Akita University Research Articles

Tanaka-Muroga Laboratory, Electrical and Electronic Engineering Course, Department of Mathematical Science and Electrical-Electronic-Computer Engineering, Graduate School of Engineering Science, Akita University

Tanaka-Muroga Laboratory, Electrical and Electronic Engineering Course, Department of Mathematical Science and Electrical-Electronic-Computer Engineering, Graduate School of Engineering Science, Akita University

MP37-04 PREOPERATIVE REBOUND OF ANTI-ABO BLOOD TYPE ANTIBODY IS A RISK FACTOR OF ACUTE ANTIBODY-MEDIATED REJECTION IN KIDNEY TRANSPLANT RECIPIENTS EVEN IN RITUXIMAB ERA

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery I (MP37)1 Sep 2021MP37-04 PREOPERATIVE REBOUND OF ANTI-ABO BLOOD TYPE ANTIBODY IS A RISK FACTOR OF ACUTE ANTIBODY-MEDIATED REJECTION IN KIDNEY TRANSPLANT RECIPIENTS EVEN IN RITUXIMAB ERA Ryohei Yamamoto, Mitsuru Saito, Ryuichiro Sagehashi, Takuro Saito, Soki Kashima, Atsushi Koizumi, Taketoshi Nara, Kazuyuki Numakura, Shintaro Narita, Shintaro Narita, Shigeru Satoh, and Tomonori Habuchi Ryohei YamamotoRyohei Yamamoto More articles by this author , Mitsuru SaitoMitsuru Saito More articles by this author , Ryuichiro SagehashiRyuichiro Sagehashi More articles by this author , Takuro SaitoTakuro Saito More articles by this author , Soki KashimaSoki Kashima More articles by this author , Atsushi KoizumiAtsushi Koizumi More articles by this author , Taketoshi NaraTaketoshi Nara More articles by this author , Kazuyuki NumakuraKazuyuki Numakura More articles by this author , Shintaro NaritaShintaro Narita More articles by this author , Shintaro NaritaShintaro Narita More articles by this author , Shigeru SatohShigeru Satoh More articles by this author , and Tomonori HabuchiTomonori Habuchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002046.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Because ABO blood-type incompatible kidney transplantation (ABOI-KT) has a potential of acute antibody-mediated rejection (ABMR), desensitization therapies including antibody removal and administration of rituximab are mandatory. Rituximab, anti-CD20 antibody, can deplete B lymphocyte, this reportedly makes easy to regulate the antibody production and “rebound phenomenon” after antibody removal. Even in rituximab era, we sometimes encounter the cases presenting rebound of anti-ABO blood-type antibody in ABOI-KT, however, the clinical significance has not been clarified yet. METHODS: From November 2005 to May 2019, 70 patients received ABOI-KT in Akita University Hospital and were enrolled in this study. All patients were administered rituximab with 200 mg/body once at 3 weeks before transplantation. The other immunosuppressive agents such as mycophenolate mofetil with 1500 mg/day (from 3 weeks before KT), tacrolimus (from 1 week before KT; target trough level is 8-10 ng/mL) and methylprednisolone with 80 mg/day (from 1 week before KT) were also administered. To decrease the antibody titer, several sessions of antibody removal were performed (our target titer is 1:32 or lower). The rebound of antibody in this study was defined as that the baseline titer was ≥1:32 and if the titer returned to the level prior to antibody removal. We investigated the risk factors of antibody rebound and its relationship with ABMR within 1 month after KT. RESULTS: The mean age of patients at KT was 54±10 years old. Baseline titer was as follows; ≤1:64 was 47 patients (67%), 1:128 was 10 (14%), 1:256 was 8 (11%), 1:512 was 4 (6%), and ≥1:1048 was 1 (2%). The cases presenting rebound was 20 (29%, the rebound group). Ten cases (14%) developed ABMR within 1 month after KT. In multivariate analysis, baseline titer ≥1:128 was one of the independent risk factors for antibody rebound (p=0.001). There was no relationship between the antibody titer at baseline, antibody titer immediately before transplant and ABMR. However, the incidence of ABMR was significantly higher in the rebound group than in the non-rebound cases (p=0.004). In multivariate analysis, “rebound” was one of the independent risk factors for ABMR (p=0.003). CONCLUSIONS: The preoperative rebound in ABOI-KT was a risk factor of ABMR. In the kidney transplant recipients presenting rebound preoperatively, we have to monitor them carefully after ABOI-KT even in rituximab era. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e646-e646 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryohei Yamamoto More articles by this author Mitsuru Saito More articles by this author Ryuichiro Sagehashi More articles by this author Takuro Saito More articles by this author Soki Kashima More articles by this author Atsushi Koizumi More articles by this author Taketoshi Nara More articles by this author Kazuyuki Numakura More articles by this author Shintaro Narita More articles by this author Shintaro Narita More articles by this author Shigeru Satoh More articles by this author Tomonori Habuchi More articles by this author Expand All Advertisement Loading ...

