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| 1 | Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma显示文摘AIM: To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients. METHODS: After the diagnosis of HCC, all 995 consecutive HCC patients were followed up at regular intervals and 151 (15.2%) patients were found to have extrahepatic metastases at the initial diagnosis of primary HCC or developed such tumors during the follow-up period. We assessed their clinical features, prognosis, and treatment strategies. RESULTS: The most frequent site of extrahepatic metastases was the lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). The cumulative survival rates after the initial diagnosis of extrahepatic metastases at 6, 12, 24, and 36 mo were 44.1%, 21.7%, 14.2%, 7.1%, respectively. The median survival time was 4.9 mo (range, 0-37 mo). Fourteen patients (11%) died of extrahepatic HCC, others died of primary HCC or liver failure. CONCLUSION: The prognosis of HCC patients with extrahepatic metastases is poor. With regard to the cause of death, many patients would die of intrahepatic HCC and few of extrahepatic metastases. Although most of HCC patients with extrahepatic metastases should undergo treatment for the primary HCC mainly, treatment of extrahepatic metastases in selected HCC patients who have good hepatic reserve, intrahepatictumor stage (T0-T2), and are free of portal venous invasion may improve survival. | Kiminori Uka Hiroshi Aikata Shintaro Takaki Hiroo Shirakawa Soo Cheol Jeong Keitaro Yamashina Akira Hiramatsu Hideaki Kodama Shoichi Takahashi Kazuaki Chayama | 2007 | World Journal of Gastroenterology2007，13，3： | 44 |
| 2 | Feasibility of cold snare polypectomy in Japan: A pilot study显示文摘AIM: To investigate the feasibility of cold snare polypectomy(CSP) in Japan.METHODS: The outcomes of 234 non-pedunculated polyps smaller than 10 mm in 61 patients who underwent CSP in a Japanese referral center were retrospectively analyzed. The cold snare polypectomies were performed by nine endoscopists with no prior experience in CSP using an electrosurgical snare without electrocautery.RESULTS: CSPs were completed for 232 of the 234 polyps. Two(0.9%) polyps could not be removed without electrocautery. Immediate postpolypectomy bleeding requiring endoscopic hemostasis occurred in eight lesions(3.4%; 95%CI: 1.1%-5.8%), but all were easily managed. The incidence of immediate bleeding after CSP for small polyps(6-9 mm) was significantly higher than that of diminutive polyps(≤ 5 mm; 15% vs 1%, respectively). Three(5%) patients complained of minor bleeding after the procedure but required no intervention. The incidence of delayed bleeding requiringendoscopic intervention was 0.0%(95%CI: 0.0%-1.7%). In total, 12% of the resected lesions could not be retrieved for pathological examination. Tumor involvement in the lateral margin could not be histologically assessed in 70(40%) lesions.CONCLUSION: CSP is feasible in Japan. However, immediate bleeding, retrieval failure and uncertain assessment of the lateral tumor margin should not be underestimated. Careful endoscopic diagnosis before and evaluation of the tumor residue after CSP are recommended when implementing CSP in Japan. | Yoji Takeuchi Takeshi Yamashina Noriko Matsuura Takashi Ito Mototsugu Fujii Kengo Nagai Fumi Matsui Tomofumi Akasaka Noboru Hanaoka Koji Higashino Hiroyasu Iishi Ryu Ishihara Henrik Thorlacius Noriya Uedo | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，17： | 14 |
| 3 | Pink-color sign in esophageal squamous neoplasia, and speculation regarding the underlying mechanism显示文摘AIM:To investigate the reasons for the occurrence of the pink-color sign of iodine-unstained lesions. METHODS:In chromoendoscopy, the pink-color sign of iodine-unstained lesions is recognized as useful for the diagnosis of esophageal squamous cell carcinoma. Patients with superficial esophageal neoplasms treated by endoscopic resection were included in the study. Areas of mucosa with and without the pink-color sign were evaluated histologically. The following histologic features that were possibly associated with the pinkcolor sign were evaluated. The keratinous layer and basal cell layer were classified as present or absent. Cellular atypia was classified as high grade, moderate grade or low grade, based on nuclear irregularity, mitotic figures, loss of polarity, chromatin pattern and nuclear/cytoplasmic ratio. Vascular change was assessed based on dilatation, tortuosity, caliber change and variability in shape. Vessels with these four findings were classified as positive for vascular change. Endoscopic images of the lesions were captured immediately after iodine staining, 2-3 min after iodine staining and after complete fading of iodine staining. Quantitative analysis of color changes after iodine staining was also performed. RESULTS:A total of 61 superficial esophageal neoplasms in 54 patients were included in the study. The lesions were located in the cervical esophagus in one case, the upper thoracic esophagus in 10 cases, the mid-thoracic esophagus in 33 cases, and the lower thoracic esophagus in 17 cases. The median diameter of the lesions was 20 mm (range:2-74 mm). Of the 61 lesions, 28 were classified as pink-color sign positive and 33 as pink-color sign negative. The histologic diagnosis was high-grade intraepithelial