2021/10/26 更新

写真a

ヒノキ アキナリ
檜 顕成
HINOKI Akinari
所属
大学院医学系研究科 希少性・難治性がん解析研究講座 特任教授
職名
特任教授
外部リンク

学位 1

  1. 博士(医学) ( 2006年10月   埼玉医科大学 ) 

研究キーワード 6

  1. 低侵襲手術

  2. 医療機器

  3. 小児外科

  4. 小児がん

  5. 希少性・難治性がん

  6. 尿中代謝物

現在の研究課題とSDGs 1

  1. 希少性・難治性がんの新しい診断技術の開発

学歴 1

  1. 埼玉医科大学   医学部   医学科

    1992年4月 - 1998年3月

所属学協会 4

  1. 日本外科感染症学会

  2. 日本内視鏡外科学会

  3. 日本小児科学会   評議員

  4. 日本外科学会

委員歴 3

  1. 日本小児外科学会   医薬品・医療機器検討委員会  

    2021年6月 - 現在   

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    団体区分:学協会

  2. 独立行政法人医薬品医療機器総合機構(PMDA)   専門委員  

    2020年4月 - 現在   

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    団体区分:政府

  3. 日本小児外科学会   保険診療委員会  

    2016年6月 - 2018年5月   

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    団体区分:学協会

 

論文 82

  1. Single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for inguinal hernia with prolapsed ovary. 査読有り

    Shirota C, Tainaka T, Sumida W, Yokota K, Makita S, Amano H, Okamoto M, Takimoto A, Yasui A, Nakagawa Y, Hinoki A, Uchida H

    Surgical endoscopy     2021年10月

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    記述言語:英語   出版者・発行元:Surgical Endoscopy  

    Background: Most studies reporting the outcomes of laparoscopic ovarian prolapsed hernia operations with large sample sizes are based on intracorporeal closure, while studies on extraperitoneal closure have limited sample sizes. We proactively used the single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) technique and obtained favorable outcomes, which we report in this paper. Methods: We retrospectively reviewed patients who had undergone laparoscopic surgery for inguinal hernia at our institution. They were retrospectively classified into two groups based on the pre- or intraoperative diagnosis of hernia with a prolapsed ovary, namely the prolapse group and the non-prolapse group, respectively. The data were statistically analyzed and p < 0.05 was considered statistically significant. Results: A total of 771 subjects underwent SILPEC during the study period, including 400 girls. Among them, 63 girls were diagnosed with an ovarian prolapsed hernia. SILPEC was successfully performed through a single port in all cases, with a single exception, in whom the forceps was inserted directly through the right lower quadrant to pull up the ovary. The duration of surgery in the prolapse group was not higher than that in the non-prolapse group. During the SILPEC surgery, the ovaries were successfully reverted into the abdominal cavity by external compression of the inguinal area alone in 38 of the 63 patients. In the remaining 25 cases, the ovaries were reverted into the abdominal cavity by external compression of the inguinal area and traction of the round ligament with forceps. None of these cases failed to return to the ovaries. Conclusion: Our study results indicate that SILPEC may be performed safely for the treatment of ovarian prolapsed inguinal hernia. Since the ovary and fallopian tube are close to the internal inguinal ring due to the short round ligament, the procedure requires careful suturing with traction of the round ligament.

    DOI: 10.1007/s00464-021-08777-4

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  2. An imaging study on tracheomalacia in infants with esophageal atresia: the degree of tracheal compression by the brachiocephalic artery is a good indicator for therapeutic intervention 査読有り

    Sumida Wataru, Tainaka Takahisa, Shirota Chiyoe, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Yasui Akihiro, Okamoto Masamune, Nakagawa Yoichi, Hinoki Akinari, Uchida Hiroo

    PEDIATRIC SURGERY INTERNATIONAL     2021年8月

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    記述言語:日本語   出版者・発行元:Pediatric Surgery International  

    Purpose: Tracheomalacia (TM) is a frequent complication after esophageal atresia (EA) repair. This study aimed to review patients who underwent aortopexy for TM after EA repair and to compare their imaging features. Methods: The patients who underwent thoracoscopic EA repair and contrast-enhanced computed tomography (CECT) at our hospital between 2013 and 2020 were retrospectively reviewed. The ratio of the lateral and anterior–posterior diameter of the trachea (LAR) where the brachiocephalic artery (BCA) crosses the trachea was defined. The LAR of the patients who underwent CECT for asymptomatic pulmonary disease was set as a normal reference. The Z-score of each LAR was calculated and compared between the patients that did or did not undergo aortopexy. Results: A total of 51 patients represented the controls, 5 patients underwent aortopexy, and 12 patients were discharged without surgery. The mean LARs in the patients who underwent aortopexy, did not undergo aortopexy, and controls were 3.54, 1.54, and 1.15, respectively. The mean Z-score of the aortopexy group was 21.2. After successful aortopexy, each patient’s LAR decreased to < 1.5. Conclusion: Aortopexy was preferred if the trachea was compressed by the BCA. The LAR is a useful indicator for predicting the therapeutic effect of aortopexy.

    DOI: 10.1007/s00383-021-04985-0

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  3. Clinical characteristics and outcomes of the right congenital diaphragmatic hernia compared to the left: a 10-year single-center experience 査読有り

    Okamoto Masamune, Amano Hizuru, Uchida Hiroo, Hinoki Akinari, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Yasui Akihiro, Nakagawa Yoichi

    PEDIATRIC SURGERY INTERNATIONAL     2021年8月

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    記述言語:日本語   出版者・発行元:Pediatric Surgery International  

    Purpose: The features of right-sided congenital diaphragmatic hernias (RCDHs) are quite different from those of left-sided CDHs (LCDHs). We have summarized the features of RCDHs experienced in our institution. Methods: This retrospective study analyzed the cases of patients with CDH registered at our institution between 2011 and 2020. Defects on each side were compared based on prenatal diagnosis, medical treatment, type of surgery, and outcomes. Results: A total of 101 patients underwent surgery at our institution during the neonatal period, and 11 had RCDHs. RCDHs and LCDHs were significantly different in terms of extracorporeal membrane oxygenation (36% vs. 6%, p = 0.002), patch repair (81% vs. 28%, p < 0.001), recurrence rate (36% vs. 11%, p = 0.022), and length of hospital stay (117 days vs. 51 days, p = 0.012). The severity of the fetal diagnosis did not reflect postnatal severity. All patients with RCDH survived to discharge, and there was no significant difference in survival rate between the right and left sides. Conclusion: Neonates with RCDH required more intensive treatments; however, the survival rate was comparable between RCDH and LCDH. RCDH was significantly different from LCDH and an optimal treatment strategy for RCDHs should be established.

    DOI: 10.1007/s00383-021-04999-8

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  4. Development of a novel diagnostic system for bile duct cancer using urinary metabolites. 査読有り

    Amano Hizuru, Hinoki Akinari, Uchida Hiroo, Yokota Kazuki, Ishigaki Takashi, Sakairi Minoru, Abe Mayumi, Terui Yasushi, Oda Hirohisa, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Takimoto Aitaro, Okamoto Masamune, Yasui Akihiro, Nakagawa Yoichi

    CANCER RESEARCH   81 巻 ( 13 )   2021年7月

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    記述言語:日本語  

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  5. NOVEL BIOMARKER DISCOVERY FOR CHILDHOOD RHABDOMYOSARCOMA USING URINARY METABOLITES 査読有り

    Amano Hizuru, Hinoki Akinari, Uchida Hiroo, Yokota Kazuki, Ishigaki Takashi, Sakairi Minoru, Abe Mayumi, Terui Yasushi, Oda Hirohisa, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Takimoto Aitaro, Kano Yoko, Okamoto Masamune, Yasui Akihiro, Nakagawa Yoichi

    PEDIATRIC BLOOD & CANCER   68 巻   頁: S46 - S46   2021年6月

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    記述言語:日本語  

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  6. Double-balloon endoscopic retrograde cholangiography can make a reliable diagnosis and good prognosis for postoperative complications of congenital biliary dilatation 査読有り

    Shirota Chiyoe, Kawashima Hiroki, Tainaka Takahisa, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Amano Hizuru, Takimoto Aitaro, Hinoki Akinari, Uchida Hiroo

    SCIENTIFIC REPORTS   11 巻 ( 1 ) 頁: 11052   2021年5月

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    記述言語:日本語   出版者・発行元:Scientific Reports  

    Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. This retrospective study included 28 patients who underwent DBERC (44 procedures) after radical surgery for CBD between January 2011 and December 2019. Strictures were diagnosed as “bile duct strictures” if endoscopy confirmed the presence of bile duct mucosa between the stenotic and anastomotic regions, and as “anastomotic strictures” if the mucosa was absent. The median patient age was 4 (range 0–67) years at the time of primary surgery for CBD and 27.5 (range 8–76) years at the time of DBERC. All anastomotic strictures could be treated with only by 1–2 courses of balloon dilatation of DBERC, while many bile duct strictures (41.2%) needed ≥ 3 treatments, especially those who underwent operative bile duct plasty as the first treatment (83.3%). Although the study was limited by the short follow-up period after DBERC treatment, DBERC is recommended as the first-line treatment for hepatolithiasis associated with biliary and anastomotic strictures in CBD patients, and it can be safely performed multiple times.

    DOI: 10.1038/s41598-021-90550-7

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  7. Novel zinc alloys for biodegradable surgical staples 査読有り

    Amano Hizuru, Miyake Koichi, Hinoki Akinari, Yokota Kazuki, Kinoshita Fumie, Nakazawa Atsuko, Tanaka Yujiro, Seto Yasuhiro, Uchida Hiroo

    WORLD JOURNAL OF CLINICAL CASES   8 巻 ( 3 ) 頁: 504 - 516   2020年2月

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    記述言語:日本語  

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  8. Identification and Validation of Novel Non-invasive Biomarkers in Patient Urine Samples for Diagnosis of New and Recurrent Neuroblastoma 査読有り

    Yokota Kazuki, Uchida Hiroo, Hinoki Akinari, Sakairi Minoru, Abe Mayumi, Tanaka Yujiro, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Oshima Kazuo, Makita Satoshi, Takimoto Aitaro, Kano Yoko, Inada Kosuke

    PEDIATRIC BLOOD & CANCER   66 巻   頁: S106 - S106   2019年12月

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    記述言語:日本語  

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  9. Factors associated with bleeding after endoscopic variceal ligation in children 査読有り 国際誌

    Yokoyama Shinya, Ishizu Yoji, Ishigami Masatoshi, Honda Takashi, Kuzuya Teiji, Ito Takanori, Hinoki Akinari, Sumida Wataru, Shirota Chiyoe, Tainaka Takahisa, Makita Satoshi, Yokota Kazuki, Uchida Hiroo, Fujishiro Mitsuhiro

    PEDIATRICS INTERNATIONAL   63 巻 ( 10 ) 頁: 1223 - 1229   2021年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatrics International  

    Background: Endoscopic variceal ligation (EVL) is a widely accepted treatment for esophagogastric varices in patients with portal hypertension (PHT). It is used for urgent treatment and prophylactic treatment of esophagogastric varices in pediatric as well as adult patients. However, major life-threatening adverse events such as early rebleeding can occur. Although early rebleeding after EVL among children and adolescents has been reported, the risk factors remain obscure. This study evaluated the risk factors for early rebleeding after EVL in children and adolescents. Methods: The subjects were children and adolescents (<18 years) with PHT who underwent EVL for esophagogastric varices. Early rebleeding was defined as hematemesis, active bleeding, or blood retention in the stomach, confirmed by esophagogastroduodenoscopy from 2 h to 5 days after EVL. Results: A total of 50 EVL sessions on 22 patients were eligible for this study. There were four episodes of early rebleeding. No other major adverse event has occurred. Multivariate analysis showed that EVL implemented at cardiac varices just below the esophagogastric junction (EGJ), within 5 mm from the EGJ, is the independent factor for a higher risk of early rebleeding: odds ratio 18.2 (95% confidence interval: 1.40–237.0), P = 0.02. Conclusions: Children and adolescents who undergo EVL for cardiac varices just below the EGJ have a higher risk of early rebleeding than those who do not.

    DOI: 10.1111/ped.14614

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  10. Late postoperative complications of congenital biliary dilatation in pediatric patients: a single-center experience of managing complications for over 20 years 査読有り

    Amano Hizuru, Shirota Chiyoe, Tainaka Takahisa, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Tanaka Yujiro, Hinoki Akinari, Kawashima Hiroki, Uchida Hiroo

    SURGERY TODAY   51 巻 ( 9 ) 頁: 1488 - 1495   2021年9月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Surgery Today  

    Purpose: To investigate late complications after surgery for congenital biliary dilatation (CBD). Methods: We retrospectively reviewed the patients treated for late postoperative complications of extrahepatic bile duct resection with bilioenteric anastomosis for CBD at our hospital between 1999 and 2019. Results: Twenty-seven complications, including bile duct stenosis with (n = 19) or without (n = 3) hepatolithiasis, remnant intrapancreatic bile duct (n = 2), intestinal obstruction (n = 2), and refractory cholangitis (n = 1) were treated in 26 patients. The median age at radical surgery and the initial treatment of complications was 3 years, 2 months and 14 years, 5 months, respectively. The median period from radical surgery to initial treatment of complications was 7 years, 1 month. Before 2013, bile duct stenosis was initially treated with bile duct plasty (n = 11) or hepatectomy (n = 3), and 71.4% (n = 10) of patients needed further treatment; after 2013, double-balloon endoscopic retrograde cholangiography (DBERC) was used (n = 8), and 25% (n = 2) of patients needed further treatment. Patients with remnant intrapancreatic bile duct, intestinal obstruction, and refractory cholangitis required surgery. Conclusion: Long-term follow-up is necessary after surgery for congenital biliary dilatation. DBERC is thus considered to be useful for bile duct stenosis management.

    DOI: 10.1007/s00595-021-02238-0

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  11. Urinary N-1,N-12-diacetylspermine as a biomarker for pediatric cancer: a case-control study 査読有り 国際誌

    Yokota Kazuki, Hinoki Akinari, Hiramatsu Kyoko, Amano Hizuru, Kawamura Machiko, Kuwatsuka Yachiyo, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Okamoto Masamune, Takimoto Aitaro, Yasui Akihiro, Nakagawa Yoichi, Uchida Hiroo, Kawakita Masao

    PEDIATRIC SURGERY INTERNATIONAL     2021年8月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: Minimally invasive examinations are particularly important in pediatric patients. Although the significance of urinary N1,N12-diacetylspermine (DiAcSpm) as a tumor marker (TM) has been reported in many types of adult cancers, its usefulness in pediatric cancers has not been reported. This may be due to urinary DiAcSpm level variations with age. This study aims to measure the normal levels of urinary DiAcSpm in healthy individuals and investigate its usefulness as a TM in childhood cancer. Methods: Urinary samples were collected from pediatric patients with and without cancer. The urinary DiAcSpm levels were measured, and the values were compared. Results: A total of 32 patients with cancer and 405 controls were enrolled in the study. Of the 32 patients, 13 had neuroblastoma, 9 had malignant lymphoma (ML), and 10 had leukemia. In the control group, the urinary DiAcSpm values markedly fluctuated among those with young age, especially infants; meanwhile, the values converged among those aged roughly 10 years and above. The sensitivity of DiAcSpm was significantly different among the three types of cancers: neuroblastoma (30.8%), ML (77.8%), and leukemia (40%). Conclusion: The urinary DiAcSpm value is a useful TM for both screening and follow-up of ML.

    DOI: 10.1007/s00383-021-04987-y

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  12. A patient with very early onset FH-deficient renal cell carcinoma diagnosed at age seven 査読有り 国際誌

    Taniguchi Rieko, Muramatsu Hideki, Okuno Yusuke, Yoshida Taro, Wakamatsu Manabu, Hamada Motoharu, Shirota Chiyoe, Sumida Wataru, Hinoki Akinari, Tainaka Takahisa, Gotoh Yoshimitsu, Tsuzuki Toyonori, Tanaka Yukichi, Kojima Seiji, Uchida Hiroo, Takahashi Yoshiyuki

    FAMILIAL CANCER     2021年6月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Familial Cancer  

    Hereditary leiomyomatosis and renal cell cancer (HLRCC) is caused by heterozygous germline variants in the fumarate hydratase (FH) gene and is associated with increased susceptibility to cutaneous leiomyomas, uterine leiomyomas, and renal cell carcinoma (RCC). HLRCC-associated RCC usually occurs in the middle age, with the median age being 40–44 years. This report describes a seven-year-old (84-month-old) male who developed a large right kidney tumor with multiple cystic lesions that contained enhanced solid components. There was no evidence of distant metastasis. The male patient underwent right nephrectomy and has been recovering well without metastasis or recurrence. Pathological examination revealed that tumor cells with relatively prominent nucleoli and surrounded by halos, were located in a limited area. Immunohistochemical staining was negative for FH. Whole-exome sequencing identified his germline variant in the FH gene and its loss of heterozygosity in the tumor. At nine years (114 months) of age, the male patient showed no recurrence of the tumor. This was the youngest-onset case of HLRCC-associated RCC to date. This report may affect the starting age for future RCC-surveillance programs for patients with HLRCC.