Severity of Depressive Symptoms is Associated with Venous Thromboembolism in Hospitalized Patients with a Major Depressive Episode.

PurposeA major depressive episode is a risk factor for venous thromboembolism (VTE) in psychiatric inpatients. However, it is unclear whether the severity of depressive symptoms or duration of the current depressive episode is associated with VTE. Further, the VTE prevalence among hospitalized patients with a major depressive episode receiving electroconvulsive therapy is unknown. This retrospective study examined factors associated with VTE among hospitalized patients with a major depressive episode and estimated the prevalence of VTE in such patients who underwent electroconvulsive therapy.Patients and MethodsPatients with a major depressive episode hospitalized in the Department of Neuropsychiatry at Akita University Hospital between January 2018 and December 2020 were included. Data from the first week of hospitalization were extracted from medical records. VTE was diagnosed based on the findings of computed tomography. To evaluate whether the severity of depressive symptoms or duration of the current depressive episode was associated with VTE, logistic regression analysis was conducted after adjusting for covariates with known VTE risk factors (antidepressants, antipsychotics, and physical comorbidities).ResultsWe analyzed 133 patients; of these, 14 were diagnosed with asymptomatic VTE. The severity of depressive symptoms (odds ratio: 1.220, 95% confidence interval: 1.081–1.377, p = 0.001) was significantly associated with VTE. The prevalence of VTE among those receiving electroconvulsive therapy was 35% (7/20).ConclusionThe prevalence of VTE was 35% among patients receiving in-hospital electroconvulsive therapy for a major depressive episode. VTE should be considered for hospitalized patients with severe depressive symptoms and patients receiving in-hospital electroconvulsive therapy for a major depressive episode.

Analysis of the role of the endoplasmic reticulum stress response-related molecule CHOP in intestinal epithelial cells

Inflammatory bowel diseases (IBDs) include ulcerative colitis and Crohn's disease. The symptoms experienced by people with IBD include diarrhea, bloody stool, extreme tiredness, weight loss and stomach pain. IBD is on the rise globally and it is unknown why. There is no existing cure for the condition and treatments are not always successful. In the quest to find a cure for IBD, researchers are investigating the mechanisms of the disease. Dr Yosuke Shimodaira, Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Japan, is seeking to understand more about the mechanisms involved in the development of the disease. A key part of this research is autophagy and Shimodaira and the team are working to shed light on why endoplasmic reticulum (ER) stress in the intestinal epithelial cells induces autophagy and the role this might play in the development of IBD. A key learning for the team was that C/EBP-homologous protein (CHOP) is involved in the ER stress response. An important focus for the researchers is on the role played by CHOP in intestinal epithelial cells in vivo and its involvement in the pathophysiology of IBD. Shimodaira and the team plan to conduct experiments using mice and patients samples to analyse these fundamental mechanism in intestinal homeostasis. This will enable them to determine whether CHOP plays a role in vivo and how CHOP affect intestinal immune system.

