研究者詳細 - 荒木　元朗

Ectopic calcification: importance of common nanoparticle scaffolds containing oxidized acidic lipids. 査読国際誌

Hiromi Kumon, Eiji Matsuura, Noriyuki Nagaoka, Toshio Yamamoto, Shinya Uehara, Motoo Araki, Yukana Matsunami, Kazuko Kobayashi, Akira Matsumoto

Nanomedicine : nanotechnology, biology, and medicine 10 ( 2 ) 441 - 50 2014年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ELSEVIER SCIENCE BV

UNLABELLED: The term nanobacteria, sometimes referred to as nanobacteria-like particles (NLPs), is presently recognized as a misnomer for inert calcified nanoparticles. However, misinterpretation of its propagation as a living organism still continues. Ultrastructural and elemental analyses, combining immuno-electron microscopy with an original NLP isolate (P-17) derived from urinary stones, and an IgM monoclonal antibody (CL-15) raised against P-17 have now revealed that, oxidized lipids with acidified functional groups were key elements in NLP propagation. Lamellar structures composed of acidic/oxidized lipids provided structural scaffolds for carbonate apatite crystals. During in vitro culture, lipid peroxidation induced by γ-irradiation of FBS was a major cause of accelerated NLP propagation. In pathological tissue samples from hyperlipidemic atherosclerosis-prone mice, CL-15 co-localized with fatty plaques, macrophage infiltrates and osteocalcin staining of aortic valve lesions. These observations indicate that naturally occurring NLP composed of mineralo-oxidized lipids complexes are generated as by-products rather than etiological agents of chronic inflammation. FROM THE CLINICAL EDITOR: The term "nanobacteria-like particles (NLPs)" is presently recognized as a misnomer for inert calcified nanoparticles as opposed to living organisms. This study convincingly demonstrates that naturally occurring NLPs composed of mineralo-oxidized lipid complexes are generated as by-products rather than etiological agents of chronic inflammation.

DOI： 10.1016/j.nano.2013.08.010

Robot-assisted radical prostatectomy: modified ultradissection reduces pT2 positive surgical margins on the bladder neck. 査読

Motoo Araki, Wooju Jeong, Sung Yul Park, Young Hoon Lee, Yasutomo Nasu, Hiromi Kumon, Sung Joon Hong, Koon Ho Rha

Acta medica Okayama 68 ( 1 ) 35 - 41 2014年

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Okayama University Medical School

The purpose of this study was to compare the positive surgical margin (PSM) rates of 2 techniques of robot-assisted radical prostatectomy (RARP) for pT2 (localized) prostate cancer. A retrospective analysis was conducted of 361 RARP cases, performed from May 2005 to September 2008 by a single surgeon (KHR) at our institution (Yonsei University College of Medicine). In the conventional technique, the bladder neck was transected first. In the modified ultradissection, the lateral border of the bladder neck was dissected and then the bladder neck was transected while the detrusor muscle of the bladder was well visualized. Perioperative characteristics and outcomes and PSM rates were analyzed retrospectively for pT2 patients (n＝217), focusing on a comparison of those undergoing conventional (n＝113) and modified ultradissection (n＝104) techniques. There was no difference between the conventional and modified ultradissection group in mean age, BMI, PSA, prostate volume, biopsy Gleason score, and D'Amico prognostic criteria distributions. The mean operative time was shorter (p＜0.001) and the estimated blood loss was less (p＜0.01) in the modified ultradissection group. The PSM rate for the bladder neck was significantly reduced by modified ultradissection, from 6.2% to 0% (p＜0.05). In conclusion, modified ultradissection reduces the PSM rate for the bladder neck.

DOI： 10.18926/AMO/52142

その他リンク： http://search.jamas.or.jp/link/ui/2014376397

A rare complication: misdirection of an indwelling urethral catheter into the ureter. 査読

Tsutomu Ishikawa, Motoo Araki, Takeshi Hirata, Masami Watanabe, Shin Ebara, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

Acta medica Okayama 68 ( 1 ) 47 - 51 2014年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Okayama University Medical School

We report 3 patients with the rare complication of an indwelling urethral catheter misdirected into the ureter. This is the largest series to date. Patients were referred to us for a variety of reasons following exchange of their chronic indwelling urinary catheters. CT in all cases demonstrated the urinary catheters residing in the left ureter. The ages of the patients were 37, 67 and 81 years old. All patients suffered from neurogenic bladder. Two patients were female, one was male, and 2 of the 3 had a sensory disorder inhibiting their pain response. The catheters were replaced with open-end Foley catheters. Extensive follow-up CT scans were obtained in one case, demonstrating improvement of hydronephrosis and no evidence of ureteral stenosis. Cystoscopy in this patient demonstrated normally positioned and functioning ureteral orifices. Although the placement of an indwelling urethral catheter is a comparatively safe procedure, one must keep in mind that this complication can occur, particularly in female patients with neurogenic bladder. CT without contrast is a noninvasive, definitive diagnostic tool.

