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Kuwano H, Yokobori T, Kumakura Y, Ogata K, Yoshida T, Kuriyama K, Sakai M, Sohda M, Miyazaki T, Saeki H, Shirabe K. Pathophysiology of Vomiting and Esophageal Perforation in Boerhaave's Syndrome. Dig Dis Sci 2020; 65:3253-3259. [PMID: 31965389 DOI: 10.1007/s10620-019-06028-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/22/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Boerhaave's syndrome, involving esophagus rupture, is considered a pathological response to vomiting that may occur just before perforation. However, the mechanism of vomiting and occurrence of this disease have not been clearly demonstrated. METHODS We identified patients with esophageal perforation between 1995 and 2017 and reviewed endoscopic findings at retching during upper gastrointestinal endoscopy. Finally, we proposed a theory for the underlying pathological mechanism. RESULTS We retrospectively investigated 10 patients with esophageal perforation between 1995 and 2017. All patients presented after vomiting associated with large volumes of food and alcohol intake. Nine were treated by primary closure of the perforation and drainage of the thoracic cavity, and one was conservatively treated. In all cases, the perforations were longitudinal tears (1-4 cm) and located in the left of the esophagus, just above the gastric cardia. CONCLUSIONS We hypothesize that vomiting occurred by retrograde propagation of gastrointestinal motor contraction from the jejunum to the gastric antrum, followed by prolapse of the gastric fornix mucosal into the esophagus. Subsequent esophageal perforation probably resulted from excessive prolapse due to strong contraction and destruction of the muscularis mucosa of the left side of abdominal esophagus, with longitudinal stretching of the whole left esophageal wall due to traction. We also propose that Boerhaave's syndrome is defined as "post-emetic esophageal perforation" to ensure broader recognition and more expedient diagnosis and treatment. Remaining conditions without any definite causes may be labeled "idiopathic" or "spontaneous" rupture of the esophagus.
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Ubukata Y, Ogata K, Sohda M, Yokobori T, Shimoda Y, Handa T, Nakazawa N, Kimura A, Kogure N, Sano A, Sakai M, Ogawa H, Kuwano H, Shirabe K, Oyama T, Saeki H. Role of PD-L1 Expression during the Progression of Submucosal Gastric Cancer. Oncology 2020; 99:15-22. [PMID: 33113541 DOI: 10.1159/000509033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Programmed death-ligand 1 (PD-L1) expression is a prognostic marker for gastric cancer that correlates with tumor diameter and depth of penetration. But the role of PD-L1 and mechanism(s) employed in the initial phase of invasion in early gastric cancer is yet to be understood. OBJECTIVE This study aims to elucidate the role of PD-L1 during the progression of gastric cancer, specifically invading the submucosa beyond the lamina muscularis mucosa. METHODS Using 107 patients with pathological submucosal gastric cancer, we determined the expression of PD-L1 based on the staining of the cell membrane or cytoplasm of tumor cells in the central and invasive front of the tumor. Samples were categorized into 3 groups based on the intensity of PD-L1 expression. CD8+ lymphocytes expressing PD-1 and CD163+ macrophages were used to determine the number of cell nuclei at the invasive front, similar to PD-L1. CMTM6 levels were determined and used to stratify samples into 3 groups. RESULTS PD-L1 expression was higher in the invasive front (26.2%) than in the central portion of the tumors (7.4%; p < 0.001). Moreover, lymphatic and vascular invasion were more frequently observed in samples with high levels of PD-L1 (lymphatic invasion: 60.7 vs. 35.4%, p = 0.0026, and vascular invasion: 39.3 vs. 16.5%, p = 0.0018). There was no correlation between PD-L1 expression and the levels of PD-1, CD8, CD163, and CMTM6. CONCLUSIONS PD-L1-expressing cancer cells at the invasive front of gastric cancer influence the initial stages of tumor invasion and lymphovascular permeation in early-stage gastric cancers. Immune checkpoint signaling may be the driving force in the invasive front during the invasion of the submucosa beyond the lamina muscularis mucosa.
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Watase Y, Takahashi H, Ushio K, Fujii M, Sakai M. IR super-resolution imaging of avian feather keratins detected by using vibrational sum-frequency generation. Biophys Chem 2020; 267:106482. [PMID: 33022568 DOI: 10.1016/j.bpc.2020.106482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022]
Abstract
IR super-resolution imaging of the cross section of the rachis of an avian feather was carried out by using a vibrational sum-frequency generation (VSFG) detected IR microscope with a sub-micrometer spatial resolution. In the YYX polarization combination, we clearly observed strong signals in the entire region of the rachis at the amide I vibration of β-keratin. On the other hand, the signal disappears from most of the cross section in the XXY polarization combination. Because the VSFG imaging detects the signal only from the interface, we conclude that the interfacial deflection inside of a rachis was detected.
