The research explored the ways and means of narrative design in which regional cultural elements are integrated into cultural and creative products.It also researched a new way of thinking and methods of creative prod...The research explored the ways and means of narrative design in which regional cultural elements are integrated into cultural and creative products.It also researched a new way of thinking and methods of creative product design based on regional cultural elements in order to satisfy consumers’emotional and cultural experiences.Narrative theory takes the perspective of narrative expression in the design of cultural and creative products.The regional cultural elements were used for better interactive communication with consumers in the form of cultural and creative products.In the narrative of cultural and creative product design,intervening in the development of regional cultural and creative design from the perspective of narratology can better exert and create the cultural value of the region itself,with cultural and creative products playing an important role in“local cultural stories.”This research adopted a qualitative approach and provided ideas and guidance for the narrative design and expression of regional cultural elements in creative products through comparative analysis of case studies.The research highlighted the role of narrative design in creating multi-layered experiences,weaving regional cultural stories into products,and the importance of deep understanding and effective use of regional cultural elements in design.展开更多
AIM:To compare the differences in kinetics,distribution,and toxicity of triamcinolone acetonide(TA)between the injection methods,sub-Tenon and intravitreal injections in rabbit ocular tissues.METHODS:TA was injected i...AIM:To compare the differences in kinetics,distribution,and toxicity of triamcinolone acetonide(TA)between the injection methods,sub-Tenon and intravitreal injections in rabbit ocular tissues.METHODS:TA was injected into the vitreous or the sub-Tenon in rabbits.For pharmacokinetic study,rabbits were sacrificed periodically and then TA in blood and ocular tissues(retina/choroids,vitreous,and aqueous humor)were measured over 91 d.For toxicological study,clinical signs,slit-lamp microscopic examination,ophthalmological test were performed.The eyeballs and surrounding tissues were collected and fixed with glutaraldehyde-formalin solution,and then paraffin embedded for histological investigation.RESULTS:Higher levels of TA were distributed in the intraocular tissues when injected into the vitreous compared to the sub-Tenon.Conversely,TA level was remarkably lower in the rabbits which received intravitreal TA injections than those treated with sub-Tenon injection throughout the study period in plasma.Optical discharge probably caused by systemic circulation of TA was observed by receiving sub-Tenon TA injection.Meanwhile,technicassociated toxicological ocular symptoms and findings were more frequently observed in intravitreal injection than in sub-Tenon injection.CONCLUSION:There are significant differences in kinetics and distribution of TA in vitreous body,aqueous humor and plasma,between the two injection methods.Although further study is needed to explain the species difference between human and rabbit,it is assumed that the difference in the frequency of intraocular pressure elevation and cataract formation by TA between the two injection methods are directly related to the TA concentrations in aqueous humor and vitreous body in each injection methods.Systemic toxicity and technic-associated toxicity are also closely related to kinetics of TA in plasma and each injection method itself,respectively.展开更多
BACKGROUND Holoprosencephaly(HPE)is a congenital malformation with various degrees of incomplete separation of the cerebral hemispheres due to differentiation disorders of the forebrain.Although HPE with diabetes insi...BACKGROUND Holoprosencephaly(HPE)is a congenital malformation with various degrees of incomplete separation of the cerebral hemispheres due to differentiation disorders of the forebrain.Although HPE with diabetes insipidus due to associated pituitary dysfunction has been reported,HPE with the syndrome of inappropriate antidiuretic hormone secretion(SIADH)is very rare.Tolvaptan,a vasopressin V2 receptor antagonist,is effective in adults with SIADH.However,there is no report of its efficacy in infants with SIADH.The purpose of this report is to demonstrate that tolvaptan is effective for SIADH in infants and that administration of tolvaptan eliminates the need for restriction of water intake and sodium administration.CASE SUMMARY A 2414-g female infant was born at 38 wk by normal vaginal delivery.Facial anomalies and head magnetic resonance imaging indicated semilobar HPE.After birth,she had hyponatremia due to SIADH and was treated using water and sodium restriction.However,she developed an exaggerated response to the fluid restrictions,resulting in large fluctuations in serum sodium levels.Subsequent administration of tolvaptan improved the fluctuations in serum sodium levels without the need for adjustment of water or sodium administration.Serum sodium was maintained within the normal range after discontinuation of tolvaptan at 80 d of life.There were no side effects,such as hypernatremia or liver dysfunction,during the administration of tolvaptan.CONCLUSION This is the first report on the safety and efficacy of tolvaptan in an infant with SIADH associated with HPE.展开更多
临床医生和放射诊断科医生对影像学的格式化报告和标准术语的要求正在不断增加。一项研究[1]发现，CT报告在对肺结节边缘和钙化表述上不统一。另一项研究[2]比较了Fleischner Society Glossary中列举的影像术语和它们常用医学词典中的...临床医生和放射诊断科医生对影像学的格式化报告和标准术语的要求正在不断增加。一项研究[1]发现，CT报告在对肺结节边缘和钙化表述上不统一。另一项研究[2]比较了Fleischner Society Glossary中列举的影像术语和它们常用医学词典中的一致性，包括国际疾病分类、标准参考医学术语和统一医学语言系统等，发现Fleischner术语应用率低，仅为3%-36%[3]。另一方面，研究提示对特殊疾病的标准影像学报告，如乳腺癌筛查报告可以改善患者治疗结果。因此希望对疑似胸腺瘤的前纵隔肿瘤制定标准的描述术语和提高这些术语的应用率，达到能促进临床医生和放射科医生之间的交流的目的，最终给患者治疗带来获益。除了制定统一的术语，报告中还应包含相关疾病知识，使之具有疾病特异性。美国放射医师协会制定了乳腺影像报告和数据系统，描述在钼靶和超声影像发现的乳腺病灶，发现影像报告结果与组织学结果具有相关性[4]。乳腺影像报告和数据系统提供一个对应各种病理类型的百分概率，并在临床上得到广泛应用[5]。一个相似的系统应用于甲状腺结节的超声评估，将这些结节分为高度恶性可能和低度恶性可能，指导适当的临床治疗，这个系统被称为甲状腺影像报告数据系统[6]。展开更多