neoplasia (HGIN) or cancer invading into the lamina propria in 26 of the 28 pink-color sign positive lesions. There was a significant association between pink-color sign positive epithelium and HGIN or invasive cancer (P = 0.0001). Univariate analyses found that absence of the keratinous layer and cellular atypia were significantly associated with the pink-color sign. After Bonferroni correction, there were no significant associations between the pink-color sign and presence of the basal membrane or vascular change. Multivariate analyses found that only absence of the keratinous layer was independently associated with the pink-color sign (OR = 58.8, 95%CI:5.5-632).Quantitative analysis was performed on 10 superficial esophageal neoplasms with both pink-color sign positive and negative areas in 10 patients. Pink-color sign positive mucosa had a lower mean color value in the late phase (pinkish color) than in the early phase (yellowish color), and had similar mean color values in the late and final phases. These findings suggest that pinkcolor positive mucosa underwent color fading from the color of the iodine (yellow) to the color of the mucosa (pink) within 2-3 min after iodine staining. Pink-color sign negative mucosa had similar mean color values in the late and early phases (yellowish color), and had a lower mean color value in the final phase (pinkish color) than in the late phase. These findings suggest that pink-color sign negative mucosa did not undergo color fading during the 2-3 min after iodine staining, and underwent color fading only after spraying of sodium thiosulfate. CONCLUSION:The pink-color sign was associated with absence of the keratinous layer. This sign may be caused by early fading of iodine staining. | Ryu Ishihara Hiromitsu Kanzaki Hiroyasu Iishi Kengo Nagai Fumi Matsui Takeshi Yamashina Noriko Matsuura Takashi Ito Mototsugu Fujii Sachiko Yamamoto Noboru Hanaoka Yoji Takeuchi Koji Higashino Noriya Uedo Masaharu Tatsuta Yasuhiko Tomita Shingo Ishiguro | 2013 | World Journal of Gastroenterology2013，19，27： | 10 |
| 4 | Delayed perforation: A hazardous complication of endoscopic resection for non‐ampullary duodenal neoplasm显示文摘 | Takuya Inoue Noriya Uedo Takeshi Yamashina Sachiko Yamamoto Noboru Hanaoka Yoji Takeuchi Koji Higashino Ryu Ishihara Hiroyasu Iishi Masaharu Tatsuta Hidenori Takahashi Hidetoshi Eguchi Hiroaki Ohigashi | 2014 | Digestive Endoscopy2014，，2： | 3 |
| 5 | Effects of aging and persistent prehypertension on arterial stiffening显示文摘 | Hirofumi Tomiyama Hideki Hashimoto Chisa Matsumoto Mari Odaira Masanobu Yoshida Kazuki Shiina Mikio Nagata Akira Yamashina Nobutaka Doba Shigeaki Hinohara | 2011 | Atherosclerosis2011，，1： | 2 |
| 6 | Kupffer cell derived prostaglandin E(2) is involved in alcoholic induced fat accumulation in rat liver显示文摘 | Enomoto N Ikejima K Yamashina S | 2000 | Am J Physiol Gastroinlest liver Physio2000，279，： | 1 |
| 7 | Validity,reproducibility,and clinical significance of noninvasive brachialankle pulse wave velocity measurement显示文摘 | Yamashina A Tomiyama H Takeda K | 2002 | Hypertens Res2002，25，3： | 1 |
| 8 | Delayed perforation after intralesional trlamcinolone injection for esophageal stricture fol- lowing endoscopic submucosal dissection显示文摘 | Yamashina T Uedo N Fujii M | 2013 | Endoscopy2013，45，2： | 1 |
| 9 | Hepatic steatosis inhibits autophagic proteolysis via impairment of autophagosomal acidification and cathepsin expression显示文摘 | Inami Y Yamashina S Izumi K | 2011 | Biochem Biophys Res Commun2011，412，4： | 1 |
| 10 | Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk显示文摘 | Yamashina A Tomiyama H Arai T | 2003 | Hypertens Res2003，26，8： | 1 |
| 11 | Eplerenone Post-AMI Heart Failure Efficacy and Survival Study (EPHESUS)显示文摘 | Takata Y Asano K Yamashina A | 2005 | Nippon Rinsho2005，63，3： | 1 |
| 12 | Validity,reproducibility,and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement显示文摘 | Yamashina A Tomiyama H Takeda K | 2002 | Hypertens Res2002，25，： | 1 |
| 13 | Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk 显示文摘 | Yamashina A Tomiyama H Arai T | 2003 | Hypertens Res2003，26，8： | 1 |
| 14 | Inherited complete deficiency of 20-kilodalton homologous restriction factor(CD59)as a cause of paroxysmal nocturnal hemoglobinuria显示文摘 | Yamashina M Ueda E Kinoshita T Takami T Ojima A Ono H | 1990 | N Engl J Med1990，323，17： | 1 |
| 15 | Suppression of autoph-agy sensitizes Kupffer cells to endotoxin 显示文摘 | Fukada H Yamashina S Izumi K | 2012 | Hepatol Res2012，42，： | 1 |
| 16 | Open reduction and in- ternal fixation of comminuted fractures of the radial head using low- profile mini-plates显示文摘 | lkeda M Yamashina ~ Kamimoto M | 2003 | J Bone Joint Surg(Br)2003，85，7： | 1 |
| 17 | Innovative product development process by integrating QFD and TRIZ显示文摘 | YAMASHINA H ITO T KAWADA H | 2002 | International Journal of Production Research2002，40，5： | 1 |
| 18 | Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk显示文摘 | Tomiyama H Arai T | 2003 | Hypertens Res2003，26，5： | 1 |
| 19 | Arteriosclerosis and pulsewave velocity 显示文摘 | Yamashina A Tomiyama H | 2004 | Nippon Rinsho2004，62，1： | 1 |
| 20 | Validitity Reproducibility and Clinical Significance of Noninvasive Brachial-Ankle Pulse Ware Velocity Measurement显示文摘 | Akira YAMASHINA | 2002 | Hypertens Res2002，25，： | 1 |
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