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Saeki H, Sohda M, Sakai M, Sano A, Shirabe K. Role of surgery in multidisciplinary treatment strategies for locally advanced esophageal squamous cell carcinoma. Ann Gastroenterol Surg 2020; 4:490-497. [PMID: 33005843 PMCID: PMC7511562 DOI: 10.1002/ags3.12364] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 12/13/2022] Open
Abstract
We reviewed the current status and future perspectives regarding the role of surgery in multidisciplinary treatment strategies for locally advanced esophageal squamous cell carcinoma (ESCC). The treatment and management of ESCC have been improved by dramatic advances in diagnostic techniques and the development of surgery, chemotherapy, radiotherapy, and immunotherapy. The current standard treatment for locally advanced ESCC is preoperative chemotherapy followed by surgery in Japan, whereas preoperative chemoradiotherapy is a globally recommended approach. Differences of recognition regarding the role for surgery between Japan and many Western countries may have created peculiar preferences for preoperative therapy. The clinical significance of conversion strategy and salvage surgery for patients with ESCC should be further evaluated in terms of curability and safety. Although strategies to identify patients who would benefit from preoperative therapy are strongly required to avoid performing unnecessary treatment, it remains difficult to predict the efficacy of preoperative therapy prior to treatment. Prospective clinical trials and basic research to identify predictive biomarkers for response to chemotherapy, radiotherapy, and immunotherapy are needed to promote the development of multidisciplinary treatment strategies for patients with ESCC.
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105
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Kubo N, Kubota Y, Oike T, Kawamura H, Sakai M, Imamura A, Komatsu S, Miyasaka Y, Sato H, Musha A, Okano N, Shirai K, Saitoh JI, Chikamatsu K, Ohno T. Skin Dose Reduction by Layer-Stacking Irradiation in Carbon Ion Radiotherapy for Parotid Tumors. Front Oncol 2020; 10:1396. [PMID: 32923391 PMCID: PMC7456805 DOI: 10.3389/fonc.2020.01396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/02/2020] [Indexed: 01/18/2023] Open
Abstract
Background: Layer-stacking irradiation (LSI) results in the accumulation of multiple small spread-out Bragg peaks along the beam direction. Although the superiority of LSI to conventional passive irradiation (CPI) regarding normal tissue sparing is theoretically evident, the clinical benefit of LSI has not been demonstrated. Here, we compared LSI with CPI using the same treatment planning-computed tomography images used for carbon ion radiotherapy (CIRT). Methods: Twenty-one parotid tumors were analyzed. The clinical target volume (CTV) 1 and CTV2 encompassed the parotid grand and the tumor, respectively. CTV1 and CTV2 received 36 Gy (RBE: relative biological effectiveness) in nine fractions and 64 Gy (RBE) in 16 fractions, respectively, using either LSI or CPI. CTV coverage was assessed by DX%, which is the dose covering at least X% of the target volume. Skin dose was assessed by SX, which is the skin surface area receiving at least X Gy (RBE). Results: For CTV1 and CTV2, there were no significant differences in D2% between LSI and CPI. D50% and D98% were slightly higher for CPI; however, the absolute difference between the two methods was <3%. S10-S60 (in increments of 10) were significantly lower for LSI than for CPI (P < 0.001 for all parameters). LSI was associated with a significant trend toward dose reduction at the skin area irradiated with a higher dose by CPI (P < 0.001). Conclusions: LSI achieved better skin sparing than CPI without sacrificing target volume coverage in parotid tumor patients.
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Okubo Y, Sakai M, Yamazaki H, Sugawara Y, Samejima J, Yoshioka E, Suzuki M, Washimi K, Kawachi K, Hayashi H, Ito H, Iwasaki H, Yokose T. Histopathological study of carcinoma showing thymus-like differentiation (CASTLE). THE MALAYSIAN JOURNAL OF PATHOLOGY 2020; 42:259-265. [PMID: 32860379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Carcinoma showing thymus-like differentiation (CASTLE) is a rare tumour that mainly arises from the thyroid gland, or occasionally, from the head and neck. Although the 10-year survival rate of patients with CASTLE is approximately 80%, local recurrence and distant metastasis are observed in some cases. A recent systematic review for CASTLE indicated that the prognostic factors are treatment-dependent, and postoperative radiotherapy significantly improves patient survival. CASE REPORT Herein, we describe and compare three cases of CASTLE, including a case with distant metastasis despite administering postoperative chemotherapy. Thus, the mechanisms underlying metastasis of CASTLE are unclear. This case study helps to elucidate the histopathological risk factors of metastasis in CASTLE. DISCUSSION We found that prominent lymphovascular invasion and higher proliferative activities might be risk factors of metastasis in CASTLE. In addition, we have summarised the cytological, morphological, and immunohistochemical features of CASTLE for an accurate diagnosis.
