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Cacioppa LM, Floridi C, Macchini M, Rosati M, Bruno A, Rossini N, Mocchegiani F, Nicolini D, Santarelli M, Rubini C, Vivarelli M, Candelari R. A Novel Use of Autologous Fibrin by Intracatheter Injection in Persistent Postoperative Biliary Defects: Technical Note on a Preliminary Experience. Cardiovasc Intervent Radiol 2024; 47:829-835. [PMID: 38806836 DOI: 10.1007/s00270-024-03735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/12/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE To introduce percutaneous selective injection of autologous platelet-rich fibrin as a novel technique for persistent bile leakage repair and sharing the results of our preliminary experience. MATERIALS AND METHODS Seven patients (57.1% females; mean age 69.6 ± 8 years) with the evidence of persistent bile leak secondary to hepatobiliary surgery and ineffective treatment with percutaneous transhepatic biliary drainage were submitted to fibrin injection. Platelet-rich fibrin, a dense fibrin clot promoting tissue regeneration, was obtained from centrifuged patient's venous blood. Repeated percutaneous injections through a catheter tip placed in close proximity to the biliary defect were performed until complete obliteration at fistulography. Technical and clinical success were evaluated. RESULTS Bile leaks followed pancreaticoduodenectomy in five and major hepatectomy in two patients. Technical success defined as fibrin injection at BD site was achieved in all seven patients, and clinical success defined as a complete healing of the BD at fistulography was achieved in six patients. The median time to BD closure was 76.7 ± 40.5 days and the average procedure number was 3 ± 1 per patient. In one patient, defect persistance after four treatments required gelatin sponge injection. No major complications occurred. One case of post-procedural transitory hyperpirexia was registered. CONCLUSION In persistent biliary defects, despite prolonged biliary drainage stay, percutaneous injection of autologous platelet-rich fibrin appears as a readily available and feasible emergent technique in promoting fistulous tracts obliteration still mantaining main ducts patency.
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Affiliation(s)
- Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona, Italy
| | - Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona, Italy
| | - Marco Macchini
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
| | - Marzia Rosati
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona, Italy
| | - Nicolò Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona, Italy
| | - Federico Mocchegiani
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Daniele Nicolini
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Marco Santarelli
- Pathology Unit, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Corrado Rubini
- Pathology Unit, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Marco Vivarelli
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
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2
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Devane AM, Schammel CM. Benign stricture of bilioenteric anastomosis after Whipple with synthetic polypropylene suture. Hepatobiliary Pancreat Dis Int 2024; 23:103-105. [PMID: 37225618 DOI: 10.1016/j.hbpd.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/02/2023] [Indexed: 05/26/2023]
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Kanadani T, Ogura T, Ueno S, Okuda A, Nishioka N, Nakamura J, Yamada M, Uba Y, Tomita M, Hattori N, Sakamoto J, Nishikawa H. Transluminal antegrade drill dilation technique for hepaticojejunostomy stricture with cholangioscopic evaluation (with video). Endosc Int Open 2024; 12:E181-E187. [PMID: 38348332 PMCID: PMC10861321 DOI: 10.1055/a-2218-1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 02/15/2024] Open
Abstract
Background and study aims Balloon dilation and plastic stent deployment have been performed as hepaticojejunostomy stricture (HJS) treatment techniques under endoscopic ultrasound guidance (EUS). Although these techniques have shown favorable clinical results, the treatment period can be long because stent deployment is required. In addition, HJS may recur even after treatment because the scar tissue itself remains. To overcome these challenges, we developed an EUS-guided antegrade drill dilation technique for treating HJS. The aim of this study was to evaluate the technical feasibility and safety of this technique in terms of the pre- and post-cholangioscopic findings. Patients and methods This retrospective study included consecutive patients whose conditions were complicated with symptomatic HJS between November 2022 and February 2023. Transluminal antegrade drill dilation (TAD) using a novel drill dilator was attempted within 14 days after EUS-guided hepaticogastrostomy (HGS). HJS was diagnosed with cholangioscopy before TAD, and resolution was evaluated after TAD using cholangioscopy. Results TAD was attempted at approximately 11 days after EUS-HGS. The cholangioscope was inserted successfully in all patients after this procedure. Cholangioscopy revealed stricture without evidence of malignancy in 19 patients. In the remaining three patients, stricture was not observed and these patients underwent stent exchange rather than TAD. Among the 19 patients, passage of the guidewire across the HJS into the intestine was unsuccessful in four patients, and the technical success rate for this procedure was 78.9%. TAD was successful in all 15 patients in whom passage of the guidewire was achieved. Conclusions In conclusion, TAD appears to be technically feasible and safe.