DOI： 10.18926/AMO/52144

その他リンク： http://search.jamas.or.jp/link/ui/2014376399

Comparison of 7 α1-adrenoceptor Antagonists in Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia:A Short-term Crossover Study 査読

Araki Tohru, Monden Koichi, Araki Motoo

Acta Medica Okayama 67 ( 4 ) 245 - 251 2013年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Okayama University Medical School

A crossover study was conducted to identify the best α1-adrenoceptor (α1AR) antagonist for individual patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). One hundred thirteen patients (mean age 70.8 years) were enrolled. All patients met BPH clinical study guidelines. Seven agents were utilized:tamsulosin 0.2mg, silodosin 8mg, urapidil 60mg, naftopidil 50mg, prazosin 1mg, terazosin 2mg, and doxazosin 1mg. Patients were initially prescribed tamsulosin or silodosin for a week and then urapidil for a week. Two weeks later, they were prescribed the better of the 2 agents for a week and a new agent for the next week. This cycle was repeated until all 7 agents were tested. Efficacy was evaluated with the International Prostate Symptom Score. The agent rankings were doxazosin (25 [22%]), silodosin (22 [19%]), urapidil (19 [17%]), naftopidil (17 [15%]), terazosin (12 [11%]), tamsulosin (11 [10%]), prazosin (7 [6%]). Only 12 patients (11%) changed agents after the crossover study was completed. The major reason was adverse events (83%). We found that each of the 7 α1AR antagonists has its own supporters. Further, the one-week crossover study was useful in identifying the best agent for the treatment of each individual with LUTS.

DOI： 10.18926/AMO/51069

その他リンク： http://search.jamas.or.jp/link/ui/2014082878

Predictive factors for acute and late urinary toxicity after permanent interstitial brachytherapy in Japanese patients. 国際誌

Ryuta Tanimoto, Kensuke Bekku, Norihisa Katayama, Yasuyuki Kobayashi, Shin Ebara, Motoo Araki, Mitsuhiro Takemoto, Hiroyuki Yanai, Yasutomo Nasu, Hiromi Kumon

International journal of urology : official journal of the Japanese Urological Association 20 ( 8 ) 812 - 7 2013年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: To describe the frequency of and to determine predictive factors associated with Radiation Therapy Oncology Group urinary toxicity in prostate brachytherapy patients. METHODS: From January 2004 to April 2011, 466 consecutive Japanese patients underwent permanent iodine-125-seed brachytherapy (median follow up 48 months). International Prostate Symptom Score and Radiation Therapy Oncology Group toxicity data were prospectively collected. Prostate volume, International Prostate Symptom Score before and after brachytherapy, and postimplant analysis were examined for an association with urinary toxicity, defined as Radiation Therapy Oncology Group urinary toxicity of Grade 1 or higher. Logistic regression analysis was used to examine the factors associated with urinary toxicity. RESULTS: The rate of Radiation Therapy Oncology Group urinary toxicity grade 1 or higher at 1, 6, 12, 24, 36 and 48 months was 67%, 40%, 21%, 31%, 27% and 28%, respectively. Grade 2 or higher urinary toxicity was less than 1% at each time-point. International Prostate Symptom Score was highest at 3 months and returned to normal 12 months after brachytherapy. On univariate analysis, patients with a larger prostate size, greater baseline International Prostate Symptom Score, higher prostate V100, higher prostate V150, higher prostate D90 and a greater number of seeds had more acute urinary toxicities at 1 month and 12 months after brachytherapy. On multivariate analysis, significant predictors for urinary toxicity at 1 month and 12 months were a greater baseline International Prostate Symptom Score and prostate V100. CONCLUSIONS: Most urinary symptoms are tolerated and resolved within 12 months after prostate brachytherapy. Acute and late urinary toxicity after brachytherapy is strongly related to the baseline International Prostate Symptom Score and prostate V100.