Gastric cancer(GC) is one of the most prevalent malignant types in the world and an aggressive disease with a poor 5-year survival. This cancer is biologically and genetically heterogeneous with a poorly understood ca...Gastric cancer(GC) is one of the most prevalent malignant types in the world and an aggressive disease with a poor 5-year survival. This cancer is biologically and genetically heterogeneous with a poorly understood carcinogenesis at the molecular level. Although the incidence is declining, the outcome of patients with GC remains dismal. Thus, the detection at an early stage utilizing useful screening approaches, selection of an appropriate treatment plan, and effective monitoring is pivotal to reduce GC mortalities. Identification of biomarkers in a basis of clinical information and comprehensive genome analysis could improve diagnosis, prognosis, prediction of recurrence and treatment response. This review summarized the current status and approaches in GC biomarker, which could be potentially used for early diagnosis, accurate prediction of therapeutic approaches and discussed the future perspective based on the molecular classification and profiling.展开更多
The association between ulcerative colitis(UC) and colorectal cancer(CRC) has been acknowledged. One of the most serious and life threatening consequences of UC is the development of CRC(UC-CRC). UC-CRC patients are y...The association between ulcerative colitis(UC) and colorectal cancer(CRC) has been acknowledged. One of the most serious and life threatening consequences of UC is the development of CRC(UC-CRC). UC-CRC patients are younger, more frequently have multiple cancerous lesions, and histologically show mucinous or signet ring cell carcinomas. The risk of CRC begins to increase 8 or 10 years after the diagnosis of UC. Risk factors for CRC with UC patients include young age at diagnosis, longer duration, greater anatomical extent of colonic involvement, the degree of inflammation, family history of CRC, and presence of primary sclerosing cholangitis. CRC on the ground of UC develop from non-dysplastic mucosa to indefinite dysplasia, lowgrade dysplasia, high-grade dysplasia and finally to invasive adenocarcinoma. Colonoscopy surveillance programs are recommended to reduce the risk of CRC and mortality in UC. Genetic alterations might play a role in the development of UC-CRC. 5-aminosalicylates might represent a favorable therapeutic option for chemoprevention of CRC.展开更多
Although liver resection is considered the most effective treatment for hepatocellular carcinoma(HCC), treatment outcomes are unsatisfactory because of the high rate of HCC recurrence. Since we reported hepatitis B e-...Although liver resection is considered the most effective treatment for hepatocellular carcinoma(HCC), treatment outcomes are unsatisfactory because of the high rate of HCC recurrence. Since we reported hepatitis B e-antigen positivity and high serum hepatitis B virus(HBV) DNA concentrations are strong risk factors for HCC recurrence after curative resection of HBV-related HCC in the early 2000 s, many investigators have demonstrated the effects of viral status on HCC recurrence and post-treatment outcomes. These findings suggest controlling viral status is important to prevent HCC recurrence and improve survival after curative treatment for HBV-related HCC. Antiviral therapy after curative treatment aims to improve prognosis by preventing HCC recurrence and maintaining liver function. Therapy with interferon and nucleos(t)ide analogs may be useful for preventing HCC recurrence and improving overall survival in patients who have undergone curative resection for HBV-related HCC. In addition, reactivation of viral replication can occur after liver resection for HBV-related HCC. Antiviral therapy can be recommended for patients to prevent HBV reactivation. Nevertheless, further studies are required to establish treatment guidelines for patients with HBVrelated HCC.展开更多
In this paper,we review the concept of quality of ulcer healing(QOUH) in the gastrointestinal tract and its role in the ulcer recurrence.In the past,peptic ulcer disease(PUD) has been a chronic disease with a cycle of...In this paper,we review the concept of quality of ulcer healing(QOUH) in the gastrointestinal tract and its role in the ulcer recurrence.In the past,peptic ulcer disease(PUD) has been a chronic disease with a cycle of repeated healing/remission and recurrence.The main etiological factor of PUD is Helicobacter pylori(H.pylori),which is also the cause of ulcer recurrence.However,H.pylori-negative ulcers are present in 12%-20% of patients;they also recur and are on occasion intractable.QOUH focuses on the fact that mucosal and submucosal structures within ulcer scars are incompletely regenerated.Within the scars of healed ulcers,regenerated tissue is immature and with distorted architecture,suggesting poor QOUH.The abnormalities in mucosal regeneration can be the basis for ulcer recurrence.Our studies have shown that persistence of macrophages in the regenerated area plays a key role in ulcer recurrence.Our studies in a rat model of ulcer recurrence have indicated that proinflammatory cytokines trigger activation of macrophages,which in turn produce increased amounts of cytokines and chemokines,which attract neutrophils to the regenerated area.Neutrophils release proteolytic enzymes that destroy the tissue,resulting in ulcer recurrence.Another important factor in poor QOUH can be deficiency of endogenous prostaglandins and a deficiency and/or an imbalance of endogenous growth factors.Topically active mucosal protective and antiulcer drugs promote high QOUH and reduce inflammatory cell infiltration in the ulcer scar.In addition to PUD,the concept of QOUH is likely applicable to inflammatory bowel diseases including Crohn's disease and ulcerative colitis.展开更多
Gastric cancer is one of the most frequent and lethal malignancies worldwide because of high frequency of metastasis. Tumor cell motility and invasion play fundamental roles in cancer metastasis. Recent studies have r...Gastric cancer is one of the most frequent and lethal malignancies worldwide because of high frequency of metastasis. Tumor cell motility and invasion play fundamental roles in cancer metastasis. Recent studies have revealed that the Rho/Rho-associated protein kinases(ROCK) pathway plays a critical role in the regulation of cancer cell motility and invasion. In addition,the Rho/ROCK pathway plays important roles in invasion and metastasis on the basis of its predominant function of cell cytoskeletal regulation in gastric cancer. According to the current understanding of tumor motility,there are two modes of tumor cell movement:mesenchymal and amoeboid. In addition,cancer cell movement can be interchangeable between the mesenchymal and amoeboid movements under certain conditions. Control of cell motility through the actin cytoskeleton creates the potential for regulating tumor cell metastasis. In this review we discuss Rho GTPases and ROCK signaling and describe the mechanisms of Rho/ROCK activity with regard to motility and metastasis in gastric cancer.In addition,we provide an insight of the therapeutic potential of targeting the Rho/ROCK pathway.展开更多
Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are present...Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori(H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.展开更多
Liver cancer ranks sixth in cancer incidence,and is the third leading cause of cancer-related deaths worldwide.Hepatocellular carcinoma(HCC)is the most common type of liver cancer,which arises from hepatocytes and acc...Liver cancer ranks sixth in cancer incidence,and is the third leading cause of cancer-related deaths worldwide.Hepatocellular carcinoma(HCC)is the most common type of liver cancer,which arises from hepatocytes and accounts for approximately 70%-85%of cases.Hepatitis B virus(HBV)frequently causes liver inflammation,hepatic damage and subsequent cirrhosis.Integrated viral DNA is found in 85%-90%of HBV-related HCCs.Its presence in tumors from non-cirrhotic livers of children or young adults further supports the role of viral DNA integration in hepatocarcinogenesis.Integration of subgenomic HBV DNA fragments into different locations within the host DNA is a significant feature of chronic HBV infection.Integration has two potential consequences:(1)the host genome becomes altered("cis"effect);and(2)the HBV genome becomes altered("trans"effect).The cis effect includes insertional mutagenesis,which can potentially disrupt host gene function or alter host gene regulation.Tumor progression is frequently associated with rearrangement and partial gain or loss of both viral and host sequences.However,the role of integrated HBV DNA in hepatocarcinogenesis remains controversial.Modern technology has provided a new paradigm to further our understanding ofdisease mechanisms.This review summarizes the role of HBV DNA integration in human carcinogenesis.展开更多
AIM:To evaluate the prognostic significance of the lymphocyte to monocyte ratio(LMR) in patients with unresectable metastatic colorectal cancer who received palliative chemotherapy.METHODS:A total of 104 patients with...AIM:To evaluate the prognostic significance of the lymphocyte to monocyte ratio(LMR) in patients with unresectable metastatic colorectal cancer who received palliative chemotherapy.METHODS:A total of 104 patients with unresectable metastatic colorectal cancer who underwent palliative chemotherapy were enrolled. The LMR was calculated from blood samples by dividing the absolute lymphocyte count by the absolute monocyte count. Pretreatment LMR values were measured within one week before the initiation of chemotherapy,while posttreatment LMR values were measured eight weeks after the initiation of chemotherapy.RESULTS:The median pre-treatment LMR was 4.16(range:0.58-14.06). We set 3.38 as the cut-off level based on the receiver operating characteristic curve. Based on the cut-off level of 3.38,66 patients were classified into the high pre-treatment LMR group and 38 patients were classified into the low pretreatment LMR group. The low pre-treatment LMR group had a significantly worse overall survival rate(P = 0.0011). Moreover,patients who demonstrated low pre-treatment LMR and normalization after treatmentexhibited a better overall survival rate than the patients with low pre-treatment and post-treatment LMR values.CONCLUSION:The lymphocyte to monocyte ratio is a useful prognostic marker in patients with unresectable metastatic colorectal cancer who receive palliative chemotherapy.展开更多
Infection with hepatitis B virus is an important healthproblem worldwide:it affects more than 350 millionpeople and is a leading cause of liver-related morbidity,accounting for 1 million deaths annually.Hepatic fibros...Infection with hepatitis B virus is an important healthproblem worldwide:it affects more than 350 millionpeople and is a leading cause of liver-related morbidity,accounting for 1 million deaths annually.Hepatic fibrosis is a consequence of the accumulation of extracellular matrix components in the liver.An accurate diagnosis of liver fibrosis is essential for the management of chronic liver disease.Liver biopsy has been considered the gold standard for diagnosing disease,grading necroinflammatory activity,and staging fibrosis.However,liver biopsy is unsuitable for repeated evaluations because it is invasive and can cause major complications,including death.Several noninvasive evaluations have been introduced for the assessment of liver fibrosis:serum biomarkers,combined indices or scores,and imaging techniques including transient elastography,acoustic radiation force impulse,real-time tissue elastography,and magnetic resonance elastography.Here,we review the recent progress of noninvasive assessment of liver fibrosis in patients with chronic hepatitis B.Most noninvasive evaluations for liver fibrosis have been validated first in patients with chronic hepatitis C,and later in those with chronic hepatitis B.The establishment of a noninvasive assessment of liver fibrosis is urgently needed to aid in the management of this leading cause of chronic liver disease.展开更多
It is estimated that 30%of the adult population in Japan is affected by nonalcoholic fatty liver disease(NAFLD).Fatty changes of the liver are generally diagnosed using imaging methods such as abdominal ultrasonograph...It is estimated that 30%of the adult population in Japan is affected by nonalcoholic fatty liver disease(NAFLD).Fatty changes of the liver are generally diagnosed using imaging methods such as abdominal ultrasonography(US)and computed tomography(CT),but the sensitivity of these imaging techniques is low in cases of mild steatosis.Alanine aminotransferase levels may be normal in some of these patients,warranting the necessity to establish a set of parameters useful for detecting NAFLD,and the more severe form of the disease,nonalcoholic steatohepatitis(NASH).Although liver biopsy is currently the gold standard for diagnosing progressive NASH,it has many drawbacks,such as sampling error,cost,and risk of complications.Furthermore,it is not realistic to perform liver biopsies on all NAFLD patients.Diagnosis of NASH using various biomarkers,scoring systems and imaging methods,such as elastography,has recently been attempted.The NAFIC score,calculated from the levels of ferritin,fasting insulin,and typeⅣcollagen 7S,is useful for the diagnosis of NASH,while the NAFLD fibrosis score and the FIB-4 index are useful for excluding NASH in cases of advanced fibrosis.This article reviews the limitations and merits of liver biopsy and noninvasive diagnostic tests in the diagnosis of NAFLD/NASH.展开更多