    DOI: 10.1007/s10689-021-00268-8

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  13. Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation (vol 37, pg 229, 2021) 査読有り 国際誌

    Takimoto Aitaro, Sumida Wataru, Amano Hizuru, Shirota Chiyoe, Tainaka Takahisa, Yokota Kazuki, Makita Satoshi, Yasui Akihiro, Kanou Yoko, Hinoki Akinari, Uchida Hiroo

    PEDIATRIC SURGERY INTERNATIONAL   37 巻 ( 6 ) 頁: 835 - 835   2021年6月

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    記述言語:日本語   出版者・発行元:Pediatric Surgery International  

    A correction to this paper has been published: https://doi.org/10.1007/s00383-021-04873-7.

    DOI: 10.1007/s00383-021-04873-7

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  14. Identification of novel neuroblastoma biomarkers in urine samples 査読有り 国際誌

    Yokota Kazuki, Uchida Hiroo, Sakairi Minoru, Abe Mayumi, Tanaka Yujiro, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Oshima Kazuo, Makita Satoshi, Amano Hizuru, Hinoki Akinari

    SCIENTIFIC REPORTS   11 巻 ( 1 ) 頁: 4055 - 4055   2021年2月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Scientific Reports  

    Urine is a complex liquid containing numerous small molecular metabolites. The ability to non-invasively test for cancer biomarkers in urine is especially beneficial for screening child patients. This study attempted to identify neuroblastoma biomarkers by comprehensively analysing urinary metabolite samples from children. A total of 87 urine samples were collected from 54 participants (15 children with neuroblastoma and 39 without cancer) and used to perform a comprehensive analysis. Urine metabolites were extracted using liquid chromatography/mass spectrometry and analysed by Metabolon, Inc. Biomarker candidates were extracted using the Wilcoxon rank sum test, random forest method (RF), and orthogonal partial least squares discriminant analysis (OPLS-DA). RF identified three important metabolic pathways in 15 samples from children with neuroblastoma. One metabolite was selected from each of the three identified pathways and combined to create a biomarker candidate (3-MTS, CTN, and COR) that represented each of the three pathways; using this candidate, all 15 cases were accurately distinguishable from the control group. Two cases in which known biomarkers were negative tested positive using this new biomarker. Furthermore, the predictive value did not decrease in cases with a low therapeutic effect. This approach could be effectively applied to identify biomarkers for other cancer types.

    DOI: 10.1038/s41598-021-83619-w

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  15. Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation 査読有り 国際誌

    Takimoto Aitaro, Sumida Wataru, Amano Hizuru, Shirota Chiyoe, Tainaka Takahisa, Yokota Kazuki, Makita Satoshi, Yasui Akihiro, Kanou Yoko, Hinoki Akinari, Uchida Hiroo

    PEDIATRIC SURGERY INTERNATIONAL   37 巻 ( 2 ) 頁: 229 - 234   2021年2月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: This study aimed to investigate the negative effects of intestinal obstruction for jaundice-free native liver survival after Kasai portoenterostomy (PE) for biliary atresia (BA). Methods: We retrospectively reviewed the records of patients who underwent PE for BA between 2006 and 2019. We evaluated the postoperative morbidity of intestinal obstruction for up to 2 years after PE and the effects of intestinal obstruction on jaundice-free native liver survival. On the basis of their initial operation, patients were divided into open portoenterostomy (Open-PE) and laparoscopic portoenterostomy (Lap-PE) groups, and morbidity was compared. Results: Of the 87 patients reviewed, 6 (6.9%) patients developed postoperative intestinal obstruction and underwent surgery to relieve the obstruction. The morbidity of early postoperative intestinal obstruction was 1.68 per 10,000 person days. The jaundice-free native liver survival rate among patients who once achieved jaundice-free status after PE was significantly lower in the patients with intestinal obstruction compared to in those without intestinal obstruction (0% vs. 73.8%; RR = 3.81, p = 0.007). No significant differences were seen in postoperative intestinal obstructions between the Open-PE and Lap-PE groups (p = 0.242). Conclusions: Intestinal obstruction negatively impact jaundice-free native liver survival, even in patients who once achieved jaundice-free status after PE for BA.

    DOI: 10.1007/s00383-020-04807-9

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  16. Usefulness of web search queries for early detection of diseases in infants 査読有り

    Yamaguchi Shuji, Hinoki Akinari, Tsubouchi Kota, Amandu Hizuru, Tajima Akira, Uchida Hiroo

    NAGOYA JOURNAL OF MEDICAL SCIENCE   83 巻 ( 1 ) 頁: 107 - 111   2021年2月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Nagoya Journal of Medical Science  

    Early detection of diseases is critical in infants. This study evaluates the usefulness of web searches in predicting diseases in order to encourage guardians to consult a doctor promptly if their children are ill. We collected six months of search queries from Yahoo! JAPAN Search between October 2016 and March 2017. Using a machine learning model, we investigated the accuracy of the search query’s ability to predict the diagnosis of biliary atresia and hypertrophic pyloric stenosis. Both diseases were modeled with an accuracy of approximately 80&, and symptoms related to the disease were significant features in the model. These findings suggest the possibility of detecting diseases from web search queries performed by guardians. Through future research, we intend to propose a method that uses web search queries for early detection of these diseases by providing appropriate and timely information to support the guardians of patients.

    DOI: 10.18999/nagjms.83.1.107

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  17. Thoracoscopic surgery for congenital lung cysts: an attempt to limit pulmonary resection in cases of lesions involving multiple lobes 査読有り 国際誌

    Shirota Chiyoe, Tainaka Takahisa, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Amano Hizuru, Hinoki Akinari, Ono Yasuyuki, Uchida Hiroo

    PEDIATRIC SURGERY INTERNATIONAL   37 巻 ( 2 ) 頁: 213 - 221   2021年2月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: Although we generally perform thoracoscopic lobectomy for congenital lung cysts (CLCs), we recently began performing thoracoscopic-limited pulmonary resection (segmentectomy or small partial lung resection) on relatively small lesions and on lesions involving multiple lobes. Our study aimed to determine the therapeutic outcomes of thoracoscopic CLC surgery. Methods: We retrospectively reviewed patients aged ≤ 18 years who underwent their first CLC surgery at our facility between 2013 and 2020. Results: A comparison between patients < 4 months old and those ≥ 4 months old showed no significant difference in operating time or incidence of complications. Blood loss volume (mL/kg) was significantly greater in patients < 4 months old and in patients who had undergone semi-urgent or urgent surgery. Operating time and postoperative complications were not increased in semi-urgent or urgent surgeries. There was no significant difference in operating time, blood loss volume, or postoperative complications between patients with a preoperative history of pneumonia and patients with no such history. Conclusion: In most patients, thoracoscopic surgery for CLC was safely performed. Limited pulmonary resection is considered difficult to perform thoracoscopically in children, but can be safely performed using new devices and navigation methods. Level of evidence: III.

    DOI: 10.1007/s00383-020-04793-y

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  18. Risk factors and outcomes of bile leak after laparoscopic surgery for congenital biliary dilatation 査読有り 国際誌

    Tanaka Yujiro, Tainaka Takahisa, Hinoki Akinari, Shirota Chiyoe, Sumida Wataru, Yokota Kazuki, Oshima Kazuo, Makita Satoshi, Amano Hizuru, Takimoto Aitaro, Kano Yoko, Uchida Hiroo

    PEDIATRIC SURGERY INTERNATIONAL   37 巻 ( 2 ) 頁: 235 - 240   2021年2月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery. Methods: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak. Results: Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (P = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (P = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards. Conclusion: Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.

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  19. 手術経験数による腹腔鏡下胆道閉鎖症手術成績の検討

    藏野 結衣, 城田 千代栄, 檜 顕成, 田井中 貴久, 住田 亙, 横田 一樹, 牧田 智, 滝本 愛太朗, 内田 広夫

    日本小児外科学会雑誌   57 巻 ( 3 ) 頁: 596 - 599   2021年

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    出版者・発行元:特定非営利活動法人 日本小児外科学会  

    <p>【目的】腹腔鏡下胆道閉鎖症手術(腹腔鏡下肝門部空腸吻合術)の執刀を熟練した術者に限定する必要性の有無を明らかにすることを目的として,自施設での治療成績を後方視的に検討した.</p><p>【方法】2014年4月から2018年8月の期間中,胆道閉鎖症に対して当院で腹腔鏡下肝門部空腸吻合術を施行した35例を対象とした.腹腔鏡下肝門部空腸吻合術を5例以上経験した術者が執刀した患者(A群:12例)と執刀経験4例以下の術者が執刀した患者(B群:23例)とに分類し,手術,術後経過と術後6か月,1年,2年の各時点における無黄疸自己肝生存についてそれぞれ統計学的解析を行い比較,検討した.</p><p>【結果】A群とB群で手術日齢,体重,出血量,ドレーン抜去時期,経口開始時期に有意差は認められなかったが,手術時間はA群が有意に短かった(<i>p</i>=0.0049).無黄疸自己肝生存率は術後6か月(A群58.3%,B群60.9%,<i>p</i>=0.506),術後1年(A群66.7%,B群65.2%,<i>p</i>=0.932),術後2年(A群58.3%,B群56.5%,<i>p</i>=0.918)でいずれの時点でも有意差は認められなかった.</p><p>【結論】今回の検討では,腹腔鏡下胆道閉鎖症手術に熟練した術者の指導の下では,執刀経験量による減黄率の有意な差は認められなかった.</p>

    DOI: 10.11164/jjsps.57.3_596

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  20. Intestinal region reconstruction of ileus cases from 3D CT images based on graphical representation and its visualization 査読有り

    Oda Hirohisa, Hayashi Yuichiro, Kitasaka Takayuki, Tamada Yudai, Takimoto Aitaro, Hinoki Akinari, Uchida Hiroo, Suzuki Kojiro, Itoh Hayato, Oda Masahiro, Mori Kensaku

    MEDICAL IMAGING 2021: COMPUTER-AIDED DIAGNOSIS   11597 巻   2021年

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    記述言語:日本語   掲載種別:研究論文(国際会議プロシーディングス)   出版者・発行元:Progress in Biomedical Optics and Imaging - Proceedings of SPIE  

    This paper proposes an intestinal region reconstruction method from CT volumes of ileus cases. Binarized intestine segmentation results often contain incorrect contacts or loops. We utilize the 3D U-Net to estimate the distance map, which is high only at the centerlines of the intestines, to obtain regions around the centerlines. Watershed algorithm is utilized with local maximums of the distance maps as seeds for obtaining "intestine segments". Those intestine segments are connected as graphs, for removing incorrect contacts and loops and to extract "intestine paths", which represent how intestines are running. Experimental results using 19 CT volumes showed that our proposed method properly estimated intestine paths. These results were intuitively visualized for understanding the shape of the intestines and finding obstructions.

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  21. A novel Lugol's iodine staining technique to visualize the upper margin of the surgical anal canal intraoperatively for Hirschsprung disease: a case series 査読有り 国際誌

    Yokota Kazuki, Amano Hizuru, Kudo Toyoki, Yamamura Takeshi, Tanaka Yujiro, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Takimoto Aitaro, Nakamura Masanao, Fujishiro Mitsuhiro, Hinoki Akinari, Uchida Hiroo

    BMC SURGERY   20 巻 ( 1 ) 頁: 317 - 317   2020年12月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BMC Surgery  

    Background: In cases of Hirschsprung disease, complete and reproducible resection of the aganglionic bowel is ideal to achieve good postoperative bowel function. Reliable identification of the upper margin of the surgical anal canal, which is the squamous-columnar junction, is necessary during transanal pull-through. Here, we describe a novel staining technique using Lugol’s iodine stain to visualize the upper margin of the surgical anal canal. Methods: Lugol’s iodine staining was performed in five patients with Hirschsprung disease treated using a single-stage laparoscopic transanal pull-through modified Swenson procedure. In two of these patients, endocytoscopic observation with ultra-high magnification was performed using methylene blue and crystal violet to mark the border of the squamous epithelium at 1 week before surgery. The alignment between the incisional line, which was revealed using Lugol’s iodine staining and endocytoscopic marking, was evaluated. Complications, including postoperative bowel dysfunction, were evaluated. Results: In all cases, Lugol’s iodine staining produced a well-demarcated line. The endocytoscopic marking of the upper margin of the surgical anal canal was aligned with the line revealed by Lugol’s iodine staining. There were no complications associated with the transanal pull-through procedure, including postoperative bowel dysfunction. Conclusions: Lugol’s iodine staining could be a safe and practical method to visualize the upper margin of the surgical anal canal intraoperatively. This finding may be useful for surgeons to make a consistent removal of the aganglionic bowel during surgery for Hirschsprung disease.

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  22. Laparoscopic Kasai portoenterostomy is advantageous over open Kasai portoenterostomy in subsequent liver transplantation 査読有り 国際誌

    Shirota Chiyoe, Murase Naruhiko, Tanaka Yujiro, Ogura Yasuhiro, Nakatochi Masahiro, Kamei Hideya, Kurata Nobuhiko, Hinoki Akinari, Tainaka Takahisa, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Oshima Kazuo, Uchida Hiroo

    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES   34 巻 ( 8 ) 頁: 3375 - 3381   2020年8月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Surgical Endoscopy  

    Background: Native liver survival after laparoscopic Kasai portoenterostomy (Lap-PE) for biliary atresia (BA) is controversial. We examined whether a jaundice-free native liver survival rate is comparable between conventional Kasai portoenterostomy (Open-PE) and Lap-PE. Then, the impact of the two types of PE on subsequent living-donor liver transplantation (LTx) was addressed in this study. Methods: The jaundice-free rate in 1- and 2-year-old patients who underwent Open-PE and Lap-PE from January 2006 to December 2017 was investigated. Additionally, perioperative data (duration from the start of surgery to the completion of hepatectomy and others) of patients aged 2 years or younger who underwent LTx after either Open-PE or Lap-PE from 2006 to 2017 were evaluated. Results: Thirty-one (67%) out of 46 Open-PE patients and 23 (77%) out of 30 Lap-PE patients showed native liver survival with jaundice-free status at 1 year of age (p = 0.384); 29 (63%) out of 46 Open-PE patients and 19 (70%) out of 27 Lap-PE patients showed native liver survival with jaundice-free status at 2 years of age (p = 0.524); there were no significant differences. Additionally, there were 37 LTx cases after PE within 2 years of birth, including 29 Open-PE and 8 Lap-PE cases. The patients in the Lap-PE group had fewer adhesions and significantly shorter durations of surgery up to the completion of the recipient’s hepatectomy and durations of post-LTx hospital stay compared to the Open-PE group. There were no differences in blood loss or duration of stay in intensive care unit between the Lap-PE and Open-PE groups. Conclusions: Jaundice-free native liver survival rate has been comparable between Open-PE and Lap-PE. Lap-PE resulted in fewer adhesions, contributing to better outcomes of subsequent LTx compared to Open-PE.