DOI： 10.1111/iju.12050

Testosterone replacement elevates the serum uric acid levels in patients with female to male gender identity disorder. 査読

Hiroaki Kurahashi, Masami Watanabe, Morito Sugimoto, Yuichi Ariyoshi, Sabina Mahmood, Motoo Araki, Kazushi Ishii, Yasutomo Nasu, Atsushi Nagai, Hiromi Kumon

Endocrine journal 60 ( 12 ) 1321 - 7 2013年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：The Japan Endocrine Society

Gender identity disorder (GID) results from a disagreement between a person's biological sex and the gender to which he or she identifies. With respect to the treatment of female to male GID, testosterone replacement therapy (TRT) is available. The uric acid (UA) level can be influenced by testosterone; however, the early effects and dose-dependency of TRT on the serum UA concentration have not been evaluated in this population. We herein conducted a dose-response analysis of TRT in 160 patients with female to male GID. The TRT consisted of three treatment groups who received intramuscular injections of testosterone enanthate: 125 mg every two weeks, 250 mg every three weeks and 250 mg every two weeks. Consequently, serum UA elevation was observed after three months of TRT and there was a tendency toward testosterone dose-dependency. The onset of hyperuricemia was more prevalent in the group who received the higher dose. We also demonstrated a positive correlation between increased levels of serum UA and serum creatinine. Since the level of serum creatinine represents an individual's muscle volume and the muscle is a major source of purine, which induces UA upregulation, the serum UA elevation observed during TRT is at least partially attributed to an increase in muscle mass. This is the first study showing an association between serum UA elevation and a TRT-induced increase in muscle mass. The current study provides important information regarding TRT for the follow-up and management of the serum UA levels in GID patients.

DOI： 10.1507/endocrj.EJ13-0203

その他リンク： http://search.jamas.or.jp/link/ui/2014187638

岡山大学病院におけるロボット補助下前立腺全摘術の初期経験

平田武志, 小林泰之, 荒木元朗, 江原伸, 上原慎也, 渡邊豊彦, 雑賀隆史, 那須保友, 公文裕巳

Japanese Journal of Endourology 25 ( 3 ) 242 - 242 2012年11月

Laparoscopic management of complicated urachal remnants in adults. 国際誌

Motoo Araki, Takashi Saika, Daiji Araki, Yasuyuki Kobayashi, Shinya Uehara, Toyohiko Watanabe, Kiyoshi Yamada, Yasutomo Nasu, Hiromi Kumon

World journal of urology 30 ( 5 ) 647 - 50 2012年10月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：SPRINGER

OBJECTIVES: The traditional surgical approach for removing a urachal remnant is via a large transverse or midline infraumbilical incision. We review our experience with laparoscopic urachal cyst excision and report the efficacy and outcomes of this approach as a less morbid, minimally invasive alternative. METHODS: Between August 2005 and March 2009, eight patients with a mean age of 26 years who had symptomatic urachal cysts underwent laparoscopic radical excision of the urachal remnant. Using three ports, the urachal remnant was dissected from the umbilicus to the bladder dome and then removed intact via the umbilicus. Umbilicoplasty was performed by a plastic surgeon. We retrospectively reviewed the perioperative records to assess morbidity and outcomes. RESULTS: All eight operations were completed successfully. No intraoperative or postoperative complications were reported at a mean follow-up of 3.2 years. Mean operative time was 147.5 min including umbilicoplasty. Pathological evaluation confirmed a benign urachal remnant in each case. There have been no recurrences of symptoms nor postoperative complications during follow-up. Mean time to full recovery, defined as return to normal life without pain, was 16 days. The patients with bladder cuff resection had a delayed full convalescence (25 vs. 13 days) due to a minimum degree of dysuria. CONCLUSION: A laparoscopic approach with the removal of urachal remnants via the umbilicus appears to be a safe and effective alternative with better cosmesis when compared to an open approach.

DOI： 10.1007/s00345-012-0829-x

直腸癌膀胱尿管転移と膀胱尿路上皮癌を同時に認めた1例

榮枝一磨, 有吉勇一, 別宮謙介, 佐々木克己, 小林泰之, 荒木元朗, 江原伸, 渡邊豊彦, 那須保友, 公文裕巳

西日本泌尿器科 74 ( 10 ) 591 - 591 2012年10月

CAN EXPERIENCE OF TURP SHORTEN THE LEARNING CURVE FOR HOLEP?