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Suzuki S, Aihara R, Ooki T, Matsumura N, Wada W, Mogi A, Hosouchi Y, Nishida Y, Sakai M, Sohda M, Saeki H, Shirabe K. Successful treatment of enterocutaneous fistula after esophagectomy with scopolamine ointment and negative pressure wound therapy: a case report. Surg Case Rep 2020; 6:177. [PMID: 32700198 PMCID: PMC7376997 DOI: 10.1186/s40792-020-00938-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite improved surgical techniques and perioperative management, anastomotic leakage (AL) after esophageal cancer surgery remains a potential complication. In most cases, spontaneous healing upon proper drainage is observed, but sometimes, AL results in intractable enterocutaneous fistulas. We here report a case of intractable enterocutaneous fistula caused by post-esophagectomy AL and successfully treated by scopolamine ointment and negative pressure wound therapy (NPWT). Case presentation A 77-year-old man underwent thoracoscopic subtotal esophagectomy with 3-field lymph node dissection, followed by gastric tube reconstruction through the posterior mediastinal route. On the 6th postoperative day, AL was identified, forming an enterocutaneous fistula. Initially, conservative treatment was performed, but the fistula failed to close. We hypothesized that the substantial amount of exudate might be hampering fistula closure. Scopolamine ointment was used to reduce the amount of fluid. NPWT was also initiated to promote wound healing. Approximately 3 weeks after the beginning of the treatment, the fistula closed; oral intake became possible, and the patient was discharged from the hospital without any symptoms. Conclusions The combination of scopolamine ointment and NPWT may be regarded as one effective treatment option for intractable enterocutaneous fistula due to AL after esophagectomy.
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Sohda M, Kuwano H, Sakai M, Miyazaki T, Kakeji Y, Toh Y, Matsubara H. A national survey on esophageal perforation: study of cases at accredited institutions by the Japanese Esophagus Society. Esophagus 2020; 17:230-238. [PMID: 32415409 DOI: 10.1007/s10388-020-00744-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To get a clear view of the current state of treatment for esophageal perforation in Japan. Esophagus perforations are the most serious gastrointestinal tract perforations and are associated with high morbidity and mortality. The optimal treatment choice remains unknown. METHODS We conducted a retrospective clinical review of 182 esophageal perforation cases at 108 hospitals accredited by the Japanese Esophageal Society between January 2010 and December 2015. RESULTS We found that 20.9% of patients were incorrectly diagnosed initially. We observed mediastinum emphysema in 83.5% of patients, and serious abscess formations of the mediastinum and intrathoracic cavity in 38.6% and 29.6%, respectively. The lower esophagus was the most commonly perforated site (77.7%). Management of esophageal perforations included nonoperative treatment in 20 patients (11%) and operative treatment in 162 patients (89%). The overall mortality rate was 6.9%. The survivors had significantly shorter times from symptom appearance to visit (p = 0.0016), and from time to visit to diagnosis confirmation (p = 0.0011). Moreover, patients older than 65 years, white blood cells less than 3000/mm3, C-reactive protein > 10 mg/L, or abscesses in the thoracic cavity showed significantly higher mortality than others. CONCLUSION Shortening the time from onset to the start of treatment contributes to reduce mortality in patients with esophageal perforation. Moreover, strict medical treatment is necessary to lower the mortality rate of elderly patients with strong inflammation and abscesses in the thoracic cavity.
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Seidman J, Troutman T, Sakai M, Li R, Ouyang Z, Spann N, Bennett H, Bruni C, Vu B, Ego K, Pasillas M, Texari L, Heinz S, Glass C. 264 Interrogating altered enhancer landscapes to decode pathogenic changes in macrophages during chronic inflammatory disease. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yoshida T, Yokobori T, Kuriyama K, Sakai M, Sano A, Ogawa H, Sohda M, Saeki H, Kuwano H, Shirabe K. ASO Author Reflections: CD36 Expression Is Associated with Cancer Aggressiveness and Energy Source in Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2020; 27:791-792. [PMID: 32591954 DOI: 10.1245/s10434-020-08752-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Indexed: 02/03/2023]
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Yoshida T, Yokobori T, Saito H, Kuriyama K, Kumakura Y, Honjo H, Hara K, Sakai M, Miyazaki T, Obinata H, Erkhem-Ochir B, Gombodorj N, Sohda M, Saeki H, Kuwano H, Shirabe K. CD36 Expression Is Associated with Cancer Aggressiveness and Energy Source in Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2020; 28:1217-1227. [PMID: 32529269 DOI: 10.1245/s10434-020-08711-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) is an important cause of cancer-related death worldwide. CD36, a long-chain fatty acid (FA) receptor, can initiate metastasis in human oral squamous cell carcinoma (SCC), and its expression is associated with poor prognosis in several cancers. The clinical significance of CD36 expression and its function in ESCC remain unknown. METHODS We examined the clinical significance of CD36 expression in 160 ESCC samples using immunohistochemical staining. Functional analysis was performed to determine the association between CD36 and ESCC characteristics (proliferative ability, invasive ability, and energy source dependency). RESULTS Thirty (18.8%) ESCC cases showed high CD36 expression, indicating a significant association with progression. CD36 suppression inhibited proliferation and invasiveness in ESCC cells. ESCC cells with CD36 suppression used specific essential amino acids (EAAs) as energy sources. Cell viability depended on FAs under CD36 expression. The viability of ESCC cells with CD36 suppression depended on EAAs but not FAs. CONCLUSIONS CD36 may be a good biomarker and therapeutic target in ESCC. Our data provide new insights into the basic mechanism of CD36-dependent energy utilization for ESCC survival. CD36 might be a key regulator of the dependency of FAs as energy source in ESCC cells.