Lenalidomide and Dexamethasone Therapy in Elderly Patients with Newly Diagnosed Multiple Myeloma to Determine Optimal Plasma Concentration of Lenalidomide

▪Background : Lenalidomide (Len) and dexamethasone (Dex) combination (Ld) therapy is now the standard treatment option for multiple myeloma (MM). MM mainly affects elderly individuals, and about 40% of MM patients are diagnosed over 75 years of age. Many elderly patients are vulnerable and therefore they are susceptible to adverse events (AEs). Therefore optimal dose intensity is needed when we treat elderly patients. Renal impairment (RI) is the most common complication of MM and 50% of MM patients develop RI during the clinical course. Len is excreted through urine and dose adjustment is required according to creatinine clearance (CCr) to prevent overexposure of Len. However despite the initial dose adjustment of Len according to CCr, unexpected adverse events (AEs) can occur. AEs are consistent with Len overexposure; however, optimal plasma concentration has not been established yet. Furthermore Len is known as an immunomodulatory drug and which can enhance the NK cell cytotoxicity as represented by the combination of elotuzumab.Purpose : We conducted a phase II trial of Ld therapy in elderly patients with newly diagnosed MM to evaluate the correlation between its efficacy, safety and Len pharmacokinetics and the immunomodulatory effect of Len against NK cells.Methods : Forty Japanese patients received oral Len on days 1-21 of a 28-day cycle and Dex weekly. The initial dose of Len was adjusted according to CCr [25 mg/day for normal renal function, 10 mg/day for mild RI (CCr 30- 60 mL/min) and 15 mg every other day for severe RI (CCr < 30 mL/min)]. The initial dose of Dex was adjusted based on patient's age [40 mg for ≤75 years and 20 mg for >75 years]. Some dose modification of Len and Dex was permitted by physician's choice if judged necessary considering the vulnerability. Whole-blood samples were collected immediately before oral administration (C0h) and 2, 4(C4h), 12, and 24 h thereafter and analyzed using liquid chromatography-tandem mass spectrometry. We predicted the AUC0−24 of Len using a previously developed formula, AUC0−24 = 37.1 × C0h + 6.4 × C4h - 32.1 × CCr + 3265.6; r2 = 0.842 (Ther Drug Monit 2014). Peripheral blood mononuclear cells (PBMCs) were used to evaluate the immunomodulatory effect of Len against NK cells. This study protocol was approved by the Ethics Committee of Akita University Hospital, and all recipients gave written informed consent.Results : Median age was 75.5 years and 21 patients showed RI necessary to adjust the Len dosage. The median initial dosage of Len and Dex was 12.5 mg and 20 mg, respectively. Overall response rate was 68.6 % and 2-year overall survival was 88.5%. The predicted AUC0-24 showed the highest correlation with the measured AUC0-24 (r = 0.956; P < 0.001). There was no correlation between response and Len pharmacokinetics. Grade 3 to 4 adverse events (AEs) were observed in 57.5% of patients and AUC0-24 was significantly higher in patients with grade 3 to 4 AEs than in those without grade 3 to 4 AEs (median 4852.0 ng · hr/mL vs. 2464.9 ng · hr/mL, P=0.027) (Figure 1). We identified a cut-off value of AUC0-24 for predicting grade 3 to 4 AEs using a receiver-operating characteristic curve and the value was 2613.5 ng · hr/mL (area under ROC curve of 0.758, p = 0.027) (Figure 2). Multivariate logistic analysis confirmed the significance of this cut-off value as a predictor of grade 3 to 4 AEs (hazard ratio 7.20, P = 0.043). The patients who achieved more than partial response (PR) showed the increased frequency and number of CD25 positive NK cells. However, there were no correlations between NK cells and PK parameters.Conclusions : These data suggest that Len overexposure could contribute to toxicity and the predicted cut-off AUC0-24 can be useful in preventing grade 3 to 4 AEs. Activated NK cells were increased in patients who achieved more than PR than in patients who did not achieve. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Disorganization of intercalated discs in dilated cardiomyopathy