Kishimoto Ryo, Araki Motoo, Seno Yuuko, Watanabe Toyohiko, Saika Takashi, Yamamoto Yasuo, Ishito Noritaka, Akazawa Nobuyuki, Takamoto Hitoshi, Nasu Yasutomo, Kumon Hiromi

JOURNAL OF ENDOUROLOGY 26 A319 2012年9月

DOES THE LENGTH OF EXPOSED URETHRAL INFLUENCE THE SURGICAL MARGINS ON LAPAROSCOPIC PROSTATECTOMY? 査読

Ryuta Tanimoto, Yasuyuki Kobayashi, Katsumi Sasaki, Motoo Araki, Shin Ebara, Shinya Uehara, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF ENDOUROLOGY 26 A308 - A308 2012年9月

LAPAROSCOPIC HEMINEPHRECTOMY IN A HORSESHOE KIDNEY: CASE REPORT

Yasuyuki Kobayashi, Ryuta Tanimoto, Taiki Kanbara, Takehiro Iwata, Motoo Araki, Katsumi Sasaki, Shin Ebara, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF ENDOUROLOGY 26 A506 - A507 2012年9月

The clinical impact of pathological review on selection the treatment modality for localized prostate cancer in candidates for brachytherapy monotherapy. 査読国際誌

Ryo Kishimoto, Takashi Saika, Kensuke Bekku, Hiroyuki Nose, Fernando Abarzua, Yasuyuki Kobayashi, Motoo Araki, Hiroyuki Yanai, Yasutomo Nasu, Hiromi Kumon

World journal of urology 30 ( 3 ) 375 - 8 2012年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：SPRINGER

AIM: To evaluate the impact of pathological review by pathologist with genitourinary expertise (PGU) on treatment modality of localized prostate cancer, we analyzed Gleason grade (GG) migration and the final treatment decision in a cohort of patients designated for permanent prostate brachytherapy (PPB). METHODS: From February 2005 to July 2010, a total of 247 patients with localized prostate cancer diagnosed by local community hospitals were referred to our hospital for PPB monotheray. All pathologic slides of prostate biopsies were reviewed by a single PGU. Patients ultimately selected their treatment modality from our recommendations based on the review. Indication for PPB monotherapy was the NCCN classification of patients as good or intermediate risk. In addition, patient with Primary GG 4 was regarded as unadapted case. RESULTS: Six cases were reinterpreted as no cancer (2.4%). GG change occurred in 94 cases (38.1%) of which 77 (81.9%) were upgraded and 17 (18.1%) downgraded. Of the total 247 patients, 86 (34.8%) changed therapies and 30 (12.1%) did so based on the pathologic slide review. CONCLUSIONS: Pathological review of biopsy specimens is mandatory for the determination of treatment modality especially in candidates for monotherapy of permanent prostate brachytherapy.

DOI： 10.1007/s00345-011-0738-4

The impact of neoadjuvant hormone therapy on the permanent I-125-seed brachytherapy for low- or intermediate-risk prostate cancer. 査読

Ryuta Tanimoto, Kensuke Bekku, Shin Ebara, Motoo Araki, Hiroyuki Yanai, Norihisa Katayama, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF CLINICAL ONCOLOGY 30 ( 5 ) 2012年2月

Predictive factors for acute and late urinary toxicities after permanent prostate brachytherapy. 査読

Ryuta Tanimoto, Kensuke Bekku, Yasuyuki Kobayashi, Shin Ebara, Motoo Araki, Norihisa Katayama, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF CLINICAL ONCOLOGY 30 ( 5 ) 2012年2月

Ureteroscopic management of chronic unilateral hematuria: a single-center experience over 22 years. 査読国際誌

Motoo Araki, Shinya Uehara, Katsumi Sasaki, Koichi Monden, Masaya Tsugawa, Toyohiko Watanabe, Manoji Monga, Yasutomo Nasu, Hiromi Kumon

PloS one 7 ( 6 ) e36729 2012年

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：PUBLIC LIBRARY SCIENCE

OBJECTIVE: To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria. METHODS: We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (Uromat™). Lesions identified ureteroscopically were treated with diathermy fulguration. RESULTS: One hundred and four (56 male, 48 female) patients were identified, with a median age of 37 (14-80) years and median follow-up of 139 (34-277) months. The median preoperative duration of gross hematuria was 5 (1-144) months. Endoscopic findings included 61 (56%) minute venous rupture (MVR; a venous bleeding without clear abnormalities), 21 (20%) hemangioma (vascular tumor-like structure), 3 (3%) varix (tortuous vein), 1 (1%) calculus and 18 (17%) no lesions. The incidence of "no lesions" was less in the recent 12 years (9%) than the first 10 years (27%), while the incidence of MVR increased from 40 to 66% (p<0.05). All patients were treated endoscopically. Immediate success rate was 96% (100% in the recent 12 years). Long-term recurrent gross hematuria rate was 7%. Six resolved spontaneously and only 1 required ureteroscopy, revealing a different bleeding site. CONCLUSION: Ureteroscopy and diathermy fulguration is highly useful for evaluation and treatment of chronic unilateral hematuria. Sophisticated technique and improved instrumentation contributes to a better outcome.

DOI： 10.1371/journal.pone.0036729