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Shiba S, Parajuli RK, Sakai M, Oike T, Ohno T, Nakano T. Use of a Si/CdTe Compton Camera for In vivo Real-Time Monitoring of Annihilation Gamma Rays Generated by Carbon Ion Beam Irradiation. Front Oncol 2020; 10:635. [PMID: 32509570 PMCID: PMC7248380 DOI: 10.3389/fonc.2020.00635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/06/2020] [Indexed: 01/03/2023] Open
Abstract
The application of annihilation gamma-ray monitoring to the adaptive therapy of carbon ion radiotherapy (C-ion RT) requires identification of the peak intensity position and confirmation of activated elements with annihilation gamma-rays generated at the C-ion-irradiated site from those transported to unirradiated sites. Real-time monitoring of C-ion-induced annihilation gamma-rays was implemented using a Compton camera in a mouse model. An adult C57BL/6 mouse was anesthetized, and C-ion beams were directed into the abdomen at 1 × 109 particles/s for 20 s. The 511 keV annihilation gamma-rays, generated by the interaction between the irradiated C-ion beam and the target mouse, were detected using a silicon/cadmium telluride (Si/CdTe) Compton camera for 20 min immediately after irradiation. The irradiated site and the peak intensity position of 511 keV gamma emissions due to C-ion beam irradiation on a mouse were observed at the abdomen of the mouse by developing Compton images. Moreover, the positron emitter transport was observed by evaluating the range of gamma-ray emission after the C-ion beam irradiation on the mouse. Our data suggest that by confirming the peak intensity and beam range of C-ion RT with Si/CdTe-based Compton camera, it would be possible to reduce the intra-fractional and inter-fractional dose distribution degradation. Therefore, the results of this study would contribute to the future development of adaptive therapy with C-ion RT for humans.
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Sakai M, Sohda M, Saito H, Ubukata Y, Nakazawa N, Kuriyama K, Hara K, Sano A, Ogata K, Yokobori T, Shirabe K, Saeki H. Impact of combined assessment of systemic inflammation and presarcopenia on survival for surgically resected esophageal cancer. Am J Surg 2020; 221:149-154. [PMID: 32594999 DOI: 10.1016/j.amjsurg.2020.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Systemic inflammation and low skeletal muscle volume (presarcopenia) have received increasing attention in many malignancies. However, their association and the combined effect on postoperative survival in esophageal cancer (EC) patients have been poorly studied. METHODS Eighty-nine patients with EC who underwent surgery between 2006 and 2014 were included in this study. Neutrophil-to-lymphocyte ratio (NLR) ≥3.0 was categorized as having systemic inflammation. Presarcopenia was defined as a Skeletal muscle index (SMI) less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women. RESULTS Multivariate analysis revealed that presarcopenia was an independent prognostic preoperative factor for overall survival (OS) (p = 0.004). Multivariate analysis for OS stratified by systemic inflammation revealed that presarcopenia with systemic inflammation (Hazard ratio(HR),20.70; 95% confidence interval (CI),1.34-318.90) was associated with nearly a seven-fold higher risk of death than those without systemic inflammation (HR, 2.94; 95%CI, 1.04-8.34). CONCLUSIONS Systemic inflammation enhanced the effect of presarcopenia on the prognosis of EC patients. The combined assessment of those factors may have potential prognostic value for EC.
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Kuriyama K, Higuchi T, Yokobori T, Saito H, Yoshida T, Hara K, Suzuki S, Sakai M, Sohda M, Higuchi T, Tsushima Y, Asao T, Kaira K, Kuwano H, Shirabe K, Saeki H. Uptake of positron emission tomography tracers reflects the tumor immune status in esophageal squamous cell carcinoma. Cancer Sci 2020; 111:1969-1978. [PMID: 32302443 PMCID: PMC7293073 DOI: 10.1111/cas.14421] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/24/2022] Open
Abstract
The relationship between the local immune status and cancer metabolism regarding 18F‐FDG and 18F‐FAMT uptake in esophageal squamous cell carcinoma (ESCC) remains unknown. The present study examined the correlations between tumor immune status, clinicopathological factors, and positron emission tomography (PET) tracer uptake in ESCC. Forty‐one ESCC patients who underwent 18F‐FDG PET and 18F‐FAMT PET before surgery were enrolled in the study. Immunohistochemistry was conducted for programmed death 1 (PD‐1), CD8, Ki‐67, CD34, GLUT1 (18F‐FDG transporter) and LAT1 (18F‐FAMT transporter). ESCC specimens with high tumoral PD‐L1 and high CD8‐positive lymphocytes were considered to have “hot tumor immune status.” High PD‐L1 expression (53.7%) was significantly associated with tumor/lymphatic/venous invasion (P = 0.028, 0.032 and 0.018), stage (P = 0.041), CD8‐positive lymphocytes (P < 0.001), GLUT1 (P < 0.001), LAT1 expression (P = 0.006), Ki‐67 labelling index (P = 0.009) and CD34‐positive vessel counts (P < 0.001). SUVmax of 18F‐FDG was significantly higher in high PD‐L1 cases than in low PD‐L1 cases (P = 0.009). SUVmax of 18F‐FAMT was significantly higher in high PD‐L1 (P < 0.001), high CD8 (P = 0.012) and hot tumor groups (P = 0.028) than in other groups. High SUVmax of 18F‐FAMT (≥4.15) was identified as the only predictor of hot tumor immune status. High PET tracer uptake was significantly associated with cancer aggressiveness and hot tumor immune status in ESCC. PET imaging may be an effective tool to predict tumor immune status in ESCC with respect to immune checkpoint inhibitor sensitivity.