IgG4-related sclerosing cholangitis(IgG4-SC)is often associated with autoimmune pancreatitis.However,the diffuse cholangiographic abnormalities observed in IgG4-SC may resemble those observed in primary sclerosing cho...IgG4-related sclerosing cholangitis(IgG4-SC)is often associated with autoimmune pancreatitis.However,the diffuse cholangiographic abnormalities observed in IgG4-SC may resemble those observed in primary sclerosing cholangitis(PSC),and the presence of segmental stenosis suggests cholangiocarcinoma(CC).IgG4-SC responds well to steroid therapy,whereas PSC is only effectively treated with liver transplantation and CC requires surgical intervention.Since IgG4-SC was first described,it has become a third distinct clinical entity of sclerosing cholangitis.The aim of this review was to introduce the diagnostic methods for IgG4-SC.IgG4-SC should be carefully diagnosed based on a combination of characteristic clinical,serological,morphological,and histopathological features after cholangiographic classification and targeting of a disease for differential diagnosis.When intrapancreatic stenosis is detected,pancreatic cancer or CC should be ruled out.If multiple intrahepatic stenoses are evident,PSC should be distinguished on the basis of cholangiographic findings and liver biopsy with IgG4 immunostaining.Associated inflammatory bowel disease is suggestive of PSC.If stenosis is demonstrated in the hepatic hilar region,CC should be discriminated by ultrasonography,intraductal ultrasonography,bile duct biopsy,and a higher cutoff serum IgG4 level of 182 mg/dL.展开更多
Several parameters for predicting survival in patients with colorectal cancer have been identified, including the performance status, age, gender and tumor-nodemetastasis(TNM) stage. Although the TNM stage is importan...Several parameters for predicting survival in patients with colorectal cancer have been identified, including the performance status, age, gender and tumor-nodemetastasis(TNM) stage. Although the TNM stage is important and useful for predicting the prognosis and determining the appropriate treatment, it is well known that the survival time varies widely, even in patients with the same stage of disease. Therefore, the identification of new parameters capable of more precisely predicting patient survival is needed to help select the optimal treatment, especially in patients in the advanced stage of disease. Although the TNM stage reflects the tumor characteristics, cancer progression and survival are not determined solely based on the local characteristics of the tumor, but also the host systemic immune/inflammatory response. Therefore, using a combination of parameters that reflect both tumor characteristics and the host systemic inflammatory status is thought to be important for accurately predicting patient survival.展开更多
Fibroblast growth factor receptors(FGFRs) regulate a variety of cellular functions, from embryogenesis to adult tissue homeostasis. FGFR signaling also plays significant roles in the proliferation, invasion, and survi...Fibroblast growth factor receptors(FGFRs) regulate a variety of cellular functions, from embryogenesis to adult tissue homeostasis. FGFR signaling also plays significant roles in the proliferation, invasion, and survival of several types of tumor cells. FGFR-induced alterations, including gene amplification, chromosomal translocation, and mutations, have been shown to be associated with the tumor initiation and progression of gastric cancer, especially in diffuse-type cancers. Therefore, the FGFR signaling pathway might be one of the therapeutic targets in gastric cancer. This review aims to provide an overview of the role of FGFR signaling in tumorigenesis, tumor progression, proliferation, and chemoresistance. We also discuss the accumulating evidence that demonstrates the effectiveness of using clinical therapeutic agents to inhibit FGFR signaling for the treatment of gastric cancer.展开更多
Although gastric cancer(GC)is one of the leading causes of cancer-related death,major therapeutic advances have not been made,and patients with GC still face poor outcomes.The prognosis of GC also remains poor because...Although gastric cancer(GC)is one of the leading causes of cancer-related death,major therapeutic advances have not been made,and patients with GC still face poor outcomes.The prognosis of GC also remains poor because the molecular mechanisms of GC progression are incompletely understood.MicroRNAs(miRNAs)are noncoding RNAs that are associated with gastric carcinogenesis.Studies investigating the regulation of gene expression by miRNAs have made considerable progress in recent years,and abnormalities in miRNA expression have been shown to be associated with the occurrence and progression of GC.miRNAs contribute to gastric carcinogenesis by altering the expression of oncogenes and tumor suppressors,affecting cell proliferation,apoptosis,motility,and invasion.Moreover,a number of miRNAs have been shown to be associated with tumor type,tumor stage,and patient survival and therefore may be developed as novel diagnostic or prognostic markers.In this review,we discuss the involvement of miRNAs in GC and the mechanisms through which they regulate gene expression and biological functions.Then,we review recent research on the involvement of miRNAs in GC prognosis,their potential use in chemotherapy,and their effects on Helicobacter pylori infections in GC.A greater understanding of the roles of miRNAs in gastric carcinogenesis could provide insights into the mechanisms of tumor development and could help to identify novel therapeutic targets.展开更多
Recent advances in molecular targeted therapies, including targeting human epidermal growth factor receptor 2(HER2), had a major forward step in the therapy for gastric cancer patients. Application of HER2-targeted th...Recent advances in molecular targeted therapies, including targeting human epidermal growth factor receptor 2(HER2), had a major forward step in the therapy for gastric cancer patients. Application of HER2-targeted therapies, in particular trastuzumab in combination with chemotherapy in metastatic HER2-positive gastric cancers, resulted in improvements in response rates, time to progression and overall survival. Nevertheless, as with breast cancer, many patients with gastric cancer develop resistance to trastuzumab. Several promising therapies are currently being developed in combination with chemotherapy to increase the efficacy and overcome the cancerresistance. Here we review the current overview of clinical application of agents targeting HER2 in gastric cancer. We also discuss the ongoing trials supporting the use of HER2-targeted agents combined with cytotoxic agents or other monoclonal antibodies.展开更多
