研究者詳細 - 三橋　利晴

論文 - 三橋　利晴

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Bilateral verses bilateral with tri-segmental endoscopic drainage using metal stents for high-grade malignant hilar biliary obstructions: A multicenter, randomized controlled trial: BRAVE study (BRAVE study). 国際誌

Kazuyuki Matsumoto, Toshiharu Mitsuhashi, Hirofumi Kawamoto, Etsuji Ishida, Masakuni Fujii, Yutaka Akimoto, Hiroyuki Seki, Yuki Ishihara, Taiji Ogawa, Tatsuhiro Yamazaki, Yuki Fujii, Hironari Kato

Medicine 101 ( 40 ) e30857 2022年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to manage hilar malignant biliary obstruction (HMBO) more effectively in comparison to unilateral drainage. An increased drainage area is predicted to prolong stent patency and patient survival. However, few reports have described the utility of trisegmental drainage and the benefits of using trisegmental drainage remain unknown. Thus, we launched a randomized clinical trial (RCT) to compare the clinical outcomes between bilateral and trisegmental drainage using SEMSs in patients with high-grade HMBO. METHODS AND ANALYSIS: This study was conducted as a multicenter randomized control trial (RCT) in 8 high-volume medical centers in Japan, and will prove the non-inferiority of bilateral drainage to trisegmental drainage. Patients with unresectable HMBO with Bismuth type IIIa or IV who pass the inclusion and exclusion criteria will be randomized to receive bilateral or trisegmental drainage at a 1:1 ratio. At each center, the on-site study investigators will obtain informed consent from the candidates, and will use an electronic data capture system (REDCap) to input necessary information, and register candidates with the registration secretariat. The primary endpoint is the rate of non-recurrent biliary obstruction (RBO) at 180 days after SEMSs placement. A -10% non-inferiority margin is assumed in the statistical analysis of the primary endpoint. Secondary endpoints include the rate of technical and clinical success, time to recurrent biliary obstruction (TRBO), causes of RBO, procedure-related adverse events (AEs), procedure time, TRBO with or without endoscopic sphincterotomy, overall survival, and the technical and clinical success rates at reintervention. DISCUSSION: If the non-inferiority of bilateral drainage is demonstrated, it is predicted that the procedure time will be shortened and the medical cost will be reduced, which will be beneficial to the patient and the medical economy. TRIAL REGISTRATION: Registered in Japan Registry of Clinical Trial-Registration (trial number. jRCTs062220038). This version number 1. Protocol dated Jun 23, 2022.

DOI： 10.1097/MD.0000000000030857

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Breastfeeding at 6 months of age had a positive impact on overweight and obesity in Japanese adolescents at 15 years of age

Tomoka Kadowaki, Naomi Matsumoto, Etsuji Suzuki, Toshiharu Mitsuhashi, Soshi Takao, Takashi Yorifuji

Acta Paediatrica 112 ( 1 ) 106 - 114 2022年9月

Examining the association between vaccine reactogenicity and antibody titer dynamics after the third dose of BNT162b2 vaccine using a mixed-effects model

Naomi Matsumoto, Hideharu Hagiya, Masanori Nakayama, Masanori Furukawa, Toshiharu Mitsuhashi, Soshi Takao, Fumio Otsuka, Takashi Yorifuji

Journal of Infection and Chemotherapy 2022年9月

Effects of Tanden Breathing on Constipation: A Randomized Controlled Trial.

Hiroshi Habu, Toshiharu Mitsuhashi, Akiko Tokinobu, Takashi Yorifuji, Soshi Takao

Acta medica Okayama 76 ( 4 ) 391 - 398 2022年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

Tanden breathing, an ancient health technique, involves expiratory abdominal pressure breathing is practiced in Japan. In this study we examined the ability of Tanden breathing to relieve constipation. The study was designed as a stratified-block randomized controlled trial enrolling 20 participants. Nineteen were female and one was male, none were elderly. During the 6-week intervention period, the participants performed video-guided Tanden breathing about 10 min once day. We evaluated constipation using the Constipation Assessment Scale (CAS). There were significant differences in the mean CAS score between time points (baseline, 3 weeks after baseline, 6 weeks after baseline), groups (intervention and control), and their interaction (time×group) using repeated-measures analysis of variance. The control group showed no change in the mean CAS score; the mean CAS scores of the intervention group changed from 7.2 at baseline to 3.9 at 3 weeks and 3.1 at 6 weeks after baseline. A regression analysis of the difference in the mean CAS between baseline and 6 weeks later showed that the CAS of the intervention group was 4.3 points lower than that of the control group (95% confidence interval, 2.5-6.1). The results suggested that Tanden breathing is effective in relieving constipation among young women.