Dilated cardiomyopathy (DCM) is a primary myocardial disease, the pathology of which is left ventricular or biventricular dilation and impaired myocardial contractility. The clinical and pathological diagnosis of DCM is difficult, and other cardiac diseases must be ruled out. Several studies have reported pathological findings that are characteristic of DCM, including cardiomyocyte atrophy, nuclear pleomorphism, and interstitial fibrosis, but none of these findings are DCM-specific. In this study, we examined the morphological differences in the intercalated discs (ICDs) between three groups of patients, a DCM group, a chronic heart failure group, and a control group. A total of 22 autopsy cases, including five DCM cases, nine CHF cases and eight control cases, were retrieved from the archives of the Department of Pathology at Akita University, Japan. The morphological differences were examined using multiple methods: macroscopic examination, light microscopy, immunohistochemistry, electron microscopy, and gene expression analyses. We observed disorganized ICDs, clearly illustrated by N-cadherin immunostaining in the DCM group. “Reduction of N-cadherin immunostaining intensity” and “ICD scattering” was DCM-specific. The results suggest that disorganized ICDs contribute to the development of DCM, and that N-cadherin immunostaining is useful for determining the presence of disorganized ICDs and for the pathological diagnosis of DCM.

Neoadjuvant Chemoradiotherapy Followed by Esophagectomy with Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma Patients with Clinical Stage III and with Supraclavicular Lymph Node Metastasis.

Simple SummaryThis study aimed to clarify the efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy with three-field lymph node (LN) dissection for clinical Stage III patients and for clinical Stage IVB patients with supraclavicular LN metastasis as the only distant metastatic factor. We observed that NACRT followed by esophagectomy with three-field lymph node dissection is feasible and offers the potential for long-term survival of these patients. It is also suggested that supraclavicular LNs should be treated as regional LNs at least in patients with upper and middle thoracic esophageal squamous cell carcinoma (ESCC).Background: Neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy is now the standard treatment for patients with resectable advanced thoracic esophageal squamous cell carcinoma (ESCC) worldwide. However, the efficacy of NACRT followed by esophagectomy with three-field lymph node dissection for clinical Stage III patients and for clinical Stage IVB patients with supraclavicular LN metastasis has not yet been determined. Methods: Between 2008 and 2018, 94 ESCC patients diagnosed as clinical Stage III and 18 patients diagnosed as clinical Stage IVB with supraclavicular LN metastasis as the only distant metastatic factor were treated with NACRT followed by esophagectomy with extended lymph node dissection at Akita University Hospital. Long-term survival and the patterns of recurrence in these 112 patients were analyzed. Results: The median follow-up period of censored cases was 60 months. The five-year OS and DSS rates among the clinical Stage III patients were 57.6% and 66.6%, respectively. The five-year OS and DSS rates among the clinical Stage IVB patients were 41.3% and 51.6%, respectively. The most frequent recurrence pattern was distant metastasis (69.2%) in the Stage III patients and LN metastasis (75.0%) in the Stage IVB patients. Conclusion: NACRT followed by esophagectomy with three-field LN dissection is feasible and offers the potential for long-term survival of clinical Stage III ESCC patients and even clinical Stage IVB patients with supraclavicular LN metastasis as the only distant metastatic factor. At least in patients with upper and middle thoracic ESCC, treating supraclavicular LNs as regional LNs seems to be appropriate.

Industry-academia-local Government Collaboration by the Research and the Development of Electric Architecture System at Akita University

Industry-academia-local Government Collaboration by the Research and the Development of Electric Architecture System at Akita University

Verification of the Optimal Interval Before Esophagectomy After Preoperative Neoadjuvant Chemoradiotherapy for Locally Advanced Thoracic Esophageal Cancer