The sentinel node(SN) technique has been established for the treatment of some types of solid cancers to avoid unnecessary lymphadenectomy. If node disease were diagnosed before surgery, minimal surgery with omission ...The sentinel node(SN) technique has been established for the treatment of some types of solid cancers to avoid unnecessary lymphadenectomy. If node disease were diagnosed before surgery, minimal surgery with omission of lymph node dissection would be an option for patients with early gastric cancer. Although SN biopsy has been well ascertained in the treatment of breast cancer and melanoma, SN navigation surgery(SNNS) in gastric cancer has not been yet universal due to the complicated lymphatic flow from the stomach. Satisfactory establishment of SNNS will result in the possible indication of minimally invasive surgery of gastric cancer. However, the results reported in the literature on SN biopsy in gastric cancer are widely divergent and many issues are still to be resolved, such as the collection method of SN, detection of micrometastasis in SN, and clinical benefit. The difference in the procedural technique and learning phase of surgeons is also varied the accuracy of SN mapping. In this review, we outline the current status of application for SNNS in gastric cancer.展开更多
文摘The research explored the ways and means of narrative design in which regional cultural elements are integrated into cultural and creative products.It also researched a new way of thinking and methods of creative product design based on regional cultural elements in order to satisfy consumers’emotional and cultural experiences.Narrative theory takes the perspective of narrative expression in the design of cultural and creative products.The regional cultural elements were used for better interactive communication with consumers in the form of cultural and creative products.In the narrative of cultural and creative product design,intervening in the development of regional cultural and creative design from the perspective of narratology can better exert and create the cultural value of the region itself,with cultural and creative products playing an important role in“local cultural stories.”This research adopted a qualitative approach and provided ideas and guidance for the narrative design and expression of regional cultural elements in creative products through comparative analysis of case studies.The research highlighted the role of narrative design in creating multi-layered experiences,weaving regional cultural stories into products,and the importance of deep understanding and effective use of regional cultural elements in design.
文摘AIM:To compare the differences in kinetics,distribution,and toxicity of triamcinolone acetonide(TA)between the injection methods,sub-Tenon and intravitreal injections in rabbit ocular tissues.METHODS:TA was injected into the vitreous or the sub-Tenon in rabbits.For pharmacokinetic study,rabbits were sacrificed periodically and then TA in blood and ocular tissues(retina/choroids,vitreous,and aqueous humor)were measured over 91 d.For toxicological study,clinical signs,slit-lamp microscopic examination,ophthalmological test were performed.The eyeballs and surrounding tissues were collected and fixed with glutaraldehyde-formalin solution,and then paraffin embedded for histological investigation.RESULTS:Higher levels of TA were distributed in the intraocular tissues when injected into the vitreous compared to the sub-Tenon.Conversely,TA level was remarkably lower in the rabbits which received intravitreal TA injections than those treated with sub-Tenon injection throughout the study period in plasma.Optical discharge probably caused by systemic circulation of TA was observed by receiving sub-Tenon TA injection.Meanwhile,technicassociated toxicological ocular symptoms and findings were more frequently observed in intravitreal injection than in sub-Tenon injection.CONCLUSION:There are significant differences in kinetics and distribution of TA in vitreous body,aqueous humor and plasma,between the two injection methods.Although further study is needed to explain the species difference between human and rabbit,it is assumed that the difference in the frequency of intraocular pressure elevation and cataract formation by TA between the two injection methods are directly related to the TA concentrations in aqueous humor and vitreous body in each injection methods.Systemic toxicity and technic-associated toxicity are also closely related to kinetics of TA in plasma and each injection method itself,respectively.
文摘BACKGROUND Holoprosencephaly(HPE)is a congenital malformation with various degrees of incomplete separation of the cerebral hemispheres due to differentiation disorders of the forebrain.Although HPE with diabetes insipidus due to associated pituitary dysfunction has been reported,HPE with the syndrome of inappropriate antidiuretic hormone secretion(SIADH)is very rare.Tolvaptan,a vasopressin V2 receptor antagonist,is effective in adults with SIADH.However,there is no report of its efficacy in infants with SIADH.The purpose of this report is to demonstrate that tolvaptan is effective for SIADH in infants and that administration of tolvaptan eliminates the need for restriction of water intake and sodium administration.CASE SUMMARY A 2414-g female infant was born at 38 wk by normal vaginal delivery.Facial anomalies and head magnetic resonance imaging indicated semilobar HPE.After birth,she had hyponatremia due to SIADH and was treated using water and sodium restriction.However,she developed an exaggerated response to the fluid restrictions,resulting in large fluctuations in serum sodium levels.Subsequent administration of tolvaptan improved the fluctuations in serum sodium levels without the need for adjustment of water or sodium administration.Serum sodium was maintained within the normal range after discontinuation of tolvaptan at 80 d of life.There were no side effects,such as hypernatremia or liver dysfunction,during the administration of tolvaptan.CONCLUSION This is the first report on the safety and efficacy of tolvaptan in an infant with SIADH associated with HPE.