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Affiliation(s)
- Takafumi Kanadani
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Junichi Nakamura
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Masanori Yamada
- Endoscopic Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuki Uba
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Mitsuki Tomita
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Nobuhiro Hattori
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Jun Sakamoto
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
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Tavassoli A, Zandbaf T, Aslzare M, Rudi IT, Mehri A, Esparham A. A Novel Minimally Invasive technique for dilatation of hepaticojejunostomy stricture: A case report. Clin Case Rep 2023; 11:e7174. [PMID: 37020669 PMCID: PMC10067802 DOI: 10.1002/ccr3.7174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
Using a nephroscope in a laparoscopic operation to relieve the hepaticojejunostomy stricture (HJS) by transjejunal dilatation is a minimally invasive and applicable method. It can be used as the first step for such patients.
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Affiliation(s)
- Alireza Tavassoli
- Endoscopic and Minimally Invasive Surgery Research Center, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad UniversityMashhadIran
| | - Mohammad Aslzare
- Department of Urology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Iman Tavakoli Rudi
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ali Mehri
- Endoscopic and Minimally Invasive Surgery Research Center, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ali Esparham
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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Sivathasan S, Nagrodzki J, McGowan D. Twelve tips for interpreting abdominal CT scans. MEDICAL TEACHER 2021; 43:956-959. [PMID: 33142074 DOI: 10.1080/0142159x.2020.1839033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Abdominal computerised tomography (CT) scans are a crucial tool in the diagnosis and management of the acute abdomen. Currently, medical students are not widely and extensively trained in the interpretation of abdominal scans. AIM We aim to provide advice about interpreting abdominal CT scans. METHODS We used the critical reflection of our experiences, both in clinical practice and in teaching, alongside advice from the literature to develop these tips. RESULTS Twelve tips following the '4As, 3Bs, 2Cs and 1D' approach are presented to assist doctors and medical students with interpreting abdominal CT scans. CONCLUSION The early identification of pathology on CT scans has been demonstrated to improve patient outcomes in certain cases, while a formal radiologist's report is awaited. Following a systematic approach, such as the one we presented here, may aid trainees in looking at abdominal CT scans.
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Affiliation(s)
| | - Jakub Nagrodzki
- Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - David McGowan
- Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
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Vacca G, Reginelli A, Urraro F, Sangiovanni A, Bruno F, Di Cesare E, Cappabianca S, Vanzulli A. Magnetic resonance severity index assessed by T1-weighted imaging for acute pancreatitis: correlation with clinical outcomes and grading of the revised Atlanta classification-a narrative review. Gland Surg 2021; 9:2312-2320. [PMID: 33447582 DOI: 10.21037/gs-20-554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute pancreatitis (AP) is a common disease that may involve pancreas and peripancreatic tissues with a prevalence of up to 50 per 100,000 individuals for year. The Atlanta classification was assessed for the first time in 1992 and modified in 2012 in order to describe morphological features of AP and its complications. AP can be morphologically distinguished in two main types: interstitial edematous pancreatitis (IEP) and necrotizing pancreatitis (NEP). This classification is very important because the presence of necrosis is directly linked to local or systemic complications, hospital stays and death. Magnetic resonance (MR) is very useful to characterize morphological features in AP and its abdominal complications. Particularly we would like to underline the diagnostic, staging and prognostic role of T1-weighted images with fat suppression that could be significant to assess many features of the AP inflammatory process and its complications (detection of the pancreatic contour, pancreatic necrosis, presence of haemorrhage). Signs of inflammatory and edema are instead observed by T1-weighted images. MR cholangiopancreatography (MRCP) is necessary to study the main pancreatic duct and the extrahepatic biliary tract and contrast-enhancement magnetic resonance imaging (MRI) allows to assess the extent of necrosis and vascular injuries.
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Affiliation(s)
- Giovanna Vacca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Angelo Vanzulli
- Department of Radiology, University "La Statale" of Milan, Milan, Italy
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7
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Barile A. Multimodality advanced imaging and intervention in gland diseases. Gland Surg 2020; 9:2211-2214. [PMID: 33447573 DOI: 10.21037/gs-20-592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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8
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Angileri SA, Rodà GM, Savoldi AP, Meglio LD, Signorelli G, Ierardi AM, Galanakis N, Tsetis D, Carrafiello G. Imaging findings and available percutaneous techniques for the treatment of bile leaks after hepatobiliary surgery. Ann Gastroenterol 2020; 33:675-679. [PMID: 33162745 PMCID: PMC7599347 DOI: 10.20524/aog.2020.0532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to evaluate the diagnosis and management of postoperative bile leaks, reporting typical diagnostic findings and available percutaneous techniques in association with other diagnostic and management methods. Methods Thirty-six patients (28 male) were treated for postoperative bile leaks. A biliary leak was clinically suspected in case of persistent leakage of bilious material from a surgical drain, or in the presence of non-specific symptoms such as abdominal pain, fever and anorexia, with or without laboratory alteration of liver enzymes. Radiological confirmation was mainly based on noninvasive methods such as ultrasound, computed tomography, and magnetic resonance cholangiopancreatography. We assessed each treatment by evaluating multiple factors, including technical success (TS) and clinical effectiveness (CE), defined as primary or secondary. We also evaluated overall CE (OCE), defined as leak control with either single or multiple procedures. Results TS and OCE were achieved in all patients (36/36; 100%) with a grade A or B biliary leak. No grade C was observed. There were no major complications. Minor complications were observed in 7/36 (19.4%) patients. No procedure-related deaths occurred. Conclusions In our study, considering all percutaneous techniques, leak healing was achieved in all the patients with a grade A or B biliary leak. These procedures provide a less invasive approach and are increasingly recognized as having a significant role in the management of complications and should be considered as an integral component in the postoperative management of these patients.