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  23. Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience 査読有り 国際誌

    Tanaka Tomoko, Amano Hizuru, Tanaka Yujiro, Takahashi Yoshiyuki, Tajiri Tatsuro, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Tani Yukiko, Hinoki Akinari, Uchida Hiroo

    BMC PEDIATRICS   20 巻 ( 1 ) 頁: 292 - 292   2020年6月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BMC Pediatrics  

    Background: The fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy. Therefore, accurate diagnosis is essential for selecting the appropriate chemotherapeutic regimen. However, malignant mediastinal tumors occasionally cause respiratory distress, and biopsies under general anesthesia are dangerous for such patients as invasive mechanical ventilation can aggravate airway obstruction caused by mass effect. In this study, we reviewed our 10-year diagnostic experience to evaluate the efficacy of our practices and confirm a safe diagnostic protocol for future patients. Methods: We retrospectively reviewed medical records of children with malignant mediastinal tumors diagnosed at Nagoya University Hospital from 2007 to 2018 who demonstrated respiratory distress. Respiratory distress included dyspnea, massive pleural effusion, wheezing, and hypoxemia owing to tumors. Data on sex, age at onset, primary symptoms, location of tumor, management strategy (especially the method of diagnosis and definitive diagnosis), clinical course, prognosis during the acute phase (within 3 months from the onset of respiratory symptoms), and long-term outcome were collected. Results: Twelve pediatric patients met the review criteria. There were seven anterior mediastinal tumors and five posterior mediastinal tumors. All anterior mediastinal tumors were diagnosed via bone marrow smear, thoracentesis, or core needle biopsy while maintaining spontaneous breathing. Regarding posterior tumors, two patients were diagnosed via a core needle biopsy and lymph node excisional biopsy under spontaneous breathing. Two cases were initially diagnosed solely using tumor markers. One patient with severe tracheal compression underwent tumor resection with extracorporeal membrane oxygenation stand-by. No patient died of diagnostic procedure-related complications. Conclusions: In 11 of the 12 cases reviewed, safe and accurate tumor diagnosis was accomplished without general anesthesia. A diagnostic strategy without general anesthesia considering the tumor location proved to be useful.

    DOI: 10.1186/s12887-020-02183-w

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  24. 術中膵管損傷に対して内視鏡的に膵管ステントを挿入した1例

    城田 千代栄, 檜 顕成, 内田 広夫, 田井中 貴久, 住田 亙, 横田 一樹, 牧田 智, 天野 日出, 滝本 愛太朗, 安井 昭洋, 石井 宏樹

    日本膵・胆管合流異常研究会プロシーディングス   43 巻 ( 0 ) 頁: 84 - 85   2020年

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    出版者・発行元:日本膵・胆管合流異常研究会  

    DOI: 10.34410/jspbm.43.0_84

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  25. 小児腹腔鏡手術における肝内胆管形成術

    田井中 貴久, 内田 広夫, 城田 千代栄, 住田 亙, 横田 一樹, 牧田 智, 滝本 愛太朗, 安井 昭洋, 石井 宏樹, 檜 顕成

    日本膵・胆管合流異常研究会プロシーディングス   43 巻 ( 0 ) 頁: 36 - 36   2020年

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    出版者・発行元:日本膵・胆管合流異常研究会  

    DOI: 10.34410/jspbm.43.0_36

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  26. Biodegradable Surgical Staple Composed of Magnesium Alloy 査読有り 国際誌

    Amano Hizuru, Hanada Kotaro, Hinoki Akinari, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Yokota Kazuki, Murase Naruhiko, Oshima Kazuo, Chiba Kosuke, Tanaka Yujiro, Uchida Hiroo

    SCIENTIFIC REPORTS   9 巻 ( 1 ) 頁: 14671 - 14671   2019年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Scientific Reports  

    Currently, surgical staples are composed of non–biodegradable titanium (Ti) that can cause allergic reactions and interfere with imaging. This paper proposes a novel biodegradable magnesium (Mg) alloy staple and discusses analyses conducted to evaluate its safety and feasibility. Specifically, finite element analysis revealed that the proposed staple has a suitable stress distribution while stapling and maintaining closure. Further, an immersion test using artificial intestinal juice produced satisfactory biodegradable behavior, mechanical durability, and biocompatibility in vitro. Hydrogen resulting from rapid corrosion of Mg was observed in small quantities only in the first week of immersion, and most staples maintained their shapes until at least the fourth week. Further, the tensile force was maintained for more than a week and was reduced to approximately one-half by the fourth week. In addition, the Mg concentration of the intestinal artificial juice was at a low cytotoxic level. In porcine intestinal anastomoses, the Mg alloy staples caused neither technical failure nor such complications as anastomotic leakage, hematoma, or adhesion. No necrosis or serious inflammation reaction was histopathologically recognized. Thus, the proposed Mg alloy staple offers a promising alternative to Ti alloy staples.

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  27. Relationship between Contact Pressure and Motion Artifacts in ECG Measurement with Electrostatic Flocked Electrodes Fabricated on Textile 査読有り 国際誌

    Takeshita Toshihiro, Yoshida Manabu, Takei Yusuke, Ouchi Atsushi, Hinoki Akinari, Uchida Hiroo, Kobayashi Takeshi

    SCIENTIFIC REPORTS   9 巻 ( 1 ) 頁: 5897 - 5897   2019年4月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Scientific Reports  

    To develop a wearable multi-lead electrocardiogram (ECG) measuring system, we fabricated the electrodes and wires by using electrostatic flocking technology on a textile. By using this technology, it was possible to fabricate many electrodes and wires, simultaneously. Also the flocked electrodes and wires had stretchability and washing resistance properties. To use dry electrodes, it is important to reduce the influence of motion artifacts (MAs). The results of the experiment with the skin phantom revealed that the contact pressure between the skin and the electrode is an important factor in MA reduction. Then, we conducted experiments with a human body to determine the relationship between the contact pressure and the MAs. Under the pressures of 200 Pa and 500 Pa, MAs were observed. Meanwhile, under the pressures of 1000 Pa, 2000Pa and 4000 Pa, the ECG signals under rest and deep breathing conditions were able to be measured without MAs. Considering the comfortability, the contact pressure from 1000 Pa to 2000 is preferable. Finally, we fabricated the wearable ECG measuring system and succeeded in measuring 18-lead ECG signals. The measured ECG waveform is in good agreement with the ECG waveform measured by a commercial system.

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  28. A Novel Laparoscopic Surgery Model with a Device to Expand the Abdominal Working Space in Rats: The Influence of Pneumoperitoneum and Skin Incision Length on Postoperative Inflammatory Cytokines 査読有り 国際誌

    Murase Naruhiko, Tainaka Takahisa, Uchida Hiroo, Hinoki Akinari, Shirota Chiyoe, Yokota Kazuki, Oshima Kazuo, Shirotsuki Ryo, Chiba Kosuke, Tanaka Yujiro

    JOURNAL OF INVESTIGATIVE SURGERY   32 巻 ( 1 ) 頁: 55 - 60   2019年1月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Investigative Surgery  

    Purpose: Experimental models of laparoscopic surgery generally use large animals owing to a sufficient abdominal working space. We developed a novel laparoscopic surgery model in rats. We performed intestinal anastomosis to demonstrate the feasibility and reliability of this model. Materials and Methods: We designed a device for rats that expanded the abdominal working space and allowed us to manipulate the intraperitoneal organs by hand under direct vision with pneumoperitoneum. We performed small bowel resection and intestinal anastomosis in rats using this model. To elucidate the effects of pneumoperitoneum and skin incision length, rats were randomly divided into four groups with differing surgical techniques: small incision group, large incision group, small incision + pneumoperitoneum group, and large incision + pneumoperitoneum group. Intraoperative abdominal pressure and postoperative cytokines were measured. Results: One experimenter completed small bowel resection and hand-sewn anastomosis under direct vision without any difficulties or assistance. Carbon dioxide pneumoperitoneum was maintained at 8–10 mmHg during surgery in both pneumoperitoneum groups. Necropsies revealed no evidence of anastomotic leakage at 24 h after surgery. The interleukin-6 and C-reactive protein concentrations were significantly greater in large incision group than in small incision group, but were not significantly different between small incision + pneumoperitoneum group and small incision group. These cytokines concentrations were the greatest in large incision + pneumoperitoneum group. Conclusions: Our laparoscopic surgery model in rats is a simple and reliable experimental model. The length of skin incision might be a more influential determinant of surgical invasiveness than pneumoperitoneum.

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  29. Multicenter, retrospective, comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high-volume centers 査読有り

    Murase Naruhiko, Hinoki Akinari, Shirota Chiyoe, Tomita Hirofumi, Shimojima Naoki, Sasaki Hideyuki, Nio Masaki, Tahara Kazunori, Kanamori Yutaka, Shinkai Masato, Yamamoto Hirotoshi, Sugawara Yasuhiko, Hibi Taizo, Ishimaru Tetsuya, Kawashima Hiroshi, Koga Hiroyuki, Yamataka Atsuyuki, Uchida Hiroo

    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES   26 巻 ( 1 ) 頁: 43 - 50   2019年1月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Hepato-Biliary-Pancreatic Sciences  

    Background: Multicenter study was undertaken to analyze the results of laparoscopic and open Kasai portoenterostomy. Methods: Subjects were infants with type III biliary atresia who underwent open operation (n = 106) or laparoscopic operation (n = 21) between January 2012 and December 2015. Clinical data were compared between open and laparoscopic operations (2016-0534). Propensity score matching was performed to reduce the effect of treatment selection bias. Multivariate analyses were used to estimate the effect of the surgical approach on the jaundice clearance rate and the native liver survival rate. Results: The postoperative jaundice clearance rate and the 1-year native liver survival rate were not significantly different between open and laparoscopic operations. Rates of cholangitis and major complications of laparoscopic operation were comparable to those of open operation. Blood loss, time to resume oral intake, time to drain removal, and duration of analgesic usage of laparoscopic operation were significantly superior to those of open operation. Similar results were observed when analysis was adjusted based on propensity score. Multivariate analyses demonstrated that only age at operation was a poor prognostic factor. Conclusion: Laparoscopic Kasai portoenterostomy was associated with several favorable perioperative outcomes compared with open Kasai portoenterostomy. The difference of surgical approach was not a significant independent predictor.

    DOI: 10.1002/jhbp.594

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  30. Spaciousness Filters for Non-contrast CT Volume Segmentation of the Intestine Region for Emergency Ileus Diagnosis 査読有り

    Oda Hirohisa, Nishio Kohei, Kitasaka Takayuki, Villard Benjamin, Amano Hizuru, Chiba Kosuke, Hinoki Akinari, Uchida Hiroo, Suzuki Kojiro, Itoh Hayato, Oda Masahiro, Mori Kensaku

    UNCERTAINTY FOR SAFE UTILIZATION OF MACHINE LEARNING IN MEDICAL IMAGING AND CLINICAL IMAGE-BASED PROCEDURES   11840 巻   頁: 104 - 114   2019年

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    記述言語:日本語   掲載種別:研究論文(国際会議プロシーディングス)   出版者・発行元:Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics)  

    This paper proposes enhancement filters for shape-specific regions, based on radial structure tensor (RST) analysis, which we name “spaciousness filters”. RST analysis can be used in a similar way to Hessian analysis for classifying intensity structures. However, RST is insufficient for enhancing regions having little contrast or non-typical morphology. Our proposed filters enhance such regions by extending the ray search scheme of RST analysis to work as a filter evaluating spaciousness. We show applications to the abdominal CT of ileus patients having specific shapes. The intestines (including small intestines) of those patients consist of air, liquid and feces portions, and are not contrast-enhanced by barium. Enhancement of liquid and walls play key roles in the sufficient segmentation of intestines and division between neighboring regions. Experimental results on 7 clinical cases showed that the proposed intestine segmentation method produced higher Dice score (0.68) than traditional RST analysis (0.44), even without specific refinement processes like machine-learning-based false positive reduction.

    DOI: 10.1007/978-3-030-32689-0_11

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  31. Introduction of resection of intrahepatic bile duct stenosis-causing membrane or septum into laparoscopic choledochal cyst excision 査読有り 国際誌

    Tanaka Yujiro, Tainaka Takahisa, Sumida Wataru, Hinoki Akinari, Shirota Chiyoe, Murase Naruhiko, Oshima Kazuo, Shirotsuki Ryo, Chiba Kosuke, Uchida Hiroo

    PEDIATRIC SURGERY INTERNATIONAL   34 巻 ( 10 ) 頁: 1087 - 1092   2018年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: We previously showed that meticulous probing and resection of the intrahepatic bile duct stenosis (IHBDS)-causing membrane or septum was effective in preventing hepatolithiasis after choledochal cyst excisions in open surgeries. Then, we introduced this maneuver into laparoscopic choledochal cyst excisions in 2014 and performed routine resections since then. The aim of this study was to show the feasibility of this method in laparoscopic surgery. Methods: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic choledochal cyst excisions at our hospital between January 2014 and December 2017. The patients who underwent surgical treatment for IHBDS-causing membrane or septum were compared with those who did not undergo the procedure. The outcomes of the patients with IHBDS were also compared between patients who were ≥ 3 years of age and those < 3 years at operation. Results: Seventeen of 35 patients underwent laparoscopic resection of IHBDS-causing membrane or septum. There were no complications related to the procedure although the operative time and intraoperative bleeding amount increased in the patients with IHBDS who were ≥ 3 years of age. Conclusions: Meticulous probing and excision of the IHBDS-causing membrane or septum is safe and feasible during laparoscopic choledochal cyst excision.

    DOI: 10.1007/s00383-018-4320-7

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  32. The impact of body weight on stapled anastomosis in pediatric patients 査読有り 国際誌

    Amano Hizuru, Tanaka Yujiro, Tainaka Takahisa, Hinoki Akinari, Kawashima Hiroshi, Kakihara Tomo, Morita Kaori, Uchida Hiroo

    JOURNAL OF PEDIATRIC SURGERY   53 巻 ( 10 ) 頁: 2036 - 2040   2018年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Pediatric Surgery  

    Purpose: The purpose of this study is to clarify the impact of body weight on outcomes of stapled anastomosis in pediatric patients. Methods: A total of 253 pediatric patients who underwent intestinal anastomosis were classified according to body weight (< 3.5 kg: light group, ≥ 3.5 kg: heavy group), and clinical outcomes of stapled and hand-sewn anastomoses were compared. Results: The light and heavy groups included 77 (stapled: n = 13, hand-sewn: n = 64) and 176 (stapled: n = 58, hand-sewn: n = 118) patients, respectively. In both groups, stapled anastomosis was associated with reduced time to initial oral feeding (light group: 4 vs. 7 days, p = 0.006; heavy group: 3 vs. 5 days, p < 0.001) and full feeding (light group: 12 vs. 16 days, p = 0.026; heavy group: 7 vs. 9 days, p = 0.001), whereas its complication rate was not significantly different from that of hand-sewn anastomosis (light group: 30.8 vs. 12.5%, p = 0.112; heavy group: 3.4 vs. 2.5%, p = 0.665). In patients who underwent stapled anastomosis, the complication rate was significantly higher in the light group (30.8 vs. 3.4%, p = 0.009), with two cases of volvulus related to anastomotic dilatation. Conclusions: Stapled anastomosis is an effective procedure facilitating prompt oral feeding. However, the risk of complications, including volvulus related to anastomotic dilatation, should be considered among patients weighing < 3.5 kg. Level of evidence: III.

    DOI: 10.1016/j.jpedsurg.2018.04.030

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  33. Single-stage laparoscopic transanal pull-through modified Swenson procedure without leaving a muscular cuff for short- and long-type Hirschsprung disease: a comparative study 査読有り 国際誌

    Yokota Kazuki, Uchida Hiroo, Tainaka Takahisa, Tanaka Yujiro, Shirota Chiyoe, Hinoki Akinari, Kato Takazumi, Sumida Wataru, Oshima Kazuo, Chiba Kosuke, Ishimaru Tetsuya, Kawashima Hiroshi

    PEDIATRIC SURGERY INTERNATIONAL   34 巻 ( 10 ) 頁: 1105 - 1110   2018年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: The Soave procedure (SO) is performed most commonly for Hirschsprung disease. SO reduces the risk of injury to the pelvic structures; however, a residual aganglionic muscle cuff could interfere with bowel movement and lead to obstructive enterocolitis. The Swenson procedure is considered ideal in terms of peristalsis. Currently, laparoscopic surgery provides better visualization and facilitates precise dissection, possibly leading to feasible performance of the laparoscopic modified Swenson procedure (SW). We present our operative technique and the efficacy of the SW compared with that of SO. Methods: We retrospectively reviewed the records of 16 and 27 patients who underwent SW and SO, respectively, between 2012 and 2017. Results: Operative time, blood loss, length of stay, and frequency of bowel movements showed no significant difference between the two groups. In the SW group, temporary dysuria occurred in one patient, postoperative enterocolitis in two, wound infection in one, and severe perianal excoriation in four, whereas in the SO group, obstructive symptoms occurred in three patients, small-bowel obstruction in one, and severe perianal excoriation in three. The complications and outcomes were comparable between both groups. Conclusion: Laparoscopic SW was safe and feasible for the short-term follow-up outcomes.

