Results: Overall, 858 patients (SLE group, 657 patients; non-SLE group, 201 patients) were analyzed. After matching, 198 pairs were created. Delayed bleeding occurred in 10 patients (5.1%) in the SLE group and 16 patients (8.1%) in the non-SLE group [odds ratio (OR) 0.605, 95% confidence interval (CI) 0.23-1.46, p = 0.310]. In the subgroup analysis, SLE reduced the incidence of delayed bleeding in patients receiving heparin bridging therapy (6.3% and 40.0%, respectively; p = 0.004). In the SLE group, prophylactic coagulation did not significantly reduce delayed bleeding compared to the no treatment group (14.6% and 8.6%, respectively; p = 0.140)., Conclusions: SLE was ineffective in reducing bleeding after gastric ESD in antithrombotic agent users, overall. A prospective comparative study is warranted to definitively evaluate the effectiveness of SLE in reducing bleeding in high-risk patients., (© 2022. The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.)
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- 2022
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41. Correction to: Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis.
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Iwatsubo T, Takeuchi T, Hakoda A, Fujiwara Y, Nagami Y, Naito Y, Dohi O, Tatsuta T, Sawaya M, Jin X, Koike T, Sugimoto M, Murata M, Hamada K, Okada H, Kobara H, Chiyo T, Yoshida N, Tomatsuri N, Inaba T, Ishikawa S, Nagahara A, Ueyama H, Koizumi E, Iwakiri K, Mizukami K, Murakami K, Furuta T, Suzuki T, Ogasawara N, Kasugai K, Isomoto H, Kawaguchi K, Shibagaki K, Kataoka H, Shimura T, Suzuki H, Nishizawa T, and Higuchi K
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- 2022
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42. Post-cardiotomy pericardial effusion and postoperative atrial fibrillation risk.
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Kikuchi Y, Saijo Y, Narita M, Shibagaki K, Okubo R, Kunioka S, Shirasaka T, and Kamiya H
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- Adult, Humans, Retrospective Studies, Predictive Value of Tests, Pericardiectomy, Atrial Fibrillation diagnosis, Atrial Fibrillation etiology, Pericardial Effusion diagnostic imaging, Pericardial Effusion etiology
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Postoperative atrial fibrillation is a poor prognostic factor associated with increased mortality rates. Patients experiencing significant pericardial effusion develop postoperative atrial fibrillation; however, little is explored about the association between postoperative atrial fibrillation and post-cardiotomy pericardial effusion. This retrospective, single-center study included adult patients who underwent cardiovascular surgery via median sternotomy from January 2016 to December 2019. Patients who underwent routine postoperative computed tomography at 7 ± 3 days after surgery (n = 294) were included. Pericardial effusion was measured at the thickest point. Patients were classified into those with (n = 127) and without (n = 167) postoperative atrial fibrillation. The association of pericardial effusion with other factors was evaluated. A possible confounder-adjusted logistic regression analysis after multiple imputation was performed to obtain odds ratios for postoperative atrial fibrillation using previously published risk factors. Age, intraoperative bleeding volume, and pericardial effusion size were all significantly higher in the group with postoperative atrial fibrillation. Multivariate logistic regression after multiple imputation revealed that age, intraoperative bleeding volume, and postoperative pericardial effusion were significantly associated with postoperative atrial fibrillation. Our findings suggest that post-cardiotomy pericardial effusion is associated with postoperative atrial fibrillation. However, the causality remains unknown, making further studies mandatory., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)
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- 2022
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43. The Simultaneous Onset of Pancreatitis and Colitis as Immune-related Adverse Events in a Patient Receiving Nivolumab Treatment for Renal Cell Carcinoma.
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Yazaki T, Moriyama I, Tobita H, Sonoyama H, Okimoto E, Oka A, Mishima Y, Oshima N, Shibagaki K, Kawashima K, Ishimura N, Nagami T, Maruyama R, Shiina H, and Ishihara S
- Subjects
- Acute Disease, Female, Humans, Male, Nivolumab, Carcinoma, Renal Cell drug therapy, Colitis chemically induced, Kidney Neoplasms drug therapy, Pancreatitis chemically induced
- Abstract
Immune checkpoint inhibitors (ICIs), which have anti-tumor effects, are currently approved for treatment of several kinds of advanced malignancies. However, with their increasing use, a variety of immune-related adverse events (irAEs) in administered patients have been reported. We herein report a rare case of the simultaneous onset of acute pancreatitis and colitis as irAEs during nivolumab treatment given to a patient with renal cell carcinoma, who then shown marked improvement with corticosteroid therapy.
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- 2022
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44. Long-lasting renal dysfunction following tacrolimus induction therapy in ulcerative colitis patients.