The interval between preoperative chemoradiotherapy and surgery reportedly affects perioperative outcomes and survival; however, the optimal interval in esophageal cancer patients remains uncertain. Our aim was to determine whether a prolonged interval between preoperative neoadjuvant chemoradiotherapy (NACRT) and esophagectomy affects the outcomes of esophageal cancer patients. A total of 131 patients with esophageal cancer received curative surgery following NACRT at Akita University Hospital between 2009 and 2017. We divided these patients into two groups based on the median interval from NACRT to esophagectomy, and compared the rates of pathological complete response (pCR), surgical outcomes, and survival. The median interval from NACRT to esophagectomy was 39days (range 21-95). Of the 131 patients, 70 (53%) received esophagectomy after 39days or more from completion of NACRT. There were no significant differences in the clinicopathological features, including pCR rates, between the two groups. Prolongation of the interval from NACRT to esophagectomy was significantly associated with an increased rate of anastomotic leakage and recurrent laryngeal nerve palsy (p = 0.0225 and p = 0.0022, respectively); however, no association with overall survival was detected. A prolonged interval between NACRT and esophagectomy had no impact on pCR rates or survival. However, delaying esophagectomy may increase the likelihood of surgical complications such as anastomotic leakage and recurrent laryngeal nerve palsy.

Comparison of the incidences of anastomotic leakage when PDSII or LACLON are used in esophago-gastric conduit handsewn anastomosis after esophagectomy

The incidence of anastomotic leakage after esophagectomy remains around 10%. It was previously reported that PDSII rapidly loses tensile strength at pH 1.0 and pH 8.5. By contrast, LACLON degradation is reportedly insensitive to pH. We therefore compared LACLON with PDSII for esophago-gastric conduit, layer-to-layer, handsewn anastomosis. Between January 2016 and January 2020, 90 patients who received posterior mediastinal gastric conduit reconstruction with layer-to-layer handsewn anastomosis (51 using PDSII and 39 using LACLON) at Akita University Hospital were enrolled. The incidence of anastomotic leakage was significantly lower in the LACLON (2.6%, 1/39 patients) than PDSII group (15.7%, 8/51 patients) (p = 0.0268). Multivariable logistic analysis showed the risk of anastomotic leakage was significantly greater with PDSII than LACLON (odds ratio 11.01; 95% CI 1.326–277.64; p = 0.024). The percentages of time the pH was higher than 8 on the gastric conduit side of the anastomosis were 3.1%, 5.7%, 20.9% and 80.5%, respectively, in the four most recent patients. The present study showed that pH at the anastomosis soon after esophagectomy tends to be alkaline rather than acidic, which raises the possibility that this alkalinity facilitates the deterioration of surgical sutures including PDSII.

The Connection between Urinary Equol Levels and the Prevalence of Atopic Dermatitis

Background: Soy isoflavones and their metabolites such as equol have been associated with a reduced risk of hormone-sensitive tumors and metabolic syndromes. However, individual soy isoflavones and equol levels in atopic dermatitis remain uninvestigated. Objective: The aim of this study is to compare the levels of urinary daidzein, genistein, and equol between atopic dermatitis patients and normal subjects and to examine the correlation between equol concentration and the severity of clinical symptoms. Methods: A cross-sectional study was conducted at Akita University Hospital and Aso Iizuka Hospital in Japan. Fifty patients with confirmed atopic dermatitis diagnosis and 67 healthy controls were recruited. Daidzein, genistein, and equol in urine were measured by using a high-performance liquid chromatography-mass spectrometry system. Results: Urinary equol levels were significantly lower in the atopic dermatitis patients than in the healthy controls (p = 0.002). The difference was particularly noticeable in young people (6–19 years, p < 0.001). No correlations were found between urinary equol levels and the severity of clinical symptoms and laboratory data in the atopic dermatitis patients. Conclusion: Equol levels in childhood might be involved in the development of atopic dermatitis.