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  34. Oral administration of eicosapentaenoic acid suppresses liver fibrosis in postoperative patients with biliary atresia 査読有り 国際誌

    Sumida Wataru, Uchida Hiroo, Tainaka Takahisa, Shirota Chiyoe, Hinoki Akinari, Kato Takazumi, Yokota Kazuki, Oshima Kazuo, Shirotuki Ryo, Chiba Kosuke, Tanaka Yujiro

    PEDIATRIC SURGERY INTERNATIONAL   34 巻 ( 10 ) 頁: 1059 - 1063   2018年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: Biliary atresia (BA) is characterized by progressive inflammation of the biliary system. This inflammation persists and causes liver fibrosis, although jaundice disappears after Kasai portoenterostomy (KP). We aimed to confirm whether the oral administration of eicosapentaenoic acid (EPA) suppresses liver fibrosis in postoperative patients with BA. Methods: We reviewed patients who underwent laparoscopic KP (lapKP) between January 2014 and September 2017. From December 2016, 30 mg/kg/day of EPA was orally administered to patients who opted to take medicine (EPA group). Patients who did not receive EPA were assigned to the non-EPA group. Mac-2 binding protein sugar chain modified isomer (M2BPGi) and hyaluronic acid (HA) levels were compared between the two groups in patients showing disappearance of jaundice at 6 months after the first lapKP. Results: Seventeen patients in the non-EPA group and 11 in the EPA group were enrolled. At 6 months after the first lapKP, 10 patients in the non-EPA group and six in the EPA group were without jaundice. M2BPGi and HA levels were significantly lower in the EPA group. Conclusions: Liver fibrosis was suppressed in patients without jaundice 6 months after lapKP, who were administered EPA. We believe that periductular inflammation was alleviated by EPA supplementation.

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  35. Long-term outcomes and complications after laparoscopic-assisted anorectoplasty vs. posterior sagittal anorectoplasty for high- and intermediate-type anorectal malformation 査読有り 国際誌

    Tainaka Takahisa, Uchida Hiroo, Tanaka Yujiro, Hinoki Akinari, Shirota Chiyoe, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Oshima Kazuo, Chiba Kosuke, Ishimaru Tetsuya, Kawashima Hiroshi

    PEDIATRIC SURGERY INTERNATIONAL   34 巻 ( 10 ) 頁: 1111 - 1115   2018年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: Laparoscopic-assisted anorectoplasty (LAARP) is a minimally invasive procedure in which the levator ani muscle is left to potentially improve postoperative fecal continence. This study aimed to retrospectively evaluate postoperative complications and long-term outcomes of fecal continence after LAARP and compare them to those after posterior sagittal anorectoplasty (PSARP). Methods: Forty-five male patients with high and intermediate anorectal malformation (aged ≥ 4 years) who underwent LAARP or PSARP (LAARP 29, PSARP 16) from 1999 to 2013 were included. Postoperative complications and postoperative fecal continence were retrospectively evaluated and compared. Postoperative complications were also compared before and after introducing a urethroscope during fistula resection. Results: Complications after LAARP and PSARP were seen in 12 vs. 2 cases (p = 0.09) of mucosal prolapse and in 9 vs. 1 case (p = 0.07) of posterior urethral diverticulum (PUD), respectively. The incidence of PUD decreased after introduction of a urethroscopy from 40% in 8/20 cases to 11% in 1/9 cases. No significant difference was found in terms of fecal continence in both groups. Conclusion: Through our study, greater improvement of postoperative fecal continence after LAARP has not been shown. LAARP was at higher risk for mucosal prolapse and PUD. However, precise dissection of the urethral fistula could be performed after the introduction of urethroscopy.

    DOI: 10.1007/s00383-018-4323-4

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  36. Investigation of the feasibility and safety of single-stage anorectoplasty in neonates with anovestibular fistula 査読有り 国際誌

    Shirota Chiyoe, Suzuki Keisuke, Uchida Hiroo, Kawashima Hiroshi, Hinoki Akinari, Tainaka Takahisa, Sumida Wataru, Murase Naruhiko, Oshima Kazuo, Chiba Kosuke, Makita Satoshi, Tanaka Yujiro

    PEDIATRIC SURGERY INTERNATIONAL   34 巻 ( 10 ) 頁: 1117 - 1120   2018年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: Anovestibular fistula (AVF) is the most common type of anorectal malformation in females. Delayed anorectoplasty with fistula dilatation is commonly performed during infancy; however, we have been actively performing anorectoplasty in neonates. We report the surgical complications and postoperative defecation function associated with single-stage anorectoplasty performed in neonates. Methods: Patients who underwent surgery for AVF between 2007 and 2017 at two institutions were retrospectively studied. The operation time, amount of bleeding, time to start oral intake, perioperative complications, and Kelly’s score were compared among patients who underwent surgery as neonates and those who underwent surgery as infants. Results: Eighteen neonates and 17 infants underwent anterior sagittal anorectoplasty. The median operation time and time to start oral intake were significantly shorter in the neonatal group (72 min; 3 days, respectively) than in the infant group (110 min, p = 0.0002; 5 days, p = 0.0024, respectively). Postoperative wound disruption was significantly more frequent in the infant group. Of the ten patients each in the neonatal and infant groups, there was no significant difference in Kelly’s score at age ≥ 4 years. Conclusion: Single-stage anorectoplasty in neonates with AVF can be feasibly performed and does not impair postoperative defecation function. Levels of evidence: III.

    DOI: 10.1007/s00383-018-4324-3

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  37. Development of multi-lead ECG measurement wear using electrostatic flocking technology 査読有り

    Takeshita T., Yosihda M., Ouchi A., Hinoki A., Uchida H., Kobayashi T.

    2018 International Conference on Electronics Packaging and iMAPS All Asia Conference, ICEP-IAAC 2018     頁: 145 - 146   2018年6月

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    記述言語:英語   掲載種別:研究論文(国際会議プロシーディングス)   出版者・発行元:2018 International Conference on Electronics Packaging and iMAPS All Asia Conference, ICEP-IAAC 2018  

    We developed textile-based multi-lead ECG measurement wear. The textile-based ECG measurement wear was fabricated by printed electronics and electrostatic flocking technology. We also developed a wireless communication system of multi-lead ECG signals. Moreover, we succeeded to get 18-lead ECG signals around heart using the ECG measurement wear and the wireless measuring system.

    DOI: 10.23919/ICEP.2018.8374690

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  38. Novel thoracoscopic navigation surgery for neonatal chylothorax using indocyanine-green fluorescent lymphography 査読有り 国際誌

    Shirotsuki Ryo, Uchida Hiroo, Tanaka Yujiro, Shirota Chiyoe, Yokota Kazuki, Murase Naruhiko, Hinoki Akinari, Oshima Kazuo, Chiba Kosuke, Sumida Wataru, Hayakawa Masahiro, Tainaka Takahisa

    JOURNAL OF PEDIATRIC SURGERY   53 巻 ( 6 ) 頁: 1246 - 1249   2018年6月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Pediatric Surgery  

    Background: Postoperative chylothorax after surgery for esophageal atresia/tracheoesophageal fistula (TEF) is a rare but serious complication, especially in neonates. This study aimed to identify the thoracic duct and ligate chylous leakage sites, using thoracoscopic navigation of an indocyanine-green (ICG)-based near-infrared (NIR) fluorescence imaging system. Methods: From November 2014 to April 2017, thoracoscopic intraoperative ICG-NIR imaging was performed in 10 newborns (11 surgeries) with first TEF operation or with persistent postoperative chylothorax after TEF operation. NIR imaging was performed 1 h after an inter-toe injection of ICG. Thoracoscopic ligations against the NIR-detected leakage sites were performed with sutures. Results: The thoracic duct or lymphatic leakage was directly visualized in each patient. In 8 surgeries with first thoracoscopic TEF operation, one case had suspected minor chylous leakage without postoperative chylothorax. Another case with no chylous leakage at the first operation resulted in chylothorax at postoperative day 11. In three neonates with postoperative chylothorax, leakage points were detected near the ablation site of the azygos vein during the first operation. These points were properly ligated, and postoperative chylous leakage ceased with no adverse events. Conclusions: Thoracoscopic ICG-NIR imaging encourages the repair of refractory chylothorax and seems reliable. Level of Evidence: IV

    DOI: 10.1016/j.jpedsurg.2018.01.019

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  39. Evaluation of Surgical Devices Using an Artificial Pediatric Thoracic Model: A Comparison Between Robot-Assisted Thoracoscopic Suturing Versus Conventional Video-Assisted Thoracoscopic Suturing 査読有り 国際誌

    Takazawa Shinya, Ishimaru Tetsuya, Harada Kanako, Deie Kyoichi, Hinoki Akinari, Uchida Hiroo, Sugita Naohiko, Mitsuishi Mamoru, Iwanaka Tadashi, Fujishiro Jun

    JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES   28 巻 ( 5 ) 頁: 622 - 627   2018年5月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Laparoendoscopic and Advanced Surgical Techniques  

    Background: Pediatric robot-assisted surgery is increasingly being performed, but it is difficult to perform this procedure in infants. A pediatric thoracoscopic model of a 1-year-old patient was developed in our previous study, and this model was used to evaluate the use of a surgical robot for infant surgery. Methods: Eight pediatric surgeons performed an intracorporeal suturing and knot-tying task using the da Vinci Xi Robotic Surgical System. The task completion time, number of needle manipulations, and force applied during suturing of the robot-assisted thoracoscopic surgery (RATS) group were compared with those of the video-assisted thoracoscopic surgery (VATS) group whose data had been collected from the same 8 surgeons in our previous study. Results: The RATS group showed a significantly shorter completion time than the VATS group in the knot-tying phase (P = .016) and in the total phase (P = .0078). The RATS group showed a significantly smaller number of manipulations than the VATS group in the total phase (P = .039). The RATS group showed a significantly smaller pushing force index than the VATS group in the suturing phase (P = .031), knot-tying phase (P = .031), and in the total phase (P = .031). A seventh rib in the model was dislocated in all RATS group cases. Conclusions: The da Vinci Surgical System might be useful in infants because of fast movement and small pushing force. However, the robotic 8 mm instruments were too large for use in the thoracic cavity of the 1-year-old infant.

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  40. Usefulness of fetal magnetic resonance imaging for postnatal management of congenital lung cysts: prediction of probability for emergency surgery 査読有り 国際誌

    Shirota Chiyoe, Tainaka Takahisa, Nakane Toshiki, Tanaka Yujiro, Hinoki Akinari, Sumida Wataru, Murase Naruhiko, Oshima Kazuo, Chiba Kosuke, Shirotsuki Ryo, Uchida Hiroo

    BMC PEDIATRICS   18 巻 ( 1 ) 頁: 105 - 105   2018年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BMC Pediatrics  

    Background: Emergency rescue lung resection is rarely performed to treat congenital lung cysts (CLCs) in neonates. Many reports have described fetal CLC treatment; however, prenatal predictors for postnatal respiratory failure have not been characterized. We hypothesized that fetal imaging findings are useful predictors of emergency surgery. Methods: We retrospectively studied patients with CLC who underwent lung surgery during the neonatal period in our hospital between January 2001 and December 2015. The demographic data, fetal imaging findings, and intra- and postoperative courses of patients who underwent emergency surgery (Em group) were compared with those of patients who received elective surgery, i.e., non-emergency surgery (Ne group). Results: The Em group and Ne group included 7 and 11 patients, respectively. No significant difference was noted in gestational age, time at prenatal diagnosis, birth weight, and body weight at surgery. The volumes of contralateral lung per thoracic volume were significantly smaller in the Em group than in the Ne group (p = 0.0188). Mediastinal compression was more common in the Em group (7/7) than in the Ne group (4/11) (p = 0.0128). Conclusions: This is the report describing neonatal emergency lobectomy in patients with CLC evaluated by fetal MRI using the lung volume ratio and mediastinal shift. In patients with CLC, mediastinal shift and significant decreases in contralateral lung volumes during the fetal stages are good prenatal predictors of postnatal emergency lung resection.

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  41. BESNet: Boundary-Enhanced Segmentation of Cells in Histopathological Images 査読有り

    Oda Hirohisa, Roth Holger R., Chiba Kosuke, Sokolic Jure, Kitasaka Takayuki, Oda Masahiro, Hinoki Akinari, Uchida Hiroo, Schnabel Julia A., Mori Kensaku

    MEDICAL IMAGE COMPUTING AND COMPUTER ASSISTED INTERVENTION - MICCAI 2018, PT II   11071 巻   頁: 228 - 236   2018年

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    記述言語:日本語   掲載種別:研究論文(国際会議プロシーディングス)   出版者・発行元:Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics)  

    We propose a novel deep learning method called Boundary-Enhanced Segmentation Network (BESNet) for the detection and semantic segmentation of cells on histopathological images. The semantic segmentation of small regions using fully convolutional networks typically suffers from inaccuracies around the boundaries of small structures, like cells, because the probabilities often become blurred. In this work, we propose a new network structure that encodes input images to feature maps similar to U-net but utilizes two decoding paths that restore the original image resolution. One decoding path enhances the boundaries of cells, which can be used to improve the quality of the entire cell segmentation achieved in the other decoding path. We explore two strategies for enhancing the boundaries of cells: (1) skip connections of feature maps, and (2) adaptive weighting of loss functions. In (1), the feature maps from the boundary decoding path are concatenated with the decoding path for entire cell segmentation. In (2), an adaptive weighting of the loss for entire cell segmentation is performed when boundaries are not enhanced strongly, because detecting such parts is difficult. The detection rate of ganglion cells was 80.0% with 1.0 false positives per histopathology slice. The mean Dice index representing segmentation accuracy was 74.0%. BESNet produced a similar detection performance and higher segmentation accuracy than comparable U-net architectures without our modifications.

    DOI: 10.1007/978-3-030-00934-2_26

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  42. The efficacy of resection of intrahepatic bile duct stenosis-causing membrane or septum for preventing hepatolithiasis after choledochal cyst excision 査読有り 国際誌

    Tanaka Yujiro, Tainaka Takahisa, Sumida Wataru, Shirota Chiyoe, Hinoki Akinari, Murase Naruhiko, Oshima Kazuo, Shirotsuki Ryo, Chiba Kosuke, Uchida Hiroo

    JOURNAL OF PEDIATRIC SURGERY   52 巻 ( 12 ) 頁: 1930 - 1933   2017年12月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Pediatric Surgery  

    Background/purpose We previously found that many patients who developed hepatolithiasis after choledochal cyst excisions had intrahepatic bile duct stenosis (IHBDS). In 1992, we started resection of the membrane or septum which was found at the site of IHBDS during choledochal cyst excisions. Since intrahepatic stones usually take years to form, the efficacy of this procedure has not been proved. Methods The records of patients who had IHBDS-causing membrane or septum and underwent choledochal cyst excision with Roux-Y hepaticojejunostomy between January 1979 and December 2006 were retrospectively analyzed. The patients who underwent surgical treatment for IHBDS-causing membrane or septum were compared with those who did not undergo the procedure. Results Sixty-nine patients met the criteria, and seven patients who were followed up for less than 5 years were excluded from the study. Thirty-three patients underwent surgical treatment for IHBDS, and three of them developed intrahepatic stones. Meanwhile, 10 of 29 patients who did not undergo the procedure developed intrahepatic stones. A statistically significant difference in intrahepatic stone formation was observed between the two groups in a log-rank test (P = 0.016). Conclusions Meticulous probing and excision of the IHBDS-causing membrane or septum are effective for preventing hepatolithiasis after choledochal cyst excisions. Type of study Retrospective Comparative Study. Level of evidence Level III.