文摘临床医生和放射诊断科医生对影像学的格式化报告和标准术语的要求正在不断增加。一项研究[1]发现，CT报告在对肺结节边缘和钙化表述上不统一。另一项研究[2]比较了Fleischner Society Glossary中列举的影像术语和它们常用医学词典中的一致性，包括国际疾病分类、标准参考医学术语和统一医学语言系统等，发现Fleischner术语应用率低，仅为3%-36%[3]。另一方面，研究提示对特殊疾病的标准影像学报告，如乳腺癌筛查报告可以改善患者治疗结果。因此希望对疑似胸腺瘤的前纵隔肿瘤制定标准的描述术语和提高这些术语的应用率，达到能促进临床医生和放射科医生之间的交流的目的，最终给患者治疗带来获益。除了制定统一的术语，报告中还应包含相关疾病知识，使之具有疾病特异性。美国放射医师协会制定了乳腺影像报告和数据系统，描述在钼靶和超声影像发现的乳腺病灶，发现影像报告结果与组织学结果具有相关性[4]。乳腺影像报告和数据系统提供一个对应各种病理类型的百分概率，并在临床上得到广泛应用[5]。一个相似的系统应用于甲状腺结节的超声评估，将这些结节分为高度恶性可能和低度恶性可能，指导适当的临床治疗，这个系统被称为甲状腺影像报告数据系统[6]。
文摘Gastric cancer(GC) is one of the most prevalent malignant types in the world and an aggressive disease with a poor 5-year survival. This cancer is biologically and genetically heterogeneous with a poorly understood carcinogenesis at the molecular level. Although the incidence is declining, the outcome of patients with GC remains dismal. Thus, the detection at an early stage utilizing useful screening approaches, selection of an appropriate treatment plan, and effective monitoring is pivotal to reduce GC mortalities. Identification of biomarkers in a basis of clinical information and comprehensive genome analysis could improve diagnosis, prognosis, prediction of recurrence and treatment response. This review summarized the current status and approaches in GC biomarker, which could be potentially used for early diagnosis, accurate prediction of therapeutic approaches and discussed the future perspective based on the molecular classification and profiling.
文摘The association between ulcerative colitis(UC) and colorectal cancer(CRC) has been acknowledged. One of the most serious and life threatening consequences of UC is the development of CRC(UC-CRC). UC-CRC patients are younger, more frequently have multiple cancerous lesions, and histologically show mucinous or signet ring cell carcinomas. The risk of CRC begins to increase 8 or 10 years after the diagnosis of UC. Risk factors for CRC with UC patients include young age at diagnosis, longer duration, greater anatomical extent of colonic involvement, the degree of inflammation, family history of CRC, and presence of primary sclerosing cholangitis. CRC on the ground of UC develop from non-dysplastic mucosa to indefinite dysplasia, lowgrade dysplasia, high-grade dysplasia and finally to invasive adenocarcinoma. Colonoscopy surveillance programs are recommended to reduce the risk of CRC and mortality in UC. Genetic alterations might play a role in the development of UC-CRC. 5-aminosalicylates might represent a favorable therapeutic option for chemoprevention of CRC.
文摘Although liver resection is considered the most effective treatment for hepatocellular carcinoma(HCC), treatment outcomes are unsatisfactory because of the high rate of HCC recurrence. Since we reported hepatitis B e-antigen positivity and high serum hepatitis B virus(HBV) DNA concentrations are strong risk factors for HCC recurrence after curative resection of HBV-related HCC in the early 2000 s, many investigators have demonstrated the effects of viral status on HCC recurrence and post-treatment outcomes. These findings suggest controlling viral status is important to prevent HCC recurrence and improve survival after curative treatment for HBV-related HCC. Antiviral therapy after curative treatment aims to improve prognosis by preventing HCC recurrence and maintaining liver function. Therapy with interferon and nucleos(t)ide analogs may be useful for preventing HCC recurrence and improving overall survival in patients who have undergone curative resection for HBV-related HCC. In addition, reactivation of viral replication can occur after liver resection for HBV-related HCC. Antiviral therapy can be recommended for patients to prevent HBV reactivation. Nevertheless, further studies are required to establish treatment guidelines for patients with HBVrelated HCC.
文摘In this paper,we review the concept of quality of ulcer healing(QOUH) in the gastrointestinal tract and its role in the ulcer recurrence.In the past,peptic ulcer disease(PUD) has been a chronic disease with a cycle of repeated healing/remission and recurrence.The main etiological factor of PUD is Helicobacter pylori(H.pylori),which is also the cause of ulcer recurrence.However,H.pylori-negative ulcers are present in 12%-20% of patients;they also recur and are on occasion intractable.QOUH focuses on the fact that mucosal and submucosal structures within ulcer scars are incompletely regenerated.Within the scars of healed ulcers,regenerated tissue is immature and with distorted architecture,suggesting poor QOUH.The abnormalities in mucosal regeneration can be the basis for ulcer recurrence.Our studies have shown that persistence of macrophages in the regenerated area plays a key role in ulcer recurrence.Our studies in a rat model of ulcer recurrence have indicated that proinflammatory cytokines trigger activation of macrophages,which in turn produce increased amounts of cytokines and chemokines,which attract neutrophils to the regenerated area.Neutrophils release proteolytic enzymes that destroy the tissue,resulting in ulcer recurrence.Another important factor in poor QOUH can be deficiency of endogenous prostaglandins and a deficiency and/or an imbalance of endogenous growth factors.Topically active mucosal protective and antiulcer drugs promote high QOUH and reduce inflammatory cell infiltration in the ulcer scar.In addition to PUD,the concept of QOUH is likely applicable to inflammatory bowel diseases including Crohn's disease and ulcerative colitis.
基金Supported by KAKENHI Grant-in-Aid for Scientific Research,No.23390329the National Cancer Center Research and Development Fund,No.23-A-9
文摘Gastric cancer is one of the most frequent and lethal malignancies worldwide because of high frequency of metastasis. Tumor cell motility and invasion play fundamental roles in cancer metastasis. Recent studies have revealed that the Rho/Rho-associated protein kinases(ROCK) pathway plays a critical role in the regulation of cancer cell motility and invasion. In addition,the Rho/ROCK pathway plays important roles in invasion and metastasis on the basis of its predominant function of cell cytoskeletal regulation in gastric cancer. According to the current understanding of tumor motility,there are two modes of tumor cell movement:mesenchymal and amoeboid. In addition,cancer cell movement can be interchangeable between the mesenchymal and amoeboid movements under certain conditions. Control of cell motility through the actin cytoskeleton creates the potential for regulating tumor cell metastasis. In this review we discuss Rho GTPases and ROCK signaling and describe the mechanisms of Rho/ROCK activity with regard to motility and metastasis in gastric cancer.In addition,we provide an insight of the therapeutic potential of targeting the Rho/ROCK pathway.