Evaluation of ground source heat pump system’s enhancement by extracting groundwater and making artificial groundwater velocity

This study used moving line source technique as a practical approach to simultaneously determine effective thermal conductivity, groundwater velocity and borehole resistance. It mainly focused on the applicability of this approach for observing the effect of groundwater extraction, in particular for ungrouted ground heat exchangers. The thermal response tests were carried out for different ground heat exchangers at two sites on the Akita University campus, northern Japan. The test conditions varied, based on different borehole filling condition (grouted/ungrouted), heat loads and presence of an extra pump for groundwater extraction. The hydro-thermal parameters of the ground were determined by a MATLAB code, especially for consideration of the effect of artificial groundwater velocity under a special test, where a water pump extracts the groundwater from the casing of the borehole during the test. This method can estimate the groundwater velocity and the effective thermal conductivity of the soil by reproducing the temperature distribution in the well and minimizing the root mean squared error between the calculated results and the measured data. As a result, the groundwater velocity and thermal conductivity calculated by this method improved to 205.3 cm/day and 7.48 W/m K, respectively, due to presence of the external pump, whereas the undisturbed groundwater velocity in the other cases without pumping was estimated in the range of 15 to 16 cm/day. Furthermore, the minimum groundwater velocity and thermal conductivity were reported for the grouted well as being equal to 10.79 cm/day and 1.16 W/m K, respectively.

589 - Overweight patients less improved kidney function after laparoscopic surgery for adrenocortical adenoma with excess cortisol secretion

Purpose: Glucocorticoid (GC) is known to be involved in the deterioration of kidney function both directly by affecting the glomeruli and renal tubules and indirectly by affecting cardiovascular function. Autonomous GC secretion is the main feature of primary adrenal hypercortisolism (PAHC). However, the ideal treatment option (operation vs. medical treatment and observation) for patients with PAHC has not been established yet. In this study, we assessed a time series of kidney function in patients with PAHC treated via laparoscopic adrenalectomy and investigated the predictive factors for kidney function 1 year after surgery. Methods: From September 1997 to July 2017, 175 laparoscopic adrenalectomies were performed for adrenal tumors at Akita University. Thirty patients, who were diagnosed as having PAHC via preoperative endocrinological evaluations and followed up for at least 1 year after surgery, were included in this study. Patients with severe complications or simultaneous aldosteronism were excluded. The mean age of the 30 patients was 57.5 years (range, 33-79 years; males, 4; females, 26), and the right and left sides were affected in 9 and 21 patients, respectively. Results: In all, 18 patients were diagnosed as having Cushing's syndrome and 12 as having subclinical Cushing's syndrome. The steroid cover was required in all cases after surgery. The estimated glomerular filtration rate significantly improved (78.4 mL/min [64.8-95.8] vs. 84.1 mL/min [66.8-104.0], p = 0.012) 1 year after surgery. Patients showing 5% or more improvement in kidney function and those showing less than 5% improvement were compared. On performing univariate analyses, factors such as a longer operative time, heavy body mass index (BMI), and preoperative unsuppressed ACTH were associated with worse improvement in kidney function. No significant associations were observed regarding metabolic disorders, clinical symptoms, and gross proteinuria. On multivariate analysis, patients with a higher BMI (≥ 24 kg/m2) showed worse improvement in kidney function at 1 year after surgery (odds ratio 14.0, 95% confidence interval 1.3-142.9, p = 0.012). Conclusions: In PAHC patients, after 1 year of follow-up, kidney function improved in terms of estimated glomerular filtration rate. Therefore, this improvement seems to be delayed in overweight patients, suggesting its direct role in renal function.

Alkane Shape- and Size-Recognized Selective Vapor Sorption in "Channel-Like" Crystals Based on Thiacalixarene Assemblies.

Invited for the cover of this issue is the group of Manabu Yamada at Akita University and colleagues from Yamagata University and Vellore Institute of Technology. The image depicts two activated "channel-like" crystals, effectively adsorb branched and cyclic alkanes from linear, branched, and cyclic alkane vapors. Read the full text of the article at 10.1002/chem.202000043.

Case study and event analysis for mitigation of unpredictable volcanic hazard

Volcanology is an extremely important scientific discipline. Shedding light on how and why volcanoes erupt, how eruptions can be predicted and their impact on humans and the environment is crucial to public safety, economies and businesses. Understanding volcanoes means eruptions can be anticipated and at-risk communities can be forewarned, enabling them to implement mitigation measures. Professor Tsukasa Ohba is a scientist based at the Graduate School of International Resource Studies, Akita University, Japan, and specialises in volcanology and petrology. Ohba and his team are focusing on volcanic phenomena including: phreatic eruptions (a steam-driven eruption driven by the heat from magma interacting with water); lahar (volcanic mudflow); and monogenetic basalt eruptions (which consist of a group of small monogenetic volcanoes, each of which erupts only once). The researchers are working to understand the mechanisms of these phenomena using Petrology. Petrology is one of the traditional methods in volcanology but has not been applied to disastrous eruptions before. The teams research will contribute to volcanic hazard mitigation.