    DOI: 10.1016/j.jpedsurg.2017.08.056

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  43. Intralobar pulmonary sequestration expanding toward the contralateral thorax: two case reports 査読有り 国際誌

    Amano Hizuru, Fujishiro Jun, Hinoki Akinari, Uchida Hiroo

    BMC SURGERY   17 巻 ( 1 ) 頁: 110 - 110   2017年11月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BMC Surgery  

    Background: Intralobar pulmonary sequestration (ILS) is defined as a portion of parenchyma that is contained within the normal pleural investment of the lung but not connected to the tracheobronchial tree, and supplied by anomalous systemic arteries. As ILS is enveloped within the lobe of the normal lung, it is extremely rare for ILS to invade into the mediastinum. We report two atypical cases of infants with ILS expanded toward the posterior mediastinum and contralateral thorax through the pulmonary ligament. Case presentation: The first case involved a baby boy diagnosed at 30 weeks gestation with a cystic area in his right lower lobe. A chest computed tomography (CT) scan at 29 days of life showed low-density masses in the right lower lung and posterior mediastinum. A complete thoracoscopic right lower lobectomy was performed at 19 months of age. After ligation of the aberrant systemic artery, the mediastinal mass was pulled into the right pleural cavity. The mass was observed to connect to the right lower lobe mass as a segment of lung parenchyma situated within the normal pleural investment of the lung, and the patient was diagnosed with ILS. The second case involved the detection by chest CT of a left lower lung cystic mass that protruded into the posterior mediastinum and contralateral chest of a one-month-old baby girl. A complete thoracoscopic left lower lobectomy was performed at the age of 18 months, and the cystic mass located in the right thoracic cavity was pulled easily into the left pleural cavity and resected. An anomalous systemic artery was identified and ligated, and the patient was also diagnosed with ILS. Conclusions: As the pulmonary ligament consists of two layers of mediastinal pleura, lower lung ILS with its visceral pleura covering can, though rarely, protrude into the mediastinum through the pulmonary ligament. Our two extremely rare cases of infants with ILS expanded toward the posterior mediastinum and contralateral thorax were successfully treated using a unilateral thoracoscopic approach. Pre-surgical differential diagnosis of mediastinal masses using contrast-enhanced multiple detector CT is important in informing the appropriate surgical approach.

    DOI: 10.1186/s12893-017-0313-z

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  44. New Navigation Surgery for Resection of Lymphatic Malformations Using Indocyanine Green Fluorescence Imaging

    Shirota Chiyoe, Hinoki Akinari, Takahashi Masataka, Tanaka Yujiro, Tainaka Takahisa, Sumida Wataru, Murase Naruhiko, Oshima Kazuo, Shirotsuki Ryo, Chiba Kosuke, Morimoto Yuji, Uchida Hiroo

    AMERICAN JOURNAL OF CASE REPORTS   18 巻   2017年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.12659/AJCR.903465

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  45. New Navigation Surgery for Resection of Lymphatic Malformations Using Indocyanine Green Fluorescence Imaging.

    Shirota C, Hinoki A, Takahashi M, Tanaka Y, Tainaka T, Sumida W, Murase N, Oshima K, Shirotsuki R, Chiba K, Morimoto Y, Uchida H

    The American journal of case reports   18 巻   頁: 529-531   2017年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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  46. Laparoscopic resection of neuroblastomas in low-to high-risk patients without image-defined risk factors is safe and feasible 査読有り 国際誌

    Shirota Chiyoe, Tainaka Takahisa, Uchida Hiroo, Hinoki Akinari, Chiba Kosuke, Tanaka Yujiro

    BMC PEDIATRICS   17 巻 ( 1 ) 頁: 71 - 71   2017年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BMC Pediatrics  

    Background: Several studies have reported that minimally invasive surgery (MIS) might be considered for resecting neuroblastomas without image-defined risk factors (IDRFs); however, there are no studies comparing the outcomes of laparotomy and laparoscopy in IDRF-negative patients. Thus, we investigated the feasibility of laparoscopic surgery and compared the two abovementioned approaches. Methods: To compare the effects of laparotomy with those of laparoscopy in patients with neuroblastomas without IDRFs, the following items were retrospectively compared: largest tumor dimension, volume of blood loss, time required to initiate postoperative feeding, locoregional recurrence rate, survival, etc. Results: Nine patients without IDRFs (three at low-to-medium risk and six at high risk) underwent laparotomy, and seven patients without IDRFs (two at low-to-medium risk and five at high risk) underwent laparoscopy. Median duration of surgery was 221 (130-304) and 172 (122-253) min in the laparotomy and laparoscopy groups, respectively, showing no significant difference. Median postoperative time required for resuming meal consumption was significantly longer in the laparotomy (4 days; 2-5) group than that in the laparoscopy group (3 days; 2-3; p = 0.023). Median blood loss was significantly higher in the laparotomy group (5 ml/Kg;2.6-16) than that in the laparoscopy group (2.1 ml/Kg;0.1-4.0; P = 0.037). Median follow-up period was 81 (52-94) and 21 (17-28) months, locoregional recurrence rates were 22 and 0% at 1 year, 1-year progression-free survival rates were 78 and 100%, and overall survival rates were 67 and 100% in the laparotomy and laparoscopy groups, respectively, with no significant differences. Conclusions: MIS for the treatment of neuroblastomas without IDRFs in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome.

    DOI: 10.1186/s12887-017-0826-8

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  47. Two-Stage Thoracoscopic Repair of Long-Gap Esophageal Atresia Using Internal Traction Is Safe and Feasible 査読有り 国際誌

    Tainaka Takahisa, Uchida Hiroo, Tanano Akihide, Shirota Chiyoe, Hinoki Akinari, Murase Naruhiko, Yokota Kazuki, Oshima Kazuo, Shirotsuki Ryo, Chiba Kosuke, Amano Hizuru, Kawashima Hiroshi, Tanaka Yujiro

    JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES   27 巻 ( 1 ) 頁: 71 - 75   2017年1月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Laparoendoscopic and Advanced Surgical Techniques  

    Background: The treatment of long-gap esophageal atresia remains an issue for pediatric surgeons. Many techniques for treating long-gap esophageal atresia have been proposed, but the optimal method has not been established. The thoracoscopic esophageal elongation technique has recently been developed. We previously reported a case in which two-stage thoracoscopic repair was performed using internal esophageal traction without esophageal tearing, and we retrospectively reviewed the outcomes of this procedure in this study. Methods: Five patients underwent thoracoscopic treatment involving internal esophageal traction for esophageal atresia involving a long gap or vascular ring over a 5-year period. Results: Between November 2010 and November 2015, 5 patients were treated with thoracoscopic traction. All of these patients successfully underwent thoracoscopic-delayed primary anastomosis. Conversion to open thoracotomy was not required in any case. The postoperative complications experienced by the patients included minor anastomotic leakage in 2 cases, anastomotic stenosis in 1 case, gastroesophageal reflux (GER) in 4 cases, and a hiatal hernia in 1 case. None of the patients died. Conclusions: Two-stage thoracoscopic repair for esophageal atresia involving a long gap or vascular ring is a safe and feasible procedure; however, we must develop methods for treating minor anastomotic complications and GER due to esophageal traction in future.

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  48. Left thoracoscopic two-stage repair of tracheoesophageal fistula with a right aortic arch and a vascular ring 査読有り

    Oshima Kazuo, Uchida Hiroo, Tainaka Takahisa, Tanano Akihide, Shirota Chiyoe, Yokota Kazuki, Murase Naruhiko, Shirotsuki Ryo, Chiba Kosuke, Hinoki Akinari

    JOURNAL OF MINIMAL ACCESS SURGERY   13 巻 ( 1 ) 頁: 73 - 75   2017年

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Minimal Access Surgery  

    A right aortic arch (RAA) is found in 5% of neonates with tracheoesophageal fistulae (TEF) and may be associated with vascular rings. Oesophageal repairs for TEF with an RAA via the right chest often pose surgical difficulties. We report for the first time in the world a successful two-stage repair by left-sided thoracoscope for TEF with an RAA and a vascular ring. We switched from right to left thoracoscopy after finding an RAA. A proximal oesophageal pouch was hemmed into the vascular ring; therefore, we selected a two-stage repair. The TEF was resected and simple internal traction was placed into the oesophagus at the first stage. Detailed examination showed the patent ductus arteriosus (PDA) completing a vascular ring. The subsequent primary oesophago-oesophagostomy and dissection of PDA was performed by left-sided thoracoscope. Therefore, left thoracoscopic repair is safe and feasible for treating TEF with an RAA and a vascular ring.

    DOI: 10.4103/0972-9941.181771

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  49. Long-term outcomes after revision of Kasai portoenterostomy for biliary atresia 査読有り

    Shirota Chiyoe, Uchida Hiroo, Ono Yasuyuki, Murase Naruhiko, Tainaka Takahisa, Yokota Kazuki, Oshima Kazuo, Shirotsuki Ryo, Hinoki Akinari, Ando Hisami

    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES   23 巻 ( 11 ) 頁: 715 - 720   2016年11月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Hepato-Biliary-Pancreatic Sciences  

    Background: The indications for and efficacy of revision of portoenterostomy (PE) for biliary atresia (BA) needs to be reassessed in an era of liver transplantation. We therefore reviewed the long-term outcomes following revision of PE. Methods: This was a retrospective study of the medical records of patients with BA who underwent PE and revision of PE. We investigated the role of revision on outcomes of jaundice-free native liver survival (approval number: 2015–0094). Results: Portoenterostomy was performed in 76 patients, among whom 22 underwent revision. Revision for recurrent jaundice was performed for four of 51 patients, who were transiently jaundice free after initial PE, but only one achieved native liver survival. Revision for repeated cholangitis in two patients achieved native liver survival over 10 years. Revision was performed in 16 of the 25 patients in whom initial PE failed; of these, four survived with their native liver (ages 3, 12, 12, and 14 years). The PE revision did not significantly affect liver transplantation duration and survival outcome. Conclusions: Revision of PE was suitable for repeated cholangitis. Revision for recurrent jaundice, regardless of whether the initial PE was successful, could have a limited but positive effect in preventing long-term progressive liver failure.

    DOI: 10.1002/jhbp.395

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  50. Comparing surgical outcomes of complete thoracoscopic lobectomy for congenital cystic lung disease between neonatal and infantile patients 査読有り

    Tainaka Takahisa, Uchida Hiroo, Tanaka Yujiro, Shirota Chiyoe, Yokota Kazuki, Murase Naruhiko, Oshima Kazuo, Shirotsuki Ryo, Chiba Kosuke, Hinoki Akinari

    Nagoya Journal of Medical Science   78 巻 ( 4 ) 頁: 447 - 454   2016年11月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Nagoya Journal of Medical Science  

    Thoracoscopic lobectomy has recently become a widely used surgical treatment for congenital cystic lung disease, but significant issues can arise in some cases, such as a limited working space in neonates, a limited view in cases involving large cystic lesions. We reviewed the treatment outcomes of neonates that underwent complete thoracoscopic lobectomy or segmentectomy and evaluated the operative difficulties. From January 2008 to October 2015, 38 patients under the age of 1 year underwent complete thoracoscopic lobectomy or segmentectomy for cystic lung disease at our institution. We compared the intra- and postoperative data of the neonate group (N group) with those of the infant group (I group). Fourteen and 24 patients underwent thoracoscopic lobectomy or segmentectomy in the N group and I group, respectively. The operative time and amount of intraoperative blood loss did not differ significantly between the two groups (p=0.694 and p=0.878, respectively), but the duration of the postoperative hospitalization period was significantly longer (p < 0.01) in the N group. The frequencies of postoperative complications did not differ significantly between the two groups. The operative time of thoracoscopic lobectomy was significantly longer in cases involving incomplete lobar fissures than in those involving normal lobar fissures. Surgical outcomes of complete thoracoscopic lobectomy for neonatal cases are almost equivalent compared with infantile cases, and thoracoscopic lobectomy takes longer in cases involving incomplete lobar fissures.

    DOI: 10.18999/nagjms.78.4.447

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  51. Steroid pulse therapy prevents restenosis following balloon dilatation for esophageal stricture 査読有り 国際誌

    Yokota Kazuki, Uchida Hiroo, Tanano Akihide, Shirota Chiyoe, Tainaka Takahisa, Hinoki Akinari, Murase Naruhiko, Oshima Kazuo, Shirotsuki Ryo, Chiba Kosuke

    PEDIATRIC SURGERY INTERNATIONAL   32 巻 ( 9 ) 頁: 875 - 879   2016年9月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Pediatric Surgery International  

    Purpose: This study aimed to evaluate the effectiveness of intravenous steroid pulse therapy following balloon dilatation for esophageal stenosis and stricture in children. Methods: The study enrolled six children, including three with congenital esophageal stenosis and three with anastomotic strictures after surgery for esophageal atresia, all of whom were treated by balloon dilatation combined with high-dose intravenous methylprednisolone pulse therapy. Methylprednisolone was injected intravenously at a dose of 20 mg/kg/day for 2 days, starting from the day of dilatation, followed by 10 mg/kg/day for 2 days, for a total of 4 days. Results: Esophageal stricture recurred in all three patients with congenital esophageal stenosis despite repeated balloon dilatation without methylprednisolone. However, the symptoms of dysphagia improved and did not recur after systemic steroid pulse therapy following balloon dilatation. Symptoms also resolved in all three patients with anastomotic strictures following balloon dilatation with systemic steroid pulse therapy. All six patients remained asymptomatic after 6–21 months follow-up, with no complications. Conclusion: Intravenous methylprednisolone pulse therapy following balloon dilatation is safe and effective for the treatment of esophageal stenosis and strictures in children.

    DOI: 10.1007/s00383-016-3939-5

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  52. Polylactic acid nanosheets in prevention of postoperative intestinal adhesion and their effects on bacterial propagation in an experimental model 査読有り 国際誌

    Hinoki A., Saito A., Kinoshita M., Yamamoto J., Saitoh D., Takeoka S.

    BRITISH JOURNAL OF SURGERY   103 巻 ( 6 ) 頁: 692 - 700   2016年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:British Journal of Surgery  

    Background Ultrathin films (nanosheets) adhere tightly to organ surfaces but prevent adhesion to other organs. The antiadhesive effect of nanosheets and their effect on bacterial propagation were investigated in a murine intestinal adhesion model. Methods Polylactic acid nanosheets (approximately 80 nm thick) were produced. Serosal defects were created by peeling off the intestinal serosa; these were left open or covered with nanosheets or Seprafilm® and the formation of intestinal adhesions was analysed. To examine bacterial propagation, a nanosheet or Seprafilm® was placed on intact murine jejunum followed by Escherichia coli inoculation at the site. Results Treatment both with nanosheets and with Seprafilm® reduced postoperative intestinal adhesion (mean adhesion score 0·67 for nanosheets, 0·43 for Seprafilm® and 2·87 for no antiadhesive treatment; P < 0·001 for nanosheets or Seprafilm® versus no adhesive treatment). Nanosheet treatment did not affect bacterial propagation in the peritoneal cavity, whereas Seprafilm®-treated mice showed bacterial propagation, leading to increased mortality. Conclusion Nanosheets may be effective novel antiadhesive agents even in the presence of bacterial contamination. Surgical relevance Intra-abdominal adhesions following surgical contamination can trigger postoperative complications and lead to deterioration in long-term quality of life. However, currently there are no effective antiadhesion materials to prevent the formation of adhesions. Treatment with ultrathin nanosheets effectively reduced postoperative intestinal adhesion in an experimental mouse model, and did not affect bacterial propagation in the peritoneal cavity. These nanosheets are potent novel antiadhesive materials that potentially can be applied even in contaminated conditions.

    DOI: 10.1002/bjs.10122

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  53. In vivo estimation of optical properties of rat liver using single-reflectance fiber probe during ischemia and reperfusion 査読有り

    Sharmin Akter, Tomoki Tanabe, Satoshi Maejima, Satoko Kawauchi, Shunichi Sato, Akinari Hinoki, Suefumi Aosasa, Junji Yamamoto, Izumi Nishidate

    OPTICAL REVIEW   23 巻 ( 2 ) 頁: 354 - 359   2016年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OPTICAL SOC JAPAN  

    To quantify the changes in optical properties of in vivo rat liver tissue, we applied diffuse reflectance spectroscopy (DRS) system using single-reflectance fiber probe during ischemia and reperfusion evoked by hepatic portal occlusion (hepatic artery, portal vein and bile duct). Changes in the reduced scattering coefficient mu(s)', the absorption coefficient mu(a), the tissue oxygen saturation StO(2), and the oxidation of heme aa3 in cytochrome c oxidase (CcO) OHaa(3) of in vivo rat liver (n = 6) were evaluated. Heme aa(3) in CcO were significantly reduced (P &lt; 0.05) during ischemia, which indicates a sign of mitochondrial energy failure induced by oxygen insufficiency of liver tissue. We found that OHaa(3) obtained from the proposed method was unchanged immediately after the onset of ischemia and started gradually decreasing at 2 min after the onset of ischemia. Difference in the time course between OHaa3 and the conventional ratio metric analysis with mu(a)(605)/mu(a)(620) reported in literature demonstrates that the proposed method is effective in reduction of optical cross talk between hemoglobin and heme aa3. Our results suggest that DRS technique is applicable and useful for assessing in vivo tissue viability and hemodynamics in liver intraoperatively.