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Affiliation(s)
- Salvatore Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy (Salvatore Alessio Angileri, Anna Maria Ierardi, Gianpaolo Carrafiello)
| | - Giovanni Maria Rodà
- Postgraduate School of Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy (Giovanni Maria Rodà, Anna Paola Savoldi, Letizia Di Meglio, Giulia Signorelli)
| | - Anna Paola Savoldi
- Postgraduate School of Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy (Giovanni Maria Rodà, Anna Paola Savoldi, Letizia Di Meglio, Giulia Signorelli)
| | - Letizia Di Meglio
- Postgraduate School of Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy (Giovanni Maria Rodà, Anna Paola Savoldi, Letizia Di Meglio, Giulia Signorelli)
| | - Giulia Signorelli
- Postgraduate School of Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy (Giovanni Maria Rodà, Anna Paola Savoldi, Letizia Di Meglio, Giulia Signorelli)
| | - Anna Maria Ierardi
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy (Salvatore Alessio Angileri, Anna Maria Ierardi, Gianpaolo Carrafiello)
| | - Nikolaos Galanakis
- Department of Radiology, Interventional Radiology Unit, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece (Nikolaos Galanakis, Dimitrios Tsetis)
| | - Dimitrios Tsetis
- Department of Radiology, Interventional Radiology Unit, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece (Nikolaos Galanakis, Dimitrios Tsetis)
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy (Salvatore Alessio Angileri, Anna Maria Ierardi, Gianpaolo Carrafiello).,Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy (Gianpaolo Carrafiello)
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Kono Y, Ishizawa T, Kokudo N, Kuriki Y, Iwatate RJ, Kamiya M, Urano Y, Kumagai A, Kurokawa H, Miyawaki A, Hasegawa K. On-Site Monitoring of Postoperative Bile Leakage Using Bilirubin-Inducible Fluorescent Protein. World J Surg 2020; 44:4245-4253. [PMID: 32909125 PMCID: PMC7599156 DOI: 10.1007/s00268-020-05774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 11/25/2022]
Abstract
Background Bile leakage is the most common postoperative complication associated with hepatobiliary and pancreatic surgery. Until now, however, a rapid, accurate diagnostic method for monitoring intraoperative and postoperative bile leakage had not been established. Method Bilirubin levels in drained abdominal fluids collected from 23 patients who had undergone hepatectomy (n = 22) or liver transplantation (n = 1) were measured using a microplate reader with excitation/emission wavelengths of 497/527 nm after applying 5 µM of UnaG to the samples. UnaG was also sprayed directly on hepatic raw surfaces in swine hepatectomy models to identify bile leaks by fluorescence imaging. Results The bilirubin levels measured by UnaG fluorescence imaging showed favorable correlations with the results of the conventional light-absorptiometric methods (indirect bilirubin: rs = 0.939, p < 0.001; direct bilirubin: rs = 0.929, p < 0.001). Approximate time required for bilirubin measurements with UnaG was 15 min, whereas it took about 40 min with the conventional method at a hospital laboratory. Following administration of UnaG on hepatic surfaces, the fluorescence imaging identified bile leaks not only on the resected specimens but also in the abdominal cavity of the swine hepatectomy models. Conclusion Fluorescence imaging techniques using UnaG may enable real-time identification of bile leaks during hepatectomy and on-site rapid diagnosis of bile leaks after surgery. Electronic supplementary material The online version of this article (10.1007/s00268-020-05774-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshiharu Kono
- Hepatobiliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Takeaki Ishizawa
- Hepatobiliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.,Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Norihiro Kokudo
- Hepatobiliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Yugo Kuriki
- Laboratory of Chemistry and Biology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Ryu J Iwatate
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mako Kamiya
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Science and Technology Agency, PRESTO, Saitama, Japan
| | - Yasuteru Urano
- Laboratory of Chemistry and Biology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.,Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Agency for Medical Research and Development, CREST, Tokyo, Japan
| | - Akiko Kumagai
- Laboratory for Cell Function Dynamics, RIKEN Centre for Brain Science, 2-1 Hirosawa, Wako, Saitama, 351-0198, Japan
| | - Hiroshi Kurokawa
- Laboratory for Cell Function Dynamics, RIKEN Centre for Brain Science, 2-1 Hirosawa, Wako, Saitama, 351-0198, Japan
| | - Atsushi Miyawaki
- Laboratory for Cell Function Dynamics, RIKEN Centre for Brain Science, 2-1 Hirosawa, Wako, Saitama, 351-0198, Japan.
| | - Kiyoshi Hasegawa
- Hepatobiliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
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