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Baatar S, Bai T, Yokobori T, Gombodorj N, Nakazawa N, Ubukata Y, Kimura A, Kogure N, Sano A, Sohda M, Sakai M, Tumenjargal A, Ogata K, Kuwano H, Shirabe K, Saeki H. High RAD18 Expression is Associated with Disease Progression and Poor Prognosis in Patients with Gastric Cancer. Ann Surg Oncol 2020; 27:4360-4368. [PMID: 32356270 DOI: 10.1245/s10434-020-08518-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND RAD18 plays an important role in DNA damage repair by inducing monoubiquitinated PCNA (mUB-PCNA) in both cancer and normal tissues. Previous studies have not determined the significance of RAD18 expression in clinical gastric cancer (GC) samples. Thus, this study aimed to clarify the expression and functional significance of RAD18 in GC. METHODS Overall, 96 resected GC samples were subjected to an immunohistochemical analysis of RAD18. GC cell lines were also subjected to functional RNA interference analyses of RAD18. RESULTS RAD18 expression was predominantly nuclear and was observed at higher levels in GC tissues than in normal tissues. In GC tissues, strong RAD18 expression was associated with progression of lymph node metastasis (p = 0.0001), lymphatic invasion (p = 0.0255), venous invasion (p < 0.0001), recurrence (p = 0.028), and disease stage (p = 0.0253). Moreover, GC patients with high tumor RAD18 expression had shorter overall survival (p = 0.0061) and recurrence-free survival durations (p = 0.035) than those with low tumor RAD18 expression. RAD18 knockdown inhibited GC proliferation and invasiveness and increased chemosensitivity by suppressing mUB-PCNA. CONCLUSIONS RAD18 expression may be a useful marker of progression and poor prognosis of GC. Moreover, therapeutic strategies that target RAD18 might be a novel chemosensitizer to eradicate the refractory GC.
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Sakai M, Parajuli RK, Kubota Y, Kubo N, Yamaguchi M, Nagao Y, Kawachi N, Kikuchi M, Arakawa K, Tashiro M. Crosstalk Reduction Using a Dual Energy Window Scatter Correction in Compton Imaging. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2453. [PMID: 32357411 PMCID: PMC7249665 DOI: 10.3390/s20092453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Abstract
Compton cameras can simultaneously detect multi-isotopes; however, when simultaneous imaging is performed, crosstalk artifacts appear on the images obtained using a low-energy window. In conventional single-photon emission computed tomography, a dual energy window (DEW) subtraction method is used to reduce crosstalk. This study aimed to evaluate the effectiveness of employing the DEW technique to reduce crosstalk artifacts in Compton images obtained using low-energy windows. To this end, in this study, we compared reconstructed images obtained using either a photo-peak window or a scatter window by performing image subtraction based on the differences between the two images. Simulation calculations were performed to obtain the list data for the Compton camera using a 171 and a 511 keV point source. In the images reconstructed using these data, crosstalk artifacts were clearly observed in the images obtained using a 171 keV photo-peak energy window. In the images obtained using a scatter window (176-186 keV), only crosstalk artifacts were visible. The DEW method could eliminate the influence of high-energy sources on the images obtained with a photo-peak window, thereby improving quantitative capability. This was also observed when the DEW method was used on experimentally obtained images.