The investigation of salvage endoscopic laryngopharyngeal surgery after chemoradiotherapy.

IntroductionEndoscopic laryngopharyngeal surgery (ELPS) is an effective treatment for early-stage oropharyngeal and hypopharyngeal cancers. Since 2007, we have performed ELPS on 14 patients with early-stage cancer who had undergone radiation therapy (salvage ELPS). We discuss the beneficial effects and issues with salvage ELPS compared with those of fresh patients since we experienced some severe complications, such as ruptured pseudoaneurysm with salvage ELPS.AimTo our knowledge, the efficacy and safety of ELPS following radiation therapy have not yet been evaluated, and several unknown factors exist. An evaluation was performed for assessing whether ELPS following radiation therapy is safe, similar to findings in fresh cases previously reported by us, and whether this treatment method can be efficacious.Material and methodsWe studied the cases of 14 patients who had undergone salvage ELPS after radiation therapy for head and neck cancer at Akita University Hospital between 2007 and 2018.ResultsThe rate of recurrence of head and neck cancer at different sites after salvage ELPS was 48.9% at 2 years. Furthermore, deformation of the pharyngolarynx made it extremely difficult to perform surgery. We also experienced extremely severe complications of ruptured pseudoaneurysms.ConclusionsIf salvage ELPS is performed after radiation therapy, patients should be followed up on an outpatient basis to monitor the onset of subsequent cancers. Complications may become severe; therefore, postoperative management should be performed cautiously. In particular, vulnerable sites, such as the piriform sinus, may not be indicated for surgery. At this stage, the expectation is that patients need to be methodically selected.

Prevalence of Asymptomatic Venous Thromboembolism in Depressive Inpatients.

PurposeWhile depression has been recognized as a risk factor for venous thromboembolism (VTE), the prevalence of VTE in depressed inpatients has never been investigated. The aim of this study was thus to examine VTE prevalence and factors associated with VTE in depressed inpatients.Patients and MethodsWe conducted a retrospective cross-sectional study of consecutive depressed inpatients (n = 94) from January 1, 2018, to June 30, 2019, at the psychiatry department of Akita University Hospital. As part of our clinical routine, depressed inpatients were screened for VTE using D-dimer, and patients who screened positive underwent enhanced CT to examine VTE. A variety of data was extracted from medical records, including, amongst others, age, sex, body mass index, diagnoses of psychiatric disorders, total scores on the 17-item Hamilton Depression Rating Scale, duration of current depressive episode, daily dosages of antidepressants and antipsychotics, catatonia, and physical restraint.ResultsVTE was detected in 8.5% of depressed inpatients. There were no significant differences between VTE-positive and VTE-negative inpatients regarding any of the considered factors.ConclusionOur analysis shows a VTE prevalence of 8.5% in depressed inpatients, higher than that of 2.3% reported in a previous study in hospitalized patients with psychiatric disorders including depression. This emphasizes the importance of VTE screening for depressive inpatients.

Second-Generation Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia with Additional Chromosomal Abnormalities

Second-Generation Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia with Additional Chromosomal Abnormalities

Overweight Patients Less Improved Kidney Function After Laparoscopic Surgery for Adrenocortical Adenoma With Excess Cortisol Secretion.

Purpose: Glucocorticoid (GC) is known to be involved in the deterioration of kidney function both directly by affecting the glomeruli and renal tubules and indirectly by affecting cardiovascular function. Autonomous GC secretion is the main feature of primary adrenal hypercortisolism (PAHC). However, the ideal treatment option (operation vs. medical treatment and observation) for patients with PAHC has not been established yet. In this study, we assessed a time series of kidney function in patients with PAHC treated via laparoscopic adrenalectomy and investigated the predictive factors for kidney function 1 year after surgery.Methods: From September 1997 to July 2017, 175 laparoscopic adrenalectomies were performed for adrenal tumors at Akita University. Thirty patients, who were diagnosed as having PAHC via preoperative endocrinological evaluations and followed up for at least 1 year after surgery, were included in this study. Patients with severe complications or simultaneous aldosteronism were excluded. The mean age of the 30 patients was 57.5 years (range, 33–79 years; males, 4; females, 26), and the right and left sides were affected in 9 and 21 patients, respectively.Results: In all, 18 patients were diagnosed as having Cushing's syndrome and 12 as having subclinical Cushing's syndrome. The steroid cover was required in all cases after surgery. The estimated glomerular filtration rate significantly improved (78.4 mL/min [64.8–95.8] vs. 84.1 mL/min [66.8–104.0], p = 0.012) 1 year after surgery. Patients showing 5% or more improvement in kidney function and those showing less than 5% improvement were compared. On performing univariate analyses, factors such as a longer operative time, heavy body mass index (BMI), and preoperative unsuppressed ACTH were associated with worse improvement in kidney function. No significant associations were observed regarding metabolic disorders, clinical symptoms, and gross proteinuria. On multivariate analysis, patients with a higher BMI (≥ 24 kg/m2) showed worse improvement in kidney function at 1 year after surgery (odds ratio 14.0, 95% confidence interval 1.3–142.9, p = 0.012).Conclusions: In PAHC patients, after 1 year of follow-up, kidney function improved in terms of estimated glomerular filtration rate. Therefore, this improvement seems to be delayed in overweight patients, suggesting its direct role in renal function.

Visual-Inertial Odometer-Based Global High Precision Indoor Human Navigation in a University Library

Abstract. AR (Augmented Reality) could be realized as a basic and high-level function on latest smartphones with a reasonable price. AR enables users to experience consistent three-dimensional (3D) spaces co-existing with 3D real and virtual objects with sensing real 3D environments and reconstructing them in the virtual world through a camera. The accuracy of sensing real 3D environments using an AR function, that is, visual-inertial odometer, of a smartphone is extremely higher than one of a GPS receiver on it, and can be less than one centimeter. However, current common AR applications generally focus on “small” real 3D spaces, not large real 3D spaces. In other words, most of the current AR applications are not designed for uses based on a geographic coordinate system.We proposed a global extension of the visual-inertial odometer with an image recognition function of geo-referenced image markers installed in real 3D spaces. Examples of geo-referenced image markers can be generated from analog guide boards existing in the real world. We tested this framework of a global extension of the visual-inertial odometer embedded in a smartphone on the first floor in the central library of Akita University. The geo-referenced image markers such as floor map boards and book categories sign boards were registered in a database of 3D geo-referenced real-world scene images. Our prototype system developed on a smartphone, that is, iPhone XS, Apple Inc., could first recognized a floor map board (Fig. 1), and could determine the 3D precise distance and direction of the smartphone from the central position of the floor map board in a local 3D coordinate space with the origin point as the central positon of the board. Then, the system could convert the relative precise position and the relative direction of the smartphone’s camera in a local coordinate space into a global precise location and orientation of it. A subject was walking the first floor in the building of the library with a world tracking function of the smartphone. The experimental result shows that the error of tracking a real 3D space of a global coordinate system was accumulated, but not bad. The accumulated error was only about 30 centimeters after the subject’s walking about 30 meters (Fig. 2). We are now planning to improve our prototype system in the accuracy of indoor navigation with calibrating the location and orientation of a smartphone based sequential recognitions of multiple referenced scene image markers which have already existed for a general user services of the library before developing this proposed new services. As the conclusion, the experiment’s result of testing our prototype system was impressive, we are now preparing a more practical high-precision LBS which enables a user to be navigated to the exact location of a book of a user’s interest in a bookshelf on a floor with AR and floor map interfaces.