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Cha N, Oshima N, Kishimoto K, Kotani S, Okimoto E, Yazaki T, Sonoyama H, Oka A, Mishima Y, Shibagaki K, Tobita H, Kawashima K, Ishimura N, and Ishihara S
- Abstract
Although tacrolimus (TAC) has remarkable effects in ulcerative colitis (UC) patients when given as remission induction therapy, some can develop renal dysfunction during TAC administration, resulting in withdrawal, though related details remain poorly understood. This study was conducted to determine the impact of oral TAC on renal function for remission induction therapy in UC patients. Fifty-five patients (10 elderly, 45 non-elderly) with UC and treated with oral TAC at our hospital were retrospectively evaluated. Renal function was assessed using estimated glomerular filtration rate (eGFR). Although a high clinical response to TAC was seen in both elderly and non-elderly, a decline in eGFR was noted in nearly all patients regardless of age, with a maximum change of -34.4% from the baseline value at week 11. Furthermore, eGFR decline recovered quickly after TAC discontinuation, though did not return to the baseline at two years following cessation. The rate of eGFR change at week 12 was significantly associated with patient age ( β = -0.3242, p = 0.0103) and peak serum trough level during TAC treatment ( β = 0.3563, p = 0.0051). Furthermore, the rate of decline in eGFR was significantly greater during treatment with TAC in the elderly as compared to non-elderly, with a large difference in eGFR decline rate between those groups also noted at two years after withdrawal of treatment. Careful attention to renal function when administering oral TAC for UC is important and changes in eGFR should be monitored closely in elderly patients even after treatment cessation., Competing Interests: SI reports receipt of personal fees from Takeda Pharmaceutical Co., Ltd. and AbbVie GK, and receiving grants for commissioned/joint research from Zeria Pharmaceutical Co., Astellas Pharma Inc., EA Pharma Co., Ltd., Janssen Pharmaceutical K.K., JIMRO Co., Ltd., Takeda Pharmaceutical Co., Ltd., AbbVie GK, and Nippon Kayaku Co., Ltd. No other authors have personal or financial conflicts to declare., (Copyright © 2022 JCBN.)
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- 2022
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45. Intestinal-type gastric dysplasia in Helicobacter pylori-naïve patients.
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Shibagaki K, Itawaki A, Miyaoka Y, Kishimoto K, Takahashi Y, Kotani S, Mishiro T, Oshima N, Kawashima K, Ishimura N, Onuma H, Nagasaki M, Nagase M, Araki A, Kadota K, Kushima R, and Ishihara S
- Subjects
- Female, Gastric Mucosa pathology, Humans, Hyperplasia pathology, Immunoglobulin D, Metaplasia pathology, Retrospective Studies, Carcinoma in Situ pathology, Helicobacter Infections pathology, Helicobacter pylori, Intestinal Neoplasms pathology, Stomach Neoplasms pathology
- Abstract
Gastric dysplasia and gastric cancer in Helicobacter pylori (Hp)-naïve patients usually exhibit a gastric phenotype, reflecting gastric mucosa without intestinal metaplasia (IM). We showed that intestinal-type gastric dysplasia (IGD) rarely occurs in the Hp-naïve stomach. In the last 10 years, we treated 1760 gastric dysplasia and gastric cancer patients, with 3.6% (63/1760) being Hp-naïve. Among these, ten were diagnosed with 14 IGDs and enrolled in this retrospective analysis. All lesions were observed by white-light endoscopy (WLE) and narrow-band imaging with magnification endoscopy (NBIME). We analyzed their endoscopic and microscopic features and patient demographics. Five men and five women aged 64 ± 21 years were included. WLE showed the depressed lesions mimicking a benign raised erosion in the prepyloric compartment. Multiple growths were confirmed in 30% (3/10) of patients. NBIME showed a near-regular microstructure and capillaries in 50% (7/14) of lesions with a gastritis-like appearance. Histologically, background mucosa was non-atrophic pyloric gland tissue, but 40.0% of samples (4/10) contained sporadic IM. Most of the lesions (8/14) were low-grade dysplasia, and others had a high-grade component, with one progressing to intramucosal carcinoma. The neoplastic surface was widely covered with foveolar epithelium in 57.1% (8/14). Immunohistochemically, neoplastic cells expressed CDX2 in all patients (14/14), MUC2 and CD10 in 92.9% (13/14), MUC5AC in 14% (2/14), and no expression of MUC6, showing an intestinal phenotype. Ki-67 was overexpressed with a mean labeling index of 58.3 ± 38.5%, and p-53 was overexpressed in 92.9% (13/14), regardless of the dysplastic grade. The IGD rarely occurs in Hp-naïve patients with distinctive clinicopathologic characteristics., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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46. Risk factors and prediction of bleeding after gastric endoscopic submucosal dissection in patients on antithrombotic therapy: newly developed bleeding prediction application software, SAMURAI model.