    DOI: 10.1007/s10043-015-0171-9

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  54. Subcutaneous endoscopically assisted ligation using miniport for the treatment of girls with inguinal hernia 査読有り

    Akinari Hinoki, Ikeda Rie, Daiki Kitagawa, Kazuki Koiwai, Takemaru Tanimizu, Kazuo Hase, Shigeki Takahashi

    Annals of Pediatric Surgery   12 巻 ( 2 ) 頁: 73 - 76   2016年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Lippincott Williams and Wilkins  

    Background: This report describes the first miniport method using subcutaneous endoscopically assisted ligation (SEAL) for the treatment of girls with inguinal hernia. To validate its safety and efficacy, the authors evaluated their early experiences. Methods: Between April 2014 and December 2014, 19 SEALs using miniport were performed on 14 patients at the Fukaya Red-Cross Hospital, Saitama, Japan. Their mean age was 6 years (range, 11-128 months). This technique was performed using two ports (a 5 mm port placed using the open technique and an additional 2 mm miniport). A 5 mm laparoscope was inserted via the umbilicus. The miniport was introduced percutaneously in the inguinal region under laparoscopic guidance and manipulated around the medial or lateral hemicircumference of the internal ring extraperitoneally to place a purse-string around the internal ring. The hernia sac and patent processus vaginalis were closed at the level of the internal inguinal ring extraperitoneally with circuit suturing using the 2 mm miniport. Only the umbilical fascia was closed with an absorbable suture. No skin sutures were applied. We collected data regarding operative time, complications, and recurrence. Results: The mean operative time was 20±6 min (unilateral, n=9) or 42±8 min (bilateral, n=5). The mean follow-up period was 12.8±2.5 (range, 9-19) months. No intraoperative complications associated with the procedure occurred and no hernial recurrences have been identified so far. Conclusion: SEAL using miniport proved to be a successful operative procedure compared with other laparoscopic percutaneous extraperitoneal closure procedures and produced excellent cosmetic results. SEAL using miniport for the treatment of girls with inguinal hernias appears to be safe, effective, and reliable.

    DOI: 10.1097/01.XPS.0000473472.66487.e6

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  55. Single-incision thoracoscopic surgery for spontaneous pneumothorax in a 14-year-old girl 査読有り

    Kazuki Koiwai, Takemaru Tanimizu, Akinari Hinoki, Ryosuke Satake, Daiki Kitagawa, Hiroaki Komuro, Kazuo Hase, Junji Yamamoto

    Annals of Pediatric Surgery   12 巻 ( 2 ) 頁: 71 - 72   2016年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Lippincott Williams and Wilkins  

    Single-incision thoracoscopic surgery has become popular because of its potential to further extend the benefits of thoracoscopic surgery, such as less pain, a faster recovery time, and improved cosmesis, but the limited visualization due to crowding of instruments requires a certain amount of skill, especially in children. We herein describe a single-access video-assisted thoracoscopic surgery for a pediatric spontaneous pneumothorax. This procedure was useful, led to less postoperative pain and a better cosmetic appearance, and resulted in satisfactory results.

    DOI: 10.1097/01.XPS.0000476011.68016.bc

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  56. Emergency hepatectomy for hepatic arteriovenous malformation combined with pulmonary hypertension in an infant 査読有り

    Murase Naruhiko, Uchida Hiroo, Tanano Akihide, Shirota Chiyoe, Hinoki Akinari, Tainaka Takahisa, Yokota Kazuki, Oshima Kazuo, Shirotsuki Ryo

    JOURNAL OF PEDIATRIC SURGERY CASE REPORTS   3 巻 ( 12 ) 頁: 534 - 536   2015年12月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Pediatric Surgery Case Reports  

    Patients with hepatic arteriovenous malformations rarely present with pulmonary hypertension. We report the case of a 3-month-old boy who developed severe pulmonary hypertension due to a hepatic arteriovenous malformation. The use of pulmonary vasodilators to treat the patient's pulmonary hypertension worsened his high-output heart failure. This is the first case in which emergency hepatectomy rescued a patient with hepatic arteriovenous malformations who developed pulmonary hypertension.

    DOI: 10.1016/j.epsc.2015.10.017

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  57. Evaluation of light scattering and absorption properties of in vivo rat liver using a single-reflectance fiber probe during preischemia, ischemia-reperfusion, and postmortem. 査読有り 国際誌

    Akter S, Maejima S, Kawauchi S, Sato S, Hinoki A, Aosasa S, Yamamoto J, Nishidate I

    Journal of biomedical optics   20 巻 ( 7 ) 頁: 076010 - 076010   2015年7月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1117/1.JBO.20.7.076010

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  58. A repressor protein, Mnt, is a novel negative regulator of vascular smooth muscle cell hypertrophy by angiotensin II and neointimal hyperplasia by arterial injury. 査読有り 国際誌

    Takayanagi T, Eguchi A, Takaguri A, Hinoki A, Bourne AM, Elliott KJ, Hurlin PJ, Eguchi S

    Atherosclerosis   228 巻 ( 1 ) 頁: 90 - 3   2013年5月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.atherosclerosis.2013.02.033

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  59. A disintegrin and metalloprotease 17 mediates neointimal hyperplasia in vasculature. 査読有り 国際誌

    Takaguri A, Kimura K, Hinoki A, Bourne AM, Autieri MV, Eguchi S

    Hypertension (Dallas, Tex. : 1979)   57 巻 ( 4 ) 頁: 841 - 5   2011年4月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1161/HYPERTENSIONAHA.110.166892

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  60. Caveolin-1 negatively regulates a metalloprotease-dependent epidermal growth factor receptor transactivation by angiotensin II. 査読有り 国際誌

    Takaguri A, Shirai H, Kimura K, Hinoki A, Eguchi K, Carlile-Klusacek M, Yang B, Rizzo V, Eguchi S

    Journal of molecular and cellular cardiology   50 巻 ( 3 ) 頁: 545 - 51   2011年3月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.yjmcc.2010.12.009

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  61. P115rgs, A G12/13 Inhibitor, Prevents Vascular Smooth Muscle Cell Activation and Neointima Formation in Response to Balloon Angioplasty

    Akira Takaguri, Katsuhiro Okuda, Katherine Elliott, Keita Kimura, Akinari Hinoki, Kunie Eguchi, Satoru Eguchi

    HYPERTENSION   56 巻 ( 5 ) 頁: E146 - E146   2010年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  62. Identification of a Repressor Protein, Mnt, as a Negative Regulator of Pathological Vascular Remodeling

    Akira Takaguri, Katsuhiro Okuda, Kathy Elliott, Akinari Hinoki, Kunie Eguchi, Satoru Eguchi

    HYPERTENSION   56 巻 ( 5 ) 頁: E118 - E118   2010年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  63. Caveolin-1 negatively regulates a metalloprotease-dependent EGF receptor transactivation by angiotensin II

    Akira Takaguri, Heigoro Shirai, Akinari Hinoki, Victor Rizzo, Satoru Eguchi

    FASEB JOURNAL   24 巻   2010年4月

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    記述言語:英語   出版者・発行元:FEDERATION AMER SOC EXP BIOL  

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  64. Pathological neovascularization is reduced by inactivation of ADAM17 in endothelial cells but not in pericytes. 査読有り 国際誌

    Weskamp G, Mendelson K, Swendeman S, Le Gall S, Ma Y, Lyman S, Hinoki A, Eguchi S, Guaiquil V, Horiuchi K, Blobel CP

    Circulation research   106 巻 ( 5 ) 頁: 932 - 40   2010年3月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1161/CIRCRESAHA.109.207415

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  65. p21-activated kinase 1 participates in vascular remodeling in vitro and in vivo. 査読有り 国際誌

    Hinoki A, Kimura K, Higuchi S, Eguchi K, Takaguri A, Ishimaru K, Frank GD, Gerthoffer WT, Sommerville LJ, Autieri MV, Eguchi S

    Hypertension (Dallas, Tex. : 1979)   55 巻 ( 1 ) 頁: 161 - 5   2010年1月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1161/HYPERTENSIONAHA.109.143057

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  66. Identification of HGF as a Novel Vascular ADAM Metalloprotease Substrate by Phage Display

    Sadaharu Higuchi, Keita Kimura, Akira Takaguri, Akinari Hinoki, Kunie Eguchi, Gerald D. Frank, Satoru Eguchi

    CIRCULATION   120 巻 ( 18 ) 頁: S1141 - S1141   2009年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  67. Signal Cross-Talk Between PDGF Receptor beta and G12/13 Mediates Vascular Smooth Muscle Cell Migration by PDGF-BB: Implication in Neointima Formation

    Akinari Hinoki, Keita Kimura, Kunie Eguchi, Sadaharu Higuchi, Kazuhiro Ishimaru, Michael V. Autieri, Laura J. Sommerville, Gerald D. Frank, Satoru Eguchi

    ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY   29 巻 ( 7 ) 頁: E56 - E57   2009年7月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  68. Role of PAK1 Activation in Migration of VSMC in Vitro and in Arterial Neointima Formation in Vivo

    Keita Kimura, Akinari Hinoki, Kazuhiro Ishimaru, Sadaharu Higuchi, Kunie Eguchi, Michael V. Autieri, Laura J. Sommerville, Gerald D. Frank, Satoru Eguchi

    ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY   29 巻 ( 7 ) 頁: E57 - E57   2009年7月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  69. Endothelial nitric oxide synthase inhibits G12/13 and rho-kinase activated by the angiotensin II type-1 receptor: implication in vascular migration. 査読有り 国際誌

    Suzuki H, Kimura K, Shirai H, Eguchi K, Higuchi S, Hinoki A, Ishimaru K, Brailoiu E, Dhanasekaran DN, Stemmle LN, Fields TA, Frank GD, Autieri MV, Eguchi S

    Arteriosclerosis, thrombosis, and vascular biology   29 巻 ( 2 ) 頁: 217 - 24   2009年2月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1161/ATVBAHA.108.181024

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  70. Distinct roles of protease-activated receptors in signal transduction regulation of endothelial nitric oxide synthase. 査読有り 国際誌

    Suzuki H, Motley ED, Eguchi K, Hinoki A, Shirai H, Watts V, Stemmle LN, Fields TA, Eguchi S

    Hypertension (Dallas, Tex. : 1979)   53 巻 ( 2 ) 頁: 182 - 8   2009年2月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1161/HYPERTENSIONAHA.108.125229

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  71. Involvement of Adam17 in Neointima Formation after Vascular Injury; Potential Role of Tyrosine Phosphorylation on its Activity

    Akinari Hinoki, Sadaharu Higuchi, Keita Kimura, Kunie Eguchi, Michael V. Autieri, Laura J. Sommerville, Gerald D. Frank, Satoru Eguchi

    CIRCULATION   118 巻 ( 18 ) 頁: S372 - S372   2008年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  72. ADAM17 is a new therapeutic target for neointima formation after vascular injury: Impact of tyrosine phosphorylation on its activity

    Keita Kimura, Akinari Hinoki, Sadaharu Higuchi, Heigoro Shirai, Kunie Eguchi, Michael V. Autieri, Laura J. Sommerville, Gerald D. Frank, Satoru Eguchi

    HYPERTENSION   52 巻 ( 4 ) 頁: E76 - E76   2008年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  73. Caveolin-1 regulates ADAM17-dependent EGF receptor transactivation induced by angiotensin II

    Akinari Hinoki, Keita Kimura, Sadaharu Higuchi, Kunie Eguchi, Baohua Yang, Victor Rizzo, Gerald D. Frank, Satoru Eguchi

    HYPERTENSION   52 巻 ( 4 ) 頁: E57 - E57   2008年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  74. Central role of Gq in the hypertrophic signal transduction of angiotensin II in vascular smooth muscle cells. 査読有り 国際誌

    Ohtsu H, Higuchi S, Shirai H, Eguchi K, Suzuki H, Hinoki A, Brailoiu E, Eckhart AD, Frank GD, Eguchi S

    Endocrinology   149 巻 ( 7 ) 頁: 3569 - 75   2008年7月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1210/en.2007-1694

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  75. Involvement of caveolin-1 in a metalloprotease-dependent EGF receptor transactivation and subsequent cell hypertrophy induced by angiotensin II

    Sadaharu Higuchi, Akinari Hinoki, Heigoro Shirai, Kunie Eguchi, Gerald D. Frank, MaryEllen Carlile, Baohua Yang, Victor Rizzo, Satoru Eguchi

    ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY   28 巻 ( 6 ) 頁: E45 - E45   2008年6月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  76. ADAM17 mediates neointima formation: Potential requirement of its tyrosine phosphorylation

    Akinari Hinoki, Sadaharu Higuchi, Heigoro Shirai, Kunie Eguchi, Gerald D. Frank, Satoru Eguchi

    ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY   28 巻 ( 6 ) 頁: E45 - E45   2008年6月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  77. Novel role of protein kinase C-delta Tyr 311 phosphorylation in vascular smooth muscle cell hypertrophy by angiotensin II. 査読有り 国際誌

    Nakashima H, Frank GD, Shirai H, Hinoki A, Higuchi S, Ohtsu H, Eguchi K, Sanjay A, Reyland ME, Dempsey PJ, Inagami T, Eguchi S

    Hypertension (Dallas, Tex. : 1979)   51 巻 ( 2 ) 頁: 232 - 8   2008年2月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1161/HYPERTENSIONAHA.107.101253

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  78. Rho-kinase mediates activation of PAK1 and its interaction with mnt by angiotensin II in vascular smooth muscle cells: Novel combination analysis using a phage display and LC/MS analysis

    Heigoro Shirai, Sadaharu Higuchi, Akinari Hinoki, Gerald D. Frank, Evangeline D. Motley, Tomoyuki Oe, Satoru Eguchi

    HYPERTENSION   50 巻 ( 4 ) 頁: E96 - E96   2007年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  79. Novel involvement of caveolin-1 in adam 17-dependent EGF receptor transactivation induced by angiotensin II

    Heigoro Shirai, Sadaharu Higuchi, Akinari Hinoki, Kunie Eguchi, Gerald D. Frank, MaryEllen Carlile-Klusacek, Baohua Yang, Victor Rizzo, Satoru Eguchi

    CIRCULATION   116 巻 ( 16 ) 頁: 236 - 236   2007年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  80. Distinct molecular regulation and eNOS sensitivity of Rho/ROCK activation and EGFR transactivation through the angiotensin II type 1 receptor

    Akinari Hinoki, Heigoro Shirai, Sadaharu Higuchi, Kunie Eguchi, Gerald D. Frank, Gerald D. Frank

    HYPERTENSION   50 巻 ( 4 ) 頁: E97 - E97   2007年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  81. Suppression of proinflammatory cytokine production in macrophages by lansoprazole.

    Hinoki A, Yoshimura K, Fujita K, Akita M, Ikeda R, Nagashima M, Nomura M, Satomi A

    Pediatric surgery international   22 巻 ( 11 ) 頁: 915 - 23   2006年11月

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  82. Suppression of proinflammatory cytokine production in macrophages by lansoprazole. 査読有り 国際誌

    Akinari Hinoki, Kazunori Yoshimura, Keiko Fujita, Masumi Akita, Rie Ikeda, Masabumi Nagashima, Masahiko Nomura, Akira Satomi

    Pediatric surgery international   22 巻 ( 11 ) 頁: 915 - 23   2006年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Macrophages (MPs) produce increased levels of proinflammatory cytokines in Crohn's disease; these cytokines are thought to play a central role in the occurrence of the disease. Biologics are currently available for anti-cytokine therapy, but treating intestinal inflammation through direct suppression of proinflammatory cytokine production could be more effective. P-ATPase inhibitors have been reported to be anti-inflammatory, and these inhibitors might suppress the production of MP proinflammatory cytokines. In this study, we examined the effect of two types of ATPase inhibitors on the expression patterns of typical proinflammatory cytokines. Peritoneal MPs from 6- to 8-week-old mice were cultured for 48 h in the presence of lansoprazole (P-ATPase inhibitor), bafilomycin A(1) (V-ATPase inhibitor), or the control solvent dimethylsulfoxide. The MPs were then examined for cytokine expression by quantitative real-time polymerase chain reaction (PCR), and culture supernatants were examined for cytokine production with a multiplex assay in a suspension array system. The possible existence of P-ATPase mRNA in MPs was explored using reverse-transcriptase PCR. P-ATPase mRNA was not detected in MP cells. However, all examined proinflammatory cytokines decreased significantly in their mRNA and protein expression in the lansoprazole-treated group. Conversely, bafilomycin A(1) increased the levels of these cytokines. Lansoprazole might be useful for the treatment of inflammatory bowel diseases (IBDs), including Crohn's disease, as it suppresses the production of relevant MP proinflammatory cytokines. However, because P-ATPase was not detected in MPs, the mechanism is unclear and remains to be studied further in an IBD animal model.