文摘Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori(H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.
文摘Liver cancer ranks sixth in cancer incidence,and is the third leading cause of cancer-related deaths worldwide.Hepatocellular carcinoma(HCC)is the most common type of liver cancer,which arises from hepatocytes and accounts for approximately 70%-85%of cases.Hepatitis B virus(HBV)frequently causes liver inflammation,hepatic damage and subsequent cirrhosis.Integrated viral DNA is found in 85%-90%of HBV-related HCCs.Its presence in tumors from non-cirrhotic livers of children or young adults further supports the role of viral DNA integration in hepatocarcinogenesis.Integration of subgenomic HBV DNA fragments into different locations within the host DNA is a significant feature of chronic HBV infection.Integration has two potential consequences:(1)the host genome becomes altered("cis"effect);and(2)the HBV genome becomes altered("trans"effect).The cis effect includes insertional mutagenesis,which can potentially disrupt host gene function or alter host gene regulation.Tumor progression is frequently associated with rearrangement and partial gain or loss of both viral and host sequences.However,the role of integrated HBV DNA in hepatocarcinogenesis remains controversial.Modern technology has provided a new paradigm to further our understanding ofdisease mechanisms.This review summarizes the role of HBV DNA integration in human carcinogenesis.
文摘AIM:To evaluate the prognostic significance of the lymphocyte to monocyte ratio(LMR) in patients with unresectable metastatic colorectal cancer who received palliative chemotherapy.METHODS:A total of 104 patients with unresectable metastatic colorectal cancer who underwent palliative chemotherapy were enrolled. The LMR was calculated from blood samples by dividing the absolute lymphocyte count by the absolute monocyte count. Pretreatment LMR values were measured within one week before the initiation of chemotherapy,while posttreatment LMR values were measured eight weeks after the initiation of chemotherapy.RESULTS:The median pre-treatment LMR was 4.16(range:0.58-14.06). We set 3.38 as the cut-off level based on the receiver operating characteristic curve. Based on the cut-off level of 3.38,66 patients were classified into the high pre-treatment LMR group and 38 patients were classified into the low pretreatment LMR group. The low pre-treatment LMR group had a significantly worse overall survival rate(P = 0.0011). Moreover,patients who demonstrated low pre-treatment LMR and normalization after treatmentexhibited a better overall survival rate than the patients with low pre-treatment and post-treatment LMR values.CONCLUSION:The lymphocyte to monocyte ratio is a useful prognostic marker in patients with unresectable metastatic colorectal cancer who receive palliative chemotherapy.
文摘Infection with hepatitis B virus is an important healthproblem worldwide:it affects more than 350 millionpeople and is a leading cause of liver-related morbidity,accounting for 1 million deaths annually.Hepatic fibrosis is a consequence of the accumulation of extracellular matrix components in the liver.An accurate diagnosis of liver fibrosis is essential for the management of chronic liver disease.Liver biopsy has been considered the gold standard for diagnosing disease,grading necroinflammatory activity,and staging fibrosis.However,liver biopsy is unsuitable for repeated evaluations because it is invasive and can cause major complications,including death.Several noninvasive evaluations have been introduced for the assessment of liver fibrosis:serum biomarkers,combined indices or scores,and imaging techniques including transient elastography,acoustic radiation force impulse,real-time tissue elastography,and magnetic resonance elastography.Here,we review the recent progress of noninvasive assessment of liver fibrosis in patients with chronic hepatitis B.Most noninvasive evaluations for liver fibrosis have been validated first in patients with chronic hepatitis C,and later in those with chronic hepatitis B.The establishment of a noninvasive assessment of liver fibrosis is urgently needed to aid in the management of this leading cause of chronic liver disease.
基金Supported by Scholarship Funds from MSD Co.Ltd.(to Sumida Y)+3 种基金Scholarship Funds from MSD Co.Ltd.Dainippon Sumitomo Pharma Co.Ltd.(to Ioh Y)
文摘It is estimated that 30%of the adult population in Japan is affected by nonalcoholic fatty liver disease(NAFLD).Fatty changes of the liver are generally diagnosed using imaging methods such as abdominal ultrasonography(US)and computed tomography(CT),but the sensitivity of these imaging techniques is low in cases of mild steatosis.Alanine aminotransferase levels may be normal in some of these patients,warranting the necessity to establish a set of parameters useful for detecting NAFLD,and the more severe form of the disease,nonalcoholic steatohepatitis(NASH).Although liver biopsy is currently the gold standard for diagnosing progressive NASH,it has many drawbacks,such as sampling error,cost,and risk of complications.Furthermore,it is not realistic to perform liver biopsies on all NAFLD patients.Diagnosis of NASH using various biomarkers,scoring systems and imaging methods,such as elastography,has recently been attempted.The NAFIC score,calculated from the levels of ferritin,fasting insulin,and typeⅣcollagen 7S,is useful for the diagnosis of NASH,while the NAFLD fibrosis score and the FIB-4 index are useful for excluding NASH in cases of advanced fibrosis.This article reviews the limitations and merits of liver biopsy and noninvasive diagnostic tests in the diagnosis of NAFLD/NASH.