DOI： 10.18926/AMO/63893

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Early enlarging cavitation after percutaneous radiofrequency ablation of lung tumors: Incidence, risk factors and outcome. 国際誌

Koji Tomita, Toshihiro Iguchi, Yusuke Matsui, Mayu Uka, Noriyuki Umakoshi, Toshiharu Mitsuhashi, Jun Sakurai, Hideo Gobara, Susumu Kanazawa, Takao Hiraki

Diagnostic and interventional imaging 103 ( 10 ) 464 - 471 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: The purpose of this study was to retrospectively determine the incidence of early enlarging cavitation after percutaneous radiofrequency ablation (RFA) of lung tumor and identify risk factors associated with their occurrence. PATIENTS AND METHODS: A total of 245 patients (140 men, 105 women; mean age, 62.7 ± 11.8 [SD] years; age range: 31-87 years) with 605 lung tumors who were treated using 401 RFA sessions from April 2010 to March 2020 were included. Of which, 31 patients with 38 early enlarging cavitation and control group (151 patients with 228 tumors) were analyzed. Early enlarging cavitation was defined as cavities with an enlarged size (>3 cm) occurring on ablated lesions within seven days after RFA. Incidence of cavitation, risk and post-procedural factors of occurrence, major adverse events (AEs) that occurred in RFA sessions with cavitation, and course of cavitation were evaluated. AEs were classified using the CIRSE classification system for complications. RESULTS: Thirty-eight cavities (6.3%, 38/605 tumors) in 31 patients occurred in an average of 3.1 ± 1.7 days (range, 1-7 days) after 32 RFA sessions. Distance from pleura ≥ 20 mm, contact with vessel ≥ 3 mm, multitined expandable electrode ≥ 3 cm, and bronchus ≥ 2 mm encompassed in the ablation zone were independent risk factors of occurrence. Fever ≥ 38.5 °C, white blood cell count ≥ 10,000/μl one day after RFA, and steroid therapy were independent post-procedural factors of occurrence. Twenty-four Grade 3 and two Grade 6 AEs occurred. Twenty-nine cavities disappeared within a mean duration of 111.9 ± 64.9 (SD) days (range: 44-274 days) and four remained with a mean follow-up of 279.2 ± 174 (SD) days; five patients were lost to follow-up. CONCLUSIONS: Early enlarging cavitation occurs in 6.3% of lung tumors treated with RFA and are associated with 26 major AEs in 32 sessions. Aforementioned procedural factors and post-procedural inflammation were significant risk factors of occurrence.

DOI： 10.1016/j.diii.2022.05.004

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Correlation between renal ablation zone in contrast-enhanced CT and non-enhanced MRI during the early period following percutaneous cryoablation.

Noriyuki Umakoshi, Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Soichiro Kajita, Motoo Araki, Toshiharu Mitsuhashi, Hideo Gobara, Susumu Kanazawa

Japanese journal of radiology 40 ( 10 ) 1087 - 1095 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To retrospectively evaluate and correlate the contrast-enhanced computed tomography (CECT) and non-enhanced magnetic resonance imaging (MRI) during the early period following renal cryoablation. MATERIALS AND METHODS: Both dynamic CECT and non-enhanced MRI were performed within 4 days following cryoablation in 34 renal tumors in 33 patients. The renal volumes of the unenhanced regions on dynamic CECT (nephrogenic phase, 4 mm thickness) and the regions with signal intensity changes on non-enhanced MRI (fat-suppressed T2-weighted image, 4 mm thickness) were evaluated. Fusion images of the axial, coronal, and sagittal sections of CECT and MRI images were created from the maximum cross-section of the renal tumor, and the match score of each image was visually evaluated on a 5-point scale. RESULTS: The mean renal volume of the unenhanced regions on CECT and those with signal intensity changes on non-enhanced MRI following cryoablation were 29.5 ± 19.9 cm3 (range, 4.3-97.4 cm3) and 30.7 ± 19.8 cm3 (range, 6.7-94.0 cm3), respectively; the difference between them was -1.17 cm3 (95% confidence interval [CI] -2.74, 0.40, P = 0.139). The Pearson's product-moment correlation coefficient (r = 0.975; 95% CI, 0.951, 0.988; P < 0.0001) showed a strong correlation between the volumes. The average match score between CECT and non-enhanced MRI was as high as 4.5 ± 0.5 points (radiologist 1, 4.3 ± 0.5; radiologist 2, 4.7 ± 0.5). Local tumor control rate was 94.1% (32/34 tumors) and recurrence-free survival rate was 82.0% (95% CI: 64.2%, 91.5%) at 5 years. CONCLUSIONS: The region with signal intensity changes on non-enhanced MRI was strongly correlated with the unenhanced region on CECT during the early period following renal cryoablation.

DOI： 10.1007/s11604-022-01285-y

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Resection depth for small colorectal polyps comparing cold snare polypectomy, hot snare polypectomy and underwater endoscopic mucosal resection. 国際誌

Junki Toyosawa, Yasushi Yamasaki, Tsuyoshi Fujimoto, Shouichi Tanaka, Takehiro Tanaka, Toshiharu Mitsuhashi, Hiroyuki Okada

Endoscopy international open 10 ( 5 ) E602-E608 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background and study aims Small colorectal polyps are removed by various methods, including cold snare