- Author
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Hakoda A, Takeuchi T, Kojima Y, Fujiwara Y, Nagami Y, Naito Y, Fukuda S, Koike T, Sugimoto M, Hamada K, Kobara H, Yoshida N, Inaba T, Nagahara A, Koizumi E, Murakami K, Furuta T, Ogasawara N, Isomoto H, Shibagaki K, Kataoka H, Suzuki H, and Higuchi K
- Abstract
Bleeding after gastric endoscopic submucosal dissection (ESD) remains problematic, especially in patients receiving antithrombotic therapy. Therefore, this study aimed to identify the risk factors. In this retrospective study, patients ( n = 1,207) who underwent gastric ESD while receiving antithrombotic therapy were enrolled at Osaka Medical and Pharmaceutical University Hospital and 18 other referral hospitals in Japan. Risks of post-ESD bleeding were calculated using multivariable logistic regression. The dataset was divided into a derivation cohort and a validation cohort. We created a prediction model using the derivation cohort. The accuracy of the model was evaluated using the validation cohort. Post-ESD bleeding occurred in 142 (11.8%) participants. Multivariable analysis yielded an odds ratio of 2.33 for aspirin, 4.90 for P2Y12 receptor antagonist, 1.79 for cilostazol, 0.95 for other antithrombotic agents, 6.53 for warfarin, 5.65 for dabigatran, 7.84 for apixaban, 10.45 for edoxaban, 6.02 for rivaroxaban, and 1.46 for heparin bridging. The created prediction model was called safe ESD management using the risk analysis of post-bleeding in patients with antithrombotic therapy (SAMURAI). This model had good predictability, with a C-statistic of 0.77. In conclusion, use of the SAMURAI model will allow proactive management of post-ESD bleeding risk in patients receiving antithrombotic therapy., Competing Interests: No potential conflicts of interest were disclosed., (Copyright © 2022 JCBN.)
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- 2022
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47. Silent cerebral ischemia detected by magnetic resonance imaging can predict postoperative delirium after total arch replacement for aneurysm.
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Shibagaki K, Shirasaka T, Sawada J, Saijo Y, Kunioka S, Kikuchi Y, and Kamiya H
- Abstract
Objective: To identify whether preoperative magnetic resonance imaging findings of the brain can predict postoperative delirium in patients who undergo arch replacement for aneurysms., Methods: Overall, 193 patients who underwent aortic replacement for the first time at a single institution between April 2014 and September 2020 were enrolled in this retrospective study. After we excluded patients with acute aortic dissection, no preoperative magnetic resonance imaging findings of the brain, and postoperative cerebral infarction, 50 patients were included and divided into 2 groups, according to their confusion scale results: postoperative delirium (group D) and nonpostoperative delirium (group ND). Preoperative magnetic resonance imaging findings of the brain were classified into lacunar stroke, periventricular hyperintensity, and deep subcortical white matter hyperintensity groups; the latter 2 groups were further classified based on the Fazekas scale, grade 0 to 3., Results: There were 23 patients (46%) in group D and 27 (54%) in group ND. The mean age was significantly greater in group D than in group ND (75 vs 70 years; P = .007). The mean operative time was significantly longer in group D than in group ND (447 vs 384 minutes; P = .024). As for preoperative magnetic resonance imaging findings of the brain, there were significantly more lacunar stroke cases in group D than in group ND ( P = .027). In multivariable logistic regression with stepwise selection, high-grade periventricular hyperintensity was significantly related to postoperative delirium (odds ratio, 9.38; 95% confidence interval, 1.55-56.56; P = .015)., Conclusions: Silent cerebral ischemia detected by preoperative magnetic resonance imaging of the brain was a significant risk factor for postoperative delirium., (© 2022 The Author(s).)
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- 2022
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48. The Early Introduction of Extracorporeal Membrane Oxygenation for Postcardiotomy Cardiogenic Shock Does Not Improve 30-Day Mortality Rates in Low-Volume Centers.