    PubMed

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科研費 18

  1. one carbon metabolismによる膵癌制御の可能性

    研究課題/研究課題番号:21K07147  2021年4月 - 2024年3月

    林 真路, 小寺 泰弘, 猪川 祥邦, 檜 顕成

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    担当区分:研究分担者 

    難治である膵臓癌発癌についてone carbon metabolismの関与を考えたとき、葉酸・メチオニン摂取により予後が改善することは疫学的に証明されているが、その分子生物学的機序は明らかでない。本研究では、膵癌切除症例について、術前尿検体に含まれる代謝産物プロファイルによりone carbon metabolismの活性化状態を評価し、対応する膵癌組織での癌化に関わる遺伝子のメチル化頻度との相関を明らかにする。つまり、one carbon metabolismの活性化が膵癌の癌化に抑制的に働く機序を解明し、治療標的とできるかについて検討する。

  2. 腎芽腫患児の代謝物網羅解析によるバイオマーカーの探索と創薬への挑戦

    研究課題/研究課題番号:21K07805  2021年4月 - 2024年3月

    田中 裕次郎, 大澤 毅, 内田 広夫, 檜 顕成, 大島 一夫, 城田 千代栄, 田井中 貴久, 住田 亙, 横田 一樹

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    担当区分:研究分担者 

    腎芽腫は小児腎腫瘍の90%を占めるが、全体の約10%に予後不良群を認め、診断バイオマーカーが存在しない。最近メタボロミクス技術の発展により生体内の代謝情報を鋭敏且つ包括的に捉えることが可能となり、様々な癌種において新たなバイオマーカーや病態の解明が進んでいる。腎芽腫においても代謝変動の解明が病因解明や新規治療法の開発に寄与すると考えられるが、その代謝変動に着目した診断マーカーや創薬は前例がない。本研究では腎芽腫をターゲットに尿だけでなく、血液、がん組織を加えた腎芽腫50サンプルの代謝物変動を捉えるメタボローム解析を行い、疾患特異的なバイオマーカー探索とその病態解明に挑む。

  3. 小児がんの診断治療に資する新規蛍光プローブの開発研究

    研究課題/研究課題番号:21K08640  2021年4月 - 2024年3月

    城田 千代栄, 浦野 泰照, 神谷 真子, 内田 広夫, 檜 顕成, 田井中 貴久, 住田 亙, 牧田 智, 横田 一樹, 滝本 愛太朗, 安井 昭洋, 岡本 眞宗

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    担当区分:研究分担者 

    小児がんは発見時にすでに進行していることが多く、遠隔転移症例の治療法の確立は喫緊の課題である。遠隔転移巣を確実に手術で摘出できれば患児の予後は劇的に改善するが、現時点では術中に微小転移巣を同定する方法がなく完全切除が難しいため、繰り返し手術が必要となることもある。そこで、特定の分子と反応すると分子構造が変化して強い蛍光を発したり、蛍光の色調が変化したりする機能性分子であり、生理活性物質の動態をリアルタイムに観測する研究ツールである蛍光プローブに着目した。本研究では、術中に迅速に簡便に小児がんの検出が可能な蛍光プローブの開発を行う。

  4. On the Job Training回避のための小児内視鏡手術前訓練の研究

    研究課題/研究課題番号:19H04225  2019年4月 - 2022年3月

    日本学術振興会  科学研究費助成事業 基盤研究(B)  基盤研究(B)

    内田 広夫, 石丸 哲也, 出家 亨一, 森 健策, 城田 千代栄, 田井中 貴久, 藤原 道隆, 檜 顕成, 田中 裕次郎

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    担当区分:研究分担者 

    小児は手術後も成長発達するため、その成長発達を阻害しない低侵襲手術が望まれている。新生児や乳児の内視鏡手術は小さなworking spaceの中で、脆弱な組織を丁寧に処理しながら、複雑な手技を完遂させなければならないが、患者数が少ないことから、手術手技をon the job trainingとして学びつつ、手術を行っている現状がある。これを防ぐためにoff the job trainingを充実させることが急務である。練習時の手術手技をリアルタイムに画像解析するシステムを作成し、早く上手になる練習プログラムを確立すると同時に実際の手術時の手技評価もできる画像解析プログラムを作り上げる。
    今まで作成してきた小児内視鏡手術練習キットである食道閉鎖症、十二指腸閉鎖症、肝管空腸吻合シミュレータを用いて、剥離操作、吻合操作の画像解析を行ってきた。熟練者および初心者、初心者が練習後うまくなった状態の動画の画像解析を進めており、熟練者と初心者との違いが明らかになってきた。鉗子や針を持ち換える回数、両手に持った鉗子の協調的な動き、運針時の針の刺し直しなどが熟練者のほうが良好な成績を示した。また鉗子の移動距離を調べると熟練者のほうが移動距離が短く、操作回数も少ないことも明らかになった。画像を細分化して機械学習を勧めており、鉗子の認識精度は85%を超える程度まで改善した。しかし針の検出精度はまだ低く今後改善が必要である。鉗子のブレ、動きのブレの解析、すなわり滑らかな動きの自動解析も進めている。これは動きの規格化分散すなわち時間あたりに動く距離、ブレを自動で解析する目的で導入した。これらの正確さもおよそ80%程度となっている。一方で現時点ではいろいろなデータ解析は人による評価のほうがより正確にできており、AIが手術手技を自動解析できるところは一部の動きだけとなっている。上達している手技の判断もAIではまだ難しい。今後はAIによる鉗子認識機構をより正確にするプログラムの作成をすすめる。画像のみではなく、鉗子の動き自体も解析を行っているため、画像と連動させた解析をすすめ、上手な動きとはなにかを明らかにする。
    今まで作成してきた小児内視鏡手術練習キットである食道閉鎖症、十二指腸閉鎖症、肝管空腸吻合シミュレータを用いて、剥離操作、吻合操作の画像解析を行ってきた。熟練者および初心者、初心者が練習後うまくなった状態の動画の画像解析を進めており、熟練者と初心者との違いが明らかになってきた。鉗子や針を持ち換える回数、両手に持った鉗子の協調的な動き、運針時の針の刺し直しなどが熟練者のほうが良好な成績を示した。また鉗子の移動距離を調べると熟練者のほうが移動距離が短く、操作回数も少ないことも明らかになった。画像を細分化して機械学習を勧めており、鉗子の認識精度は85%を超える程度まで改善した。しかし針の検出精度はまだ低く今後改善が必要である。鉗子のブレ、動きのブレの解析、すなわち滑らかな動きの自動解析も進めている。これは動きの規格化分散すなわち時間あたりに動く距離、ブレの解析であるが、これを用いて動きのスムーズさを自動で解析していった。これらの解析もおよそ80%程度可能となっている。一方で現時点ではいろいろなデータ解析は人による評価のほうがより正確にできており、AIが手術手技を自動解析できるところは一部の動きだけとなっている。上達している手技の判断もAIではまだ難しい。今後はAIによる鉗子認識機構をより正確にするプログラムの作成をすすめる。
    今まで作成してきた小児内視鏡手術練習キットである食道閉鎖症、十二指腸閉鎖症、肝管空腸吻合シミュレータを用いて、剥離操作、吻合操作の画像解析を行ってきた。熟練者および初心者、初心者が練習後うまくなった状態の動画の画像解析を進めており、熟練者と初心者との違いが明らかになってきた。鉗子や針を持ち換える回数、両手に持った鉗子の協調的な動き、運針時の針の刺し直しなどが熟練者のほうが良好な成績を示した。また鉗子の移動距離を調べると熟練者のほうが移動距離が短く、操作回数も少ないことも明らかになった。画像を細分化して機械学習を勧めており、鉗子の認識精度は85%を超える程度まで改善した。しかし針の検出精度はまだ低く今後改善が必要である。鉗子のブレ、動きのブレの解析、すなわち滑らかな動きの自動解析も進めている。これは動きの規格化分散すなわち時間あたりに動く距離、ブレの解析であるが、これを用いて動きのスムーズさを自動で解析していった。これらの解析もおよそ80%程度可能となっている。一方で現時点ではいろいろなデータ解析は人による評価のほうがより正確にできており、AIが手術手技を自動解析できるところは一部の動きだけとなっている。上達している手技の判断もAIではまだ難しい。今後はAIによる鉗子認識機構をより正確にするプログラムの作成をすすめる。画像のみではなく、鉗子の動き自体も解析を行っているため、画像と連動させた解析をすすめ、上手な動きとはなにかを明らかにする。鉗子の挙動を解析する際に、私達がチェック項目を用いて点数をつけるような視点とは異なった見地から判断できるようにすることで、AIでしか判定できない項目を画像および動きの解析から新たに探求する。さらに横隔膜ヘルニア根治術などのシミュレータを新たに開発し、その手術操作をoff the job trainingできるようにする。

  5. 縫合不全と術後癒着防止のための自己支持性高分子超薄膜(ナノシート)の開発

    研究課題/研究課題番号:20K08979  2020年4月 - 2023年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    横田 一樹

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    担当区分:研究分担者 

    外科手術における重篤な合併症である縫合不全、断端漏及び術後癒着を防止するための補強材として、自己支持性高分子超薄膜(ナノシート)を開発する。すなわち腸管吻合部のみならず、胆管、尿管などの吻合部や、肝臓、膵臓、気管などの組織断端部や、開腹創や外傷などの縫合部に置くだけで、吻合部や断端部を補強し、それらの創傷治癒を促し、縫合不全や断端瘻などの合併症が起きない外科治療を補完するナノシートを開発する。

  6. 新規生分解性Mg気管内ステントの開発

    研究課題/研究課題番号:19K22654  2019年6月 - 2021年3月

    挑戦的研究(萌芽)

    内田 広夫

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    担当区分:研究分担者 

    本研究の目的は、小児の気管軟化症に対して従来の侵襲性の高い気管切開術や外ステント術や大動脈釣り上げ術などの外科的治療法を回避し、より低侵襲な方法で治療するために、生分解性の気管内ステントを開発することである。ステントの素材として、優れた加工性と高い力学的信頼性を併せ持つ生分解性マグネシウム合金を使用する。気管軟化症は成長に伴う気管径の増大とともに改善することが多く、生分解性の気管内ステントを開発することで今まで問題となっていた合併症のリスクを減らすことができる。また気管切開が困難な気管分岐部の狭窄部位にも 留置できるため、気管軟化症の多くが低侵襲な生分解性気管内ステント術で治療可能となる。
    2019年度では、マグネシウム合金製気管内ステントの細胞毒性試験を行い、生体適合性を評価し、毒性はほとんどないことを確認した。現在、体内模擬環境での分解動態を検索するため、人工血漿に浸漬し、ICP 質量分析装置による抽出金属の分析、走査電子顕微鏡/元素マッピングによる腐食産物の同定、拡張把持力の経時的推移などを評価している。より最適なものを作成するために動物実験などの結果も踏まえて、花田幸太郎がマグネシウム合金の改良、気管ステントの改良を進める。2019年度はラットを用いて、マグネシウム合金製気管内ステント留置術および短期飼育実験を行った。 有効・安全性を検証する。ラットの気管内に気管支鏡を用いてステントを留置後、 3週間、6週間で観察を行ったところ、ステントは迷入せずにきれいに気管内に留置されていた。その後肺炎などの呼吸器合併症は見られず、そよそ80%の生存率であった。死因は現状ではわからないため、精査している。現在μCTを撮影しているところである。採血により炎症反応や、肝機能・腎機能障害、血中Mg 濃度の上昇がないことを確認した。経時的に犠牲死させ、出血や肉芽形成を観察している最中である。気管の病理組織学的評価を行い、ステント周囲組織の炎症を確認しているが強い炎症は見られていない。摘出したステントは、走査電子顕微鏡/元素マッピングによる腐食産物の同定を行う予定となっている。残存ステントの定量評価、拡張把持力の評価はまだ行われていない。
    2019年度では、マグネシウム合金製気管内ステントの細胞毒性試験を行い、生体適合性を評価し、毒性はほとんどないことを確認した。現在、体内模擬環境での分解動態を検索するため、人工血漿に浸漬し、ICP 質量分析装置による抽出金属の分析、走査電子顕微鏡/元素マッピングによる腐食産物の同定、拡張把持力の経時的推移などを評価している。より最適なものを作成するために動物実験などの結果も踏まえて、花田幸太郎がマグネシウム合金の改良、気管ステントの改良を進める。2019年度はラットを用いて、マグネシウム合金製気管内ステント留置術および短期飼育実験を行った。 有効・安全性を検証する。ラットの気管内に気管支鏡を用いてステントを留置後、 3週間、6週間で観察を行ったところ、ステントは迷入せずにきれいに気管内に留置されていた。その後肺炎などの呼吸器合併症は見られず、そよそ80%の生存率であった。死因は現状ではわからないため、精査している。現在μCTを撮影しているところである。採血により炎症反応や、肝機能・腎機能障害、血中Mg 濃度の上昇がないことを確認した。経時的に犠牲死させ、出血や肉芽形成を観察している最中である。気管の病理組織学的評価を行い、ステント周囲組織の炎症を確認しているが強い炎症は見られていない。摘出したステントは、走査電子顕微鏡/元素マッピングによる腐食産物の同定を行う予定となっている。残存ステントの定量評価、拡張把持力の評価はまだ行われていない。現在長期観察中であり、また標本の出来上がりを待っているところであるが、金属を含んだ標本のため、かなり時間がかかることは以前よりわかっており、計画通り進んでいる。
    2019年度では、マグネシウム合金製気管内ステントの細胞毒性試験を行い、生体適合性を評価し、毒性はほとんどないことを確認した。現在、体内模擬環境での分解動態を検索するため、人工血漿に浸漬し、ICP 質量分析装置による抽出金属の分析、走査電子顕微鏡/元素マッピングによる腐食産物の同定、拡張把持力の経時的推移などを評価している。より最適なものを作成するために動物実験などの結果も踏まえて、花田幸太郎がマグネシウム合金の改良、気管ステントの改良を進める。2019年度はラットを用いて、マグネシウム合金製気管内ステント留置術および短期飼育実験を行った。 有効・安全性を検証する。ラットの気管内に気管支鏡を用いてステントを留置後、 3週間、6週間で観察を行ったところ、ステントは迷入せずにきれいに気管内に留置されていた。その後肺炎などの呼吸器合併症は見られず、そよそ80%の生存率であった。死因は現状ではわからないため、精査している。現在μCTを撮影しているところである。採血により炎症反応や、肝機能・腎機能障害、血中Mg 濃度の上昇がないことを確認した。経時的に犠牲死させ、出血や肉芽形成を観察している最中である。気管の病理組織学的評価を行い、ステント周囲組織の炎症を確認しているが強い炎症は見られていない。摘出したステントは、走査電子顕微鏡/元素マッピングによる腐食産物の同定を行う予定となっている。今後は残存ステントの定量評価および拡張把持力の評価を行っていく。次に家兎の気管軟化症モデルとして第二から第四気管輪に縦切開を加え、ステントの有無で呼吸状態の評価を長期的に行う。気管内の状態を新生児用気管支ファイバーにより観察して有効性を評価し、臨床応用の可能性を評価し、非臨床POCへの過程を決定する。

  7. 一細胞から紐解く新生児の腸管免疫システム

    研究課題/研究課題番号:18K19503  2018年6月 - 2020年3月

    挑戦的研究(萌芽)

    澤 新一郎

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    担当区分:研究分担者 

    ヒト新生児期の腸管免疫細胞の構成と機能を明らかにし、新生児期の腸炎病態を免疫学的な側面から理解することを目的とした。本研究では手術対象となったヒト新生児腸管から採取した免疫細胞に関してシングルセル遺伝子発現を網羅的に解析した。新生児壊死性腸炎(NEC)および現局性腸穿孔(FIP)を比較したところ、強い炎症と壊死が生じる新生児壊死性腸炎のT細胞において、ケモカイン受容体や接着因子の発現が増強することが明らかになった。
    本研究はヒトの新生児腸管粘膜における免疫細胞の構成や機能に関する情報を網羅的に取得することで、これまで病態が不明である新生児壊死性腸炎について免疫学的な新知見をもたらした。
    また、新生児早期における免疫状態は成人期以降のヒトの免疫異常やアレルギー疾患の発症しやすさに何らかの関係があると想定されているが、これまでヒト新生児の臓器局所に存在するリンパ球は詳細に解析されてこなかった。本研究により、情報が取得しにくいヒトの腸管免疫細胞に関する新たな解析方法が提案できたと考えている。