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Adams DQ, Alduino C, Alfonso K, Avignone FT, Azzolini O, Bari G, Bellini F, Benato G, Biassoni M, Branca A, Brofferio C, Bucci C, Caminata A, Campani A, Canonica L, Cao XG, Capelli S, Cappelli L, Cardani L, Carniti P, Casali N, Chiesa D, Chott N, Clemenza M, Copello S, Cosmelli C, Cremonesi O, Creswick RJ, D'Addabbo A, D'Aguanno D, Dafinei I, Davis CJ, Dell'Oro S, Di Domizio S, Dompè V, Fang DQ, Fantini G, Faverzani M, Ferri E, Ferroni F, Fiorini E, Franceschi MA, Freedman SJ, Fujikawa BK, Giachero A, Gironi L, Giuliani A, Gorla P, Gotti C, Gutierrez TD, Han K, Heeger KM, Huang RG, Huang HZ, Johnston J, Keppel G, Kolomensky YG, Ligi C, Ma YG, Ma L, Marini L, Maruyama RH, Mei Y, Moggi N, Morganti S, Napolitano T, Nastasi M, Nikkel J, Nones C, Norman EB, Novati V, Nucciotti A, Nutini I, O'Donnell T, Ouellet JL, Pagliarone CE, Pagnanini L, Pallavicini M, Pattavina L, Pavan M, Pessina G, Pettinacci V, Pira C, Pirro S, Pozzi S, Previtali E, Puiu A, Rosenfeld C, Rusconi C, Sakai M, Sangiorgio S, Schmidt B, Scielzo ND, Sharma V, Singh V, Sisti M, Speller D, Surukuchi PT, Taffarello L, Terranova F, Tomei C, Vignati M, Wagaarachchi SL, Wang BS, Welliver B, Wilson J, Wilson K, Winslow LA, Zanotti L, Zimmermann S, Zucchelli S. Improved Limit on Neutrinoless Double-Beta Decay in ^{130} Te with CUORE. PHYSICAL REVIEW LETTERS 2020; 124:122501. [PMID: 32281829 DOI: 10.1103/physrevlett.124.122501] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/11/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
We report new results from the search for neutrinoless double-beta decay in ^{130} Te with the CUORE detector. This search benefits from a fourfold increase in exposure, lower trigger thresholds, and analysis improvements relative to our previous results. We observe a background of (1.38±0.07)×10^{-2} counts/(keV kg yr)) in the 0νββ decay region of interest and, with a total exposure of 372.5 kg yr, we attain a median exclusion sensitivity of 1.7×10^{25} yr. We find no evidence for 0νββ decay and set a 90% credibility interval Bayesian lower limit of 3.2×10^{25} yr on the ^{130} Te half-life for this process. In the hypothesis that 0νββ decay is mediated by light Majorana neutrinos, this results in an upper limit on the effective Majorana mass of 75-350 meV, depending on the nuclear matrix elements used.
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Sakai M, Parajuli RK, Kubota Y, Kubo N, Kikuchi M, Arakawa K, Nakano T. Improved iterative reconstruction method for Compton imaging using median filter. PLoS One 2020; 15:e0229366. [PMID: 32142552 PMCID: PMC7059936 DOI: 10.1371/journal.pone.0229366] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/04/2020] [Indexed: 11/18/2022] Open
Abstract
A Compton camera is a device for imaging a radio-source distribution without using a mechanical collimator. Ordered-subset expectation-maximization (OS-EM) is widely used to reconstruct Compton images. However, the OS-EM algorithm tends to over-concentrate and amplify noise in the reconstructed image. It is, thus, necessary to optimize the number of iterations to develop high-quality images, but this has not yet been achieved. In this paper, we apply a median filter to an OS-EM algorithm and introduce a median root prior expectation-maximization (MRP-EM) algorithm to overcome this problem. In MRP-EM, the median filter is used to update the image in each iteration. We evaluated the quality of images reconstructed by our proposed method and compared them with those reconstructed by conventional algorithms using mathematical phantoms. The spatial resolution was estimated using the images of two point sources. Reproducibility was evaluated on an ellipsoidal phantom by calculating the residual sum of squares, zero-mean normalized cross-correlation, and mutual information. In addition, we evaluated the semi-quantitative performance and uniformity on the ellipsoidal phantom. MRP-EM reduces the generated noise and is robust with respect to the number of iterations. An evaluation of the reconstructed image quality using some statistical indices shows that our proposed method delivers better results than conventional techniques.
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Nakano T, Sakai M, Torikai K, Suzuki Y, Takeda S, Noda SE, Yamaguchi M, Nagao Y, Kikuchi M, Odaka H, Kamiya T, Kawachi N, Watanabe S, Arakawa K, Takahashi T. Imaging of 99mTc-DMSA and 18F-FDG in humans using a Si/CdTe Compton camera. ACTA ACUST UNITED AC 2020; 65:05LT01. [DOI: 10.1088/1361-6560/ab33d8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ishiuchi SI, Kamizori J, Tsuji N, Sakai M, Miyazaki M, Dedonder C, Jouvet C, Fujii M. Excited state hydrogen transfer dynamics in phenol-(NH 3) 2 studied by picosecond UV-near IR-UV time-resolved spectroscopy. Phys Chem Chem Phys 2020; 22:5740-5748. [PMID: 32104812 DOI: 10.1039/c9cp06369b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Time-evolutions of excited state hydrogen transfer (ESHT) in phenol (PhOH)-(NH3)2 clusters have been measured by three-color picosecond (ps) ultraviolet (UV)-near infrared (NIR)-UV pump-probe ion dip spectroscopy. The formation of a reaction product, ˙NH4NH3, is detected by its NIR absorption due to a 3p-3s Rydberg transition. The ESHT reactions from all of the vibronic levels show biexponential time-evolutions, even from the S1 origin. Based on the biexponential time-evolution, it is suggested that there is a second reaction path via the triplet πσ* state, which gives the slow component. The fast time-evolution of the ESHT reaction from the S1 origin is measured to be 268 ps, which is 10-times slower than that in PhOH-(NH3)3, and a higher barrier between the ππ* and reactive πσ* states is suggested. The size dependence of the ESHT reaction rates is discussed based on a potential distortion due to the proton transferred state in the ππ* potential surface.