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Kunioka S, Shirasaka T, Miyamoto H, Shibagaki K, Kikuchi Y, Akasaka N, and Kamiya H
- Abstract
Background and objective Postcardiotomy cardiogenic shock (PCS) is one of the most critical conditions observed in cardiac surgery. Recently, the early initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been recommended for PCS patients to ensure end-organ perfusion, especially in high-volume centers. In this study, we investigated the effectiveness of earlier initiation of VA-ECMO for PCS in low-volume centers. Methods We retrospectively assessed patients admitted in two of our related facilities from April 2014 to March 2019. The patients who underwent VA-ECMO during peri- or post-cardiac surgery (within 48 hours) were included. We divided the patients into two groups according to the timing of VA-ECMO initiation. In the early initiation of VA-ECMO group, the "early ECMO group," VA-ECMO was initiated when patients needed high-dose inotropic support with high-dose catecholamines, such as epinephrine, without waiting for PCS recovery. In the late initiation of VA-ECMO group, the "late ECMO group," VA-ECMO was delayed until PCS was not controlled with high-dose catecholamines, with the intent of avoiding severe bleeding complications. Results A total of 30 patients were included in the analysis (early ECMO group/late ECMO group: 19/11 patients). Thirty-day mortality in the entire cohort was 60% (n=18), and there was no significant difference between the two groups (early ECMO group/late ECMO group: 64%/55%, p=0.712). Thirteen and six patients died without being weaned off in the early ECMO (43%) and late ECMO groups (55%), respectively; there was no significant difference between the two groups (p=0.696). The median duration of ECMO support was five days (IQR: 1.5-6.5). Conclusions The early initiation of ECMO did not contribute to patients' 30-day outcomes in low-volume centers. To improve outcomes of ECMO therapy in patients with PCS, centralization of low-volume centers may be required., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kunioka et al.)
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- 2022
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49. Five-minute test to prevent postcardiotomy reexploration.
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Kunioka S, Shirasaka T, Narita M, Shibagaki K, Kikuchi Y, Saijo Y, and Kamiya H
- Abstract
Objective: To evaluate the effectiveness of the 5-minute test (FMT), developed to record the amount of pericardial bleeding in patients undergoing general cardiac surgery, and determine the relationship between this test and postcardiotomy bleeding., Methods: The medical records of 573 patients who underwent adult cardiac surgery between January 2016 and December 2019 were reviewed retrospectively. Patients were divided into 2 groups: the FMT group included patients who underwent general cardiac surgery between January 2018 and December 2019 (n = 278), and the control group included patients who underwent general cardiac surgery between January 2016 and December 2017 (n = 295). The postcardiotomy reexploration rate due to intrapericardial bleeding or cardiac tamponade within 1 week after surgery and the amount of bleeding until 2 days after surgery were compared. The FMT procedure involved counting the amount of bleeding by packing 4 to 6 surgical gauze sheets for 5 minutes. Sternal closure was performed when the amount of blood measured by the FMT was <100 g., Results: Compared with the control group, the FMT group had a significantly lower incidence of postcardiotomy reexploration (1.5% vs 5.7%; P = .007) and a reduced amount of bleeding after cardiac surgery (median, 1165 mL [interquartile range (IQR), 756.2-1743.8 mL] versus 1440 mL [IQR, 825.0-2130.0 mL]; P = .005). There was a significant positive correlation between the FMT gauze sheet weight and postcardiotomy bleeding ( r = 0.322; P < .001)., Conclusions: The FMT is an objective and effective tool for estimating postoperative bleeding during cardiac surgery that can prevent postcardiotomy reexploration and reduce the amount of postcardiotomy bleeding., (© 2022 The Author(s).)
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- 2022
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50. Development and Validation of a Closed-Loop Functional Electrical Stimulation-Based Controller for Gait Rehabilitation Using a Finite State Machine Model.
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Hayami N, Williams HE, Shibagaki K, Vette AH, Suzuki Y, Nakazawa K, Nomura T, and Milosevic M
- Subjects
- Adult, Electric Stimulation, Electromyography, Gait physiology, Humans, Walking physiology, Electric Stimulation Therapy methods
- Abstract
Functional electrical stimulation (FES) can be used to initiate lower limb muscle contractions and has been widely applied in gait rehabilitation. Establishing the correct timing of FES activation during each phase of the gait (walking) cycle remains challenging as most FES systems rely on open-loop control, whereby the controller receives no feedback about joint kinematics and instead relies on predetermined/timed muscle stimulation. The objective of this study was to develop and validate a closed-loop FES-based control solution for gait rehabilitation using a finite state machine (FSM) model. A two-phased study approach was taken: (1) Experimentally-Informed Study: A neuromuscular-derived FSM model was developed to drive closed-loop FES-based control for gait rehabilitation. The finite states were determined using electromyography and joint kinematics data of 12 non-disabled adults, collected during treadmill walking. The gait cycles were divided into four states, namely: swing-to-stance, push off, pre-swing, and toe up. (2) Simulation Study: A closed-loop FES-based control solution that employed the resulting FSM model, was validated through comparisons of neuro-musculo-skeletal computer simulations of impaired versus healthy gait. This closed-loop controller yielded steadier simulated impaired gait, in comparison to an open-loop alternative. The simulation results confirmed that accurate timing of FES activation during the gait cycle, as informed by kinematics data, is important to natural gait retraining. The closed-loop FES-based solution, introduced in this study, contributes to the repository of gait rehabilitation control options and offers the advantage of being simplistic to implement. Furthermore, this control solution is expected to integrate well with powered exoskeleton technologies.
- Published
- 2022
- Full Text
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