文摘IgG4-related sclerosing cholangitis(IgG4-SC)is often associated with autoimmune pancreatitis.However,the diffuse cholangiographic abnormalities observed in IgG4-SC may resemble those observed in primary sclerosing cholangitis(PSC),and the presence of segmental stenosis suggests cholangiocarcinoma(CC).IgG4-SC responds well to steroid therapy,whereas PSC is only effectively treated with liver transplantation and CC requires surgical intervention.Since IgG4-SC was first described,it has become a third distinct clinical entity of sclerosing cholangitis.The aim of this review was to introduce the diagnostic methods for IgG4-SC.IgG4-SC should be carefully diagnosed based on a combination of characteristic clinical,serological,morphological,and histopathological features after cholangiographic classification and targeting of a disease for differential diagnosis.When intrapancreatic stenosis is detected,pancreatic cancer or CC should be ruled out.If multiple intrahepatic stenoses are evident,PSC should be distinguished on the basis of cholangiographic findings and liver biopsy with IgG4 immunostaining.Associated inflammatory bowel disease is suggestive of PSC.If stenosis is demonstrated in the hepatic hilar region,CC should be discriminated by ultrasonography,intraductal ultrasonography,bile duct biopsy,and a higher cutoff serum IgG4 level of 182 mg/dL.
文摘Several parameters for predicting survival in patients with colorectal cancer have been identified, including the performance status, age, gender and tumor-nodemetastasis(TNM) stage. Although the TNM stage is important and useful for predicting the prognosis and determining the appropriate treatment, it is well known that the survival time varies widely, even in patients with the same stage of disease. Therefore, the identification of new parameters capable of more precisely predicting patient survival is needed to help select the optimal treatment, especially in patients in the advanced stage of disease. Although the TNM stage reflects the tumor characteristics, cancer progression and survival are not determined solely based on the local characteristics of the tumor, but also the host systemic immune/inflammatory response. Therefore, using a combination of parameters that reflect both tumor characteristics and the host systemic inflammatory status is thought to be important for accurately predicting patient survival.
基金Supported by KAKENHI(partiallyGrant-in-Aid for Scientific ResearchNo.23390329)
文摘Fibroblast growth factor receptors(FGFRs) regulate a variety of cellular functions, from embryogenesis to adult tissue homeostasis. FGFR signaling also plays significant roles in the proliferation, invasion, and survival of several types of tumor cells. FGFR-induced alterations, including gene amplification, chromosomal translocation, and mutations, have been shown to be associated with the tumor initiation and progression of gastric cancer, especially in diffuse-type cancers. Therefore, the FGFR signaling pathway might be one of the therapeutic targets in gastric cancer. This review aims to provide an overview of the role of FGFR signaling in tumorigenesis, tumor progression, proliferation, and chemoresistance. We also discuss the accumulating evidence that demonstrates the effectiveness of using clinical therapeutic agents to inhibit FGFR signaling for the treatment of gastric cancer.
文摘Although gastric cancer(GC)is one of the leading causes of cancer-related death,major therapeutic advances have not been made,and patients with GC still face poor outcomes.The prognosis of GC also remains poor because the molecular mechanisms of GC progression are incompletely understood.MicroRNAs(miRNAs)are noncoding RNAs that are associated with gastric carcinogenesis.Studies investigating the regulation of gene expression by miRNAs have made considerable progress in recent years,and abnormalities in miRNA expression have been shown to be associated with the occurrence and progression of GC.miRNAs contribute to gastric carcinogenesis by altering the expression of oncogenes and tumor suppressors,affecting cell proliferation,apoptosis,motility,and invasion.Moreover,a number of miRNAs have been shown to be associated with tumor type,tumor stage,and patient survival and therefore may be developed as novel diagnostic or prognostic markers.In this review,we discuss the involvement of miRNAs in GC and the mechanisms through which they regulate gene expression and biological functions.Then,we review recent research on the involvement of miRNAs in GC prognosis,their potential use in chemotherapy,and their effects on Helicobacter pylori infections in GC.A greater understanding of the roles of miRNAs in gastric carcinogenesis could provide insights into the mechanisms of tumor development and could help to identify novel therapeutic targets.
基金KAKENHI(Grant-in-Aid for Scientific Research),No.23390329the National Cancer Center Research and Development Fund(23-A-9)
文摘Recent advances in molecular targeted therapies, including targeting human epidermal growth factor receptor 2(HER2), had a major forward step in the therapy for gastric cancer patients. Application of HER2-targeted therapies, in particular trastuzumab in combination with chemotherapy in metastatic HER2-positive gastric cancers, resulted in improvements in response rates, time to progression and overall survival. Nevertheless, as with breast cancer, many patients with gastric cancer develop resistance to trastuzumab. Several promising therapies are currently being developed in combination with chemotherapy to increase the efficacy and overcome the cancerresistance. Here we review the current overview of clinical application of agents targeting HER2 in gastric cancer. We also discuss the ongoing trials supporting the use of HER2-targeted agents combined with cytotoxic agents or other monoclonal antibodies.
基金Partially funded by KAKENHI(Grant-in-Aid forScientific Research),No.23390329by the National Cancer Center Research and Development Fund(23-A-9)by PriorityResearch Fund of Osaka City University
文摘The sentinel node(SN) technique has been established for the treatment of some types of solid cancers to avoid unnecessary lymphadenectomy. If node disease were diagnosed before surgery, minimal surgery with omission of lymph node dissection would be an option for patients with early gastric cancer. Although SN biopsy has been well ascertained in the treatment of breast cancer and melanoma, SN navigation surgery(SNNS) in gastric cancer has not been yet universal due to the complicated lymphatic flow from the stomach. Satisfactory establishment of SNNS will result in the possible indication of minimally invasive surgery of gastric cancer. However, the results reported in the literature on SN biopsy in gastric cancer are widely divergent and many issues are still to be resolved, such as the collection method of SN, detection of micrometastasis in SN, and clinical benefit. The difference in the procedural technique and learning phase of surgeons is also varied the accuracy of SN mapping. In this review, we outline the current status of application for SNNS in gastric cancer.