  8. リンパ管腫のリンパ動態に基づいた光線力学療法による根治の試み

    研究課題/研究課題番号:18K08559  2018年4月 - 2021年3月

    高橋 正貴

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    担当区分:研究分担者 

    本研究では、病変特異的な異常リンパ動態を利用して、病変にのみICGを取り込ませ、蛍光イメージングによる局在診断の有用性を検証する。さらに同部位に近赤外光を照射した際に発生する温熱を利用して、リンパ管腫を選択的に治療する光温熱治療の有効性を実証する。
    申請者らはすでに、In vitro実験の検証により、リンパ管腫リンパ管内皮細胞(以下HL-LEC)はICGを取り込み、取り込んだ細胞に近赤外光を照射すると、100%近い細胞の細胞死を誘導することも確認している。また、設定温度が47度以上で確実に細胞死を誘導することを確認している。
    今回、申請者は既に確立した背部皮下リンパ管腫モデルマウスを用いてICGによる蛍光イメージングならびに光温熱治療の治療効果を確認した。背部皮下のリンパ管腫モデルマウスにICGを嚢胞内に打ち込み、近赤外光を照射したところ、病理組織学的に移植片のリンパ管内皮細胞を細胞死に導くことができることを確認した。
    申請書類と同等の進捗状況である。
    申請者らが樹立したリンパ管腫内皮細胞に発光遺伝子(Nano-Lantern)を導入した細胞系を確立している。それを用いて治療効果の検証には、生体イメージングシステム(IVIS&#174;)で、病変の増殖・縮退を経時的に繰り返し観察する。この細胞を用いて作製したモデルマウスにおいては、体外から無侵襲(体毛の剃毛すら不要)かつ短時間(~1 s)に腫瘍局在、サイズ等を検出することができる。一方で超音波イメージングでは50 μmの分解能で、嚢胞や周辺組織を描出できる。定量的な治療効果の検証ができると期待していたが、Nano-Lantern入りHL-LECはIVISで発光せず、定量的な比較が困難であることが判明した。また、モデルマウスの作成に3-4か月を要する。
    現時点では当初の予定通りに進んでいるが、上記事項を考慮して研究を進めていく。
    動物モデルで治療効果の有効性が明らかなので、対照群と比較して量的に有効性を示す必要性がある。
    移植細胞の特殊性と上述した事項から、現時点では定量的評価が困難である。定量的評価を確立させる必要が有るために、HL-LECにfflucやAka-Lucの導入し、In vivo imaging systemを用いて経時的に半定量的評価を行うモデルマウスの作成を予定している。
    それらの体表モデルを用いて体表からの照射を行い、コントロール群との治療効果の比較、照射部位の副作用の比較検討を定量的行う。
    次のステップとして臨床で遭遇する深部体腔内のリンパ管腫病変を想定し、筋肉内病変モデルや後腹膜腫瘍モデルなどのマウスを作製して、本診断・治療法の有効性を確認する。実臨床に即した照射方法として体表照射のみならず、手術時併用を想定に開創時の照射などを検討予定である。

  9. AI遠隔医療プラットホームを活用した小児外科医療資源最適化への挑戦

    研究課題/研究課題番号:17H06280  2017年6月 - 2020年3月

    挑戦的研究(開拓)

    城田 千代栄

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    担当区分:研究分担者 

    アプリを開発し、1対多のモバイルテレメディシンを活用して医療現場をセキュアに連携し、小児外科医療インフラの解決と同時に専門性の高い遠隔医療支援の普及と発展を目指した。本アプリを介して各地域で分散して発生する症例をあたかも一箇所に集約化した状況(スマホ上で1対多の遠隔テレビ会議、画像共有が可能)を作り出すことで、多くの医師が症例をリアルタイムに共有し、治療方針の検討に参加し、意見を交わすことができる。希望する国内の医師、病院との医療現場をセキュアに連携し、24時間対応で専門性の高い遠隔医療支援を開始した。システムの有効活用により、専門医と貴重な症例の仮想的集約化を同時に行うことが可能となった。
    小児外科疾患は日本各地で発生するが、それに対応する小児外科医が各地に広くいることは不可能である。これまでは、専門性の高い医療を僻地で行うことは難しかった。アプリを使用した1対多のモバイルテレメディシンを活用して医療現場を連携し、専門性の高い遠隔医療支援の普及と発展を目指した。具体的には、専門性の高い医療の支援を求める病院と、全国に点在する複数の専門医をリアルタイムに繋いで医療支援を行うことを目的とした。本システムを開発し導入したところ、希望する国内の医師、病院との医療現場の連携が容易となり、24時間対応で専門性の高い遠隔医療支援を開始することができた。

  10. ドラッグデリバリー型光温熱薬剤と加温制御機構を駆使した高効率がん治療システム

    研究課題/研究課題番号:17H02114  2017年4月 - 2020年3月

    守本 祐司

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    担当区分:研究分担者 

    申請者らは、がん治療法として、ドラッグデリバリーシステム型光吸収薬剤(ICGラクトソーム)と近赤外光照射を組み合わせた光温熱治療システムの開発を進めている。
    本課題では、超小型サーモセンサーアレイ搭載腹腔鏡カメラを創製し、温度制御型鏡視下レーザーアブレーションシステムを開発した。
    ドラッグデリバリーシステム型光吸収薬剤を用いた光加温方式の温熱治療において、腫瘍温度の実測モニタリングによって腫瘍縮退を確実に誘導できる医療技術の報告はなく、独創的である。そして本方式は、物理エネルギーを使用する各種がん治療法に比して以下の点で優位である。
    ①局所病変に対してのみ選択的に細胞死を誘導できる②光照射中の腫瘍の実測定によって確実な腫瘍縮退を期待できる③深部病変を治療できる。

  11. 新生児消化器疾患発症機序の分子生物学的解明に向けた解析ワークフローの確立

    研究課題/研究課題番号:17H04235  2017年4月 - 2020年3月

    田中 裕次郎

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    担当区分:研究分担者 

    手術で切除されたヒト腸管合計71検体に対して、リンパ球を抽出してフローサイトメトリーを行い、腸管リンパ球の分布を調べた。いずれにもILC3を認めたが、その割合は在胎週数、病態で一定しなかった。また、ヒト新生児消化管穿孔について、壊死性腸炎と非壊死性腸穿孔の遺伝子発現を腸管のひとつひとつの細胞にラベリングを行った上で1症例につき約1万個調べ、どの細胞が働いていたかを世界で初めて評価した。壊死群ではT細胞が優位でMYC targets、mTORC1 signaling、TNFA signalingなど炎症に関する経路が有意に高発現しており、非壊死群では単球系細胞が優位であった。
    新生児にとって致死的になりうる壊死性腸炎と、壊死性腸炎ほどに致死的ではない限局性腸穿孔を比べて、ひとつひとつの腸管細胞における遺伝子発現の違いを調べた。結果として、壊死性腸炎では、炎症が起きる際に認める多くの遺伝子発現が明らかに高度だった。この結果について、さらに分析を進めることで、予後不良な新生児壊死性腸炎の原因追及や、予防法、新規治療法の開発に発展させられる可能性がある。これによって命が助かる子供や、その後の人生の不自由が減る子供がでてくると期待している。また、新生児壊死性腸炎は主に低出生体重児の新生児期にのみ起こる疾患であり、ヒト腸管の免疫機能の発達を解明するてがかりになる可能性がある。

  12. 体内で分解し残存異物とならない新規マグネシウムデバイス開発と各種疾患治療への応用

    研究課題/研究課題番号:16H03197  2016年4月 - 2019年3月

    内田 広夫

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    担当区分:研究分担者 

    生分解性Mg合金ステープルを用いた自動縫合器の研究開発に取り組んだ。 Mg合金は生体への安全性が高いが、自動縫合用ステープルとしての臨床実用化には、強度、剛性、耐食性および加工性など多くの課題を抱えていた。我々はステープルの製造に必要な微細加工を可能とする素材成分を見出し、さらに応力集中による屈曲や腐食による断裂をおこし難い湾曲形状にすることで、幅0.2mmx長さ3mmと精巧緻で破断せずに生体内で安定した縫合効果を得られるステープルの作製が可能となった。ステープルを用いて家兎(n=24)や豚(n=3)などの中大動物を用いて消化管吻合実験を行い縫合不全などの合併症なく全例生存することを確認した。
    生分解性Mg合金ステープルを用いた自動縫合器の研究開発に取り組んだ。素材を開発、形状工夫により安定した縫合効果を得られるステープルが制作できた。本ステープルを用いて中大動物を用いて消化管吻合実験を行い、縫合不全などの合併症なく全例生存した。細胞毒性もなく、Mg合金は3ヶ月で生分解した。ステープルが残存異物とならないため患者のQOLが向上し、本製品は生分解性金属を用いた世界初の自動縫合器となりうる。

  13. 超高齢化社会の医療人材不足を克服する次世代医療用ウエアラブルセンサーの新規開発

    研究課題/研究課題番号:16K12957  2016年4月 - 2019年3月

    内田 広夫

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    担当区分:研究分担者 

    印刷技術やフレキシブルエレクトロニクス技術を用いたウェア型のバイタルセンサの研究開発を行った。衣類上に静電植毛技術を用いて銀メッキを施した繊維を垂直に起立した状態で植毛することができた。これにより低コストで、長期間使用可能な洗濯できるものが完成した。コンプレッションウェアの胸部に18個の電極を形成し、また右肩、左肩、左脇腹に不関電極用の3つの電極を、右脇腹にアース用電極を形成した。この心電図測定ウェアを用いて、安静時に心電図測定が十分に行えた。1000Pa-2000Paの圧力で皮膚と接着しているウェアでは心電図測定の際に大きなモーションアーチファクトは確認されなかった。
    ウェア型のバイタルセンサの研究開発を行った。印刷技術と静電植毛技術を用いることで一括で多数のドライ電極を衣類上に織物のように作製する技術を開発し、多極心電図測定ウェアを作製することができた。このウェアは低コストで、長期間使用可能で、洗濯にも耐えられるものとなった。このような身体に貼るものではない電極を用いる場合、安定した皮膚との接触状態を保てるかが問題となるが、コンプレッションウェアと組み合わせることで、少しの体動でもブレがでない心電図測定が可能となった。

  14. DDS型超分子デバイスを用いた光線力学療法による難治性小児がん根治への試み

    研究課題/研究課題番号:16K15741  2016年4月 - 2018年3月

    田井中 貴久

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    担当区分:研究分担者 

    小児固形がんは浸潤・転移があっても集学的治療で腫瘍を完全除去できれば根治しうるが、実臨床においてそれは容易でない。しかし研究代表者らは、診断と治療の一期的施行(セラノスティクス)を可能とした新しいDDS(ドラッグデリバリーシステム)型薬剤である「ICGラクトソーム」を用いた蛍光診断および光温熱治療により、浸潤性神経芽腫モデル動物の腫瘍を縮退させることに成功した。小動物を用いた非臨床研究を進め、光温熱治療による腫瘍温度をモニタリングし43℃以上に光加温することで、ほぼ確実に腫瘍消褪効果を得た。また、動物実験によって、腫瘍への高い選択的集積性を証明した。

  15. 電気電導体繊維の渦電流変化を利用した閉創前遺残ガーゼ感知システムの構築

    研究課題/研究課題番号:15K15258  2015年4月 - 2018年3月

    檜 顕成

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    担当区分:研究代表者 

    配分額:3510000円 ( 直接経費:2700000円 、 間接経費:810000円 )

    電気伝導体を手術用ガーゼに封入し、閉創前に渦電流の変化を体外から探知することで遺残ガーゼの有無を検証した。 今回使用した電気伝導体繊維である銀に関して体内模擬環境における分解動態の検索を行った。金属元素(銀)の定量結果及び抽出液のpH変化は共にごく微量であり、銀自体の人体への影響は非常に少ないと判断した。以上より生体適合性及び電気抵抗、実際の探知距離、銀の体内模擬環境における分解動態を考慮すると、現状では銀繊維よりなる4個あるいは16個程度の環状部(閉ループ 巻数3~7回)をもつ手術用ガーゼが閉創前遺残ガーゼ探知システムに適していることがわかった。

  16. 会陰アプローチによる仙骨前隙を利用した腹腔鏡下手術

    研究課題/研究課題番号:25670562  2013年4月 - 2017年3月

    谷水 長丸

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    担当区分:研究分担者 

    解剖学的に仙骨前隙正中に主要な血管や神経叢が無いことに着目し、仙骨前隙経路を利用した腹腔鏡下手術の可能性を検討した。一般的に仙骨前隙正中に主要な血管及び神経叢を認めない。更に会陰ポート挿入時は鏡視下で血管・神経を確認しながら行えるのでこれらの損傷を回避する安全確実な手技といえる。
    仙骨前隙を利用した腹腔鏡手術の手技の実現性、難易度、安全性を確認するために1動物実験、2画像による検証、3献体による正常解剖の確認、4組織学的検討の4項目を行った。

  17. Compromised hostへの重度侵襲対策

    研究課題/研究課題番号:25293369  2013年4月 - 2016年3月

    木下 学

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    担当区分:研究分担者 

    Compromised hostsでは侵襲時の貪食細胞の活性酸素や炎症性サイトカイン産生が亢進し、その制御で臓器障害が軽減したが、これらは菌排除や肝再生にも重要であった。肝には菌排除に重要な肝固有とTNF-FasL系で肝障害を起こす骨髄由来の2つのクッパー細胞があり、compromised hostsでは前者が減少、後者が増加し感染と臓器障害が増悪したことからクッパー細胞の亜型と機能の正常化が肝要と考えた。また、ナノシートの創傷被覆効果を検討し、銀ナノ粒子担持の抗菌ナノシートを開発した。凝固障害を伴う大量出血時の止血ナノ粒子による止血や、光線力学療法の免疫賦活作用を利用した感染対策も検討した。

  18. 着磁体による磁界の乱れを利用した閉創前ガーゼ感知システムの開発

    研究課題/研究課題番号:24659254  2012年4月 - 2016年3月

    檜 顕成

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    担当区分:研究代表者 

    配分額:1690000円 ( 直接経費:1300000円 、 間接経費:390000円 )

    手術時に体内に残存しても短時間で体外より検知できる閉創前ガーゼ感知システムの構築を試みた。ガーゼ感知デバイス及び感知ガーゼを数種類試作し、閉創前に感知ガーゼに含まれる金属繊維を検出することで遺残ガーゼを検知する。これまでの閉創前ガーゼ感知システムの改良で、研究開始当初の検知距離は約10㎝であったが、現在では約30㎝離れた部位から感知ガーゼを検出できるようになった。更に聴覚と視覚に同時に訴えるガーゼ感知デバイスの試作器を作製したが、現状では遺残ガーゼの位置を特定するシステムではない。

▼全件表示

産業財産権 5

  1. 新規検査開発サーバ及び新規検査開発方法

    東海国立大学機構,日立製作所

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    出願日:2020年2月

    公開番号:2021-128115  公開日:2021年9月

    出願国:国内   取得国:国内

  2. 尿中腫瘍マーカーによるがん検出方法、キット及び装置

    東海国立大学機構,日立製作所

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    出願日:2018年11月

    公開番号:2020-079729  公開日:2020年5月

    出願国:国内   取得国:国内

  3. 医療用線状材料

    法人名大,三井金属鉱業

     詳細を見る

    出願日:2018年6月

    公開番号:WO 2018/230415  公開日:2018年12月

    出願国:外国   取得国:外国

  4. 小児がん検査用尿中代謝物マーカー

    東海国立大学機構,日立製作所

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    出願日:2018年3月

    公開番号:2019-168319  公開日:2019年10月

    出願国:国内   取得国:国内

  5. 生体吸収性ステープル

    法人名大,産業技術総合研究所

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    出願日:2016年10月

    公開番号:WO 2017/061616  公開日:2017年4月

    出願国:外国   取得国:外国

 

担当経験のある科目 (本学) 1

  1. 小児外科

    2021

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  1. 小児外科

    2020年4月 - 現在 防衛省 防衛医科大学校)

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    科目区分:学部専門科目 

 

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