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Sakai M, Ohtera S, Iwao T, Neff Y, Kato G, Takahashi Y, Nakayama T. Validation of claims data to identify death among aged persons utilizing enrollment data from health insurance unions. Environ Health Prev Med 2019; 24:63. [PMID: 31759388 PMCID: PMC6875027 DOI: 10.1186/s12199-019-0819-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/23/2019] [Indexed: 12/24/2022] Open
Abstract
The identification of death is critical for epidemiological research. Despite recent developments in health insurance claims databases, the quality of death information in claims is not guaranteed because health insurance claims are collected primarily for reimbursement. We aimed to examine the usefulness and limitations of death information in claims data and to examine methods for improving the quality of death information for aged persons. We used health insurance claims data and enrollment data (as the gold standard) from September 2012 through August 2015 for nondependent persons aged 65–74 years enrolled in Japanese workplace health insurance. Overall, 3,710,538 insured persons were registered in the database during the study period. We analyzed 45,441 eligible persons. Inpatient and outpatient deaths were identified from the discharge/disease status in the claims, with sensitivities of 94.3% and 47.4%, specificities of 98.5% and 99.9%, and PPVs of 96.3% and 95.7%, respectively, using enrollment data as the gold standard. For outpatients, death defined as a combination of disease status and charge data for terminal care still indicated low sensitivity (54.7%). The validity of death information in inpatient claims was high, suggesting its potential usefulness for identifying death. However, given the low sensitivity for outpatient deaths, the use of death information obtained solely from records in outpatient claims is not recommended.
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Sakai M, Suzuki A, Shiga T, Tanaka Y, Kouno E, Osada A, Matsuura J, Hayashi N, Matsui Y, Hagiwara N. 4332Benefit of sinus rhythm restoration in acute decompensated heart failure patients with atrial tachyarrhythmia treated with landiolol. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial tachyarrhythmias (ATA), such as atrial fibrillation / atrial tachycardia are frequently observed in patients with acute decompensated heart failure (ADHF). Because ATA leads to clinical deterioration and worsen HF, the conversion and prevention of ATA is important of ADHF with ATA. Landiolol, an ultrashort-acting intravenous beta-1 blocker, was developed and has been used for the treatment of ATA.
Purpose
We evaluated the acute effect of landiolol treatment on heart rate or blood pressure (BP), also the rates and benefits of sinus rhythm (SR) restoration among AHF patients with ATA treated with landiolol.
Methods
We studied 67 consecutive HF patients with ATA (age: 67±12 years, 36 male) treated with landiolol from 2015 to December 2017 at our University Hospital. They were compared with 50 paired subjects, matched for gender, age and baseline BP who developed HF with ATA from HIJ-HF 2 study (consisted of HF patients hospitalized between 2013 and 2014).
Results
At the start of landiolol treatment, mean left ventricular ejection fraction (LVEF) was 41±14%. The median maintenance dose of landiolol was 3.0 (1.0–12.0) μ/kg/min and the median treatment duration of landiolol was 5 (1–24) days. After 6 hours from administration of landiolol, mean HR decreased significantly from 140±18 to 100±21 bpm (p<0.05), whereas BP was not difference during landiolol treatment. Sinus rhythm was restored spontaneously in 15 (22%), and by electrical or pharmacological cardioversion in 5 (7%) during a treatment with intravenous landiolol. Furthermore, sinus rhythm was restored in 22 patients using additional rhythm control treatment, such as amiodarone or catheter ablation after intravenous landiolol treatement. Eight patients experienced in-hospital death. Forty-one (69%) of 59 patients discharged alive were in SR. During the follow-up period of 16±12 months, 4 patients died and 12 patients experienced rehospitalization due to worsening HF after hospital discharge. There was a significant higher rate of death or HF rehospitalization in patients without SR restoration than patients with SR restoration (44% vs. 20%, p<0.05) (Figure A). Compared with 50 paired subjects from HIJ-HF 2 study, those who treated with landiolol developed a significant higher rate of SR restoration (68% vs. 20%, p<0.05) (Figure B).
Figure 1
Conclusion
This study demonstrated that landiolol treatment was effective for both rate control and conversion to sinus rhythm in ADHF patient with ATA. We should consider that the benefits of rhythm control in ADHF patients with ATA during and after landiolol treatment.
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Misawa K, Mochizuki Y, Sakai M, Teramoto H, Morimoto D, Nakayama H, Tanaka N, Matsui T, Ito Y, Ito S, Tanaka K, Uemura K, Morita S, Kodera Y. Randomized clinical trial of extensive intraoperative peritoneal lavage versus standard treatment for resectable advanced gastric cancer (CCOG 1102 trial). Br J Surg 2019; 106:1602-1610. [PMID: 31573086 DOI: 10.1002/bjs.11303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 06/10/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND A survival benefit of extensive intraoperative peritoneal lavage (EIPL) has been reported in patients with gastric cancer with positive peritoneal cytology. The hypothesis of this study was that EIPL may reduce peritoneal recurrence in patients with advanced gastric cancer who undergo surgery with curative intent. METHODS This was an open-label, multi-institutional, randomized, phase 3 trial to assess the effects of EIPL versus standard treatment after curative gastrectomy for resectable gastric cancer of T3 status or above. The primary endpoint was disease-free survival (DFS); secondary endpoints were overall survival, peritoneal recurrence-free survival and incidence of adverse events. RESULTS Between July 2011 and January 2014, 314 patients were enrolled from 15 institutions and 295 patients were analysed (145 and 150 in the EIPL and no-EIPL groups respectively). The 3-year DFS rate was 63·9 (95 per cent c.i. 55·5 to 71·2) per cent in the EIPL group and 59·7 (51·3 to 67·1) per cent in the control group (hazard ratio (HR) 0·81, 95 per cent c.i. 0·57 to 1·16; P = 0·249). The 3-year overall survival rate was 75·0 (67·1 to 81·3) per cent in the EIPL group and 73·7 (65·9 to 80·1) per cent in the control group (HR 0·91, 0·60 to 1·37; P = 0·634). Peritoneal recurrence-free survival was not significantly different between the two groups (HR 0·92, 0·62 to 1·36; P = 0·676). No intraoperative complications related to EIPL were observed. CONCLUSION EIPL did not improve survival or peritoneal recurrence in patients who underwent gastrectomy for advanced gastric cancer. Registration number: 000005907 (http://www.umin.ac.jp/ctr/index.htm).
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Sakai M, Kubota Y, Saitoh JI, Irie D, Shirai K, Okada R, Torikoshi M, Ohno T, Nakano T. Robustness of patient positioning for interfractional error in carbon ion radiotherapy for stage I lung cancer: Bone matching versus tumor matching. Radiother Oncol 2019; 129:95-100. [PMID: 29100701 DOI: 10.1016/j.radonc.2017.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 09/30/2017] [Accepted: 10/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Patient positioning was compared by tumor matching (TM) and conventional bony structure matching (BM) in carbon ion radiotherapy for stage I non-small cell lung cancer to evaluate the robustness of TM and BM in determining interfractional error. MATERIAL AND METHODS Sixty irradiation fields were analyzed. Computed tomography (CT) images acquired before treatment initiation for confirmation (Conf-CT) were obtained under the same settings as the treatment planning CT images and used to evaluate both positioning methods. The dose distributions were recalculated for Conf-CT using both BM and TM, and the dose-volume histogram parameters [V95% of clinical target volume, V5Gy(RBE) of normal lung, and acceptance ratio (ratio of cases with V95% > 95%)] were evaluated. The required margin, which in 90% of cases achieved the acceptable condition, was also examined. RESULTS Using BM and TM, the median V95% was 98.93% and 100% (p < 0.001) and the mean V5Gy(RBE) was 135.9 and 125.8 (p = 0.694), respectively. The estimated required margins were 7.9 and 3.3 mm and increased by 53.9% and 2.5% of V5Gy(RBE), respectively, compared with planning. CONCLUSIONS TM ensured a better dose distribution than did BM. To enable TM, volumetric imaging is crucial and should replace 2D radiographs for carbon therapy of stage I lung cancer.
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Sakai M, Kubota Y, Parajuli RK, Kikuchi M, Arakawa K, Nakano T. Compton imaging with 99mTc for human imaging. Sci Rep 2019; 9:12906. [PMID: 31501461 PMCID: PMC6733951 DOI: 10.1038/s41598-019-49130-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/20/2019] [Indexed: 11/13/2022] Open
Abstract
We have been developing a medical imaging system using a Compton camera and demonstrated the imaging ability of Compton camera for 99mTc-DMSA accumulated in rat kidneys. In this study, we performed imaging experiments using a human body phantom to confirm its applicability to human imaging. Preliminary simulations were conducted using a digital phantom with varying activity ratios between the kidney and body trunk regions. Gamma rays (141 keV) were generated and detected by a Compton camera based on a silicon and cadmium telluride (Si/CdTe) detector. Compton images were reconstructed with the list mode median root prior expectation maximization method. The appropriate number of iterations of the condition was confirmed through simulations. The reconstructed Compton images revealed two bright points in the kidney regions. Furthermore, the numerical value calculated by integrating pixel values inside the region of interest correlated well with the activity of the kidney regions. Finally, experimental studies were conducted to ascertain whether the results of the simulation studies could be reproduced. The kidneys could be successfully visualised. In conclusion, considering that the conditions in this study agree with those of typical human bodies and imaginable experimental setup, the Si/CdTe Compton camera has a high probability of success in human imaging. In addition, our results indicate the capability of (semi-) quantitative analysis using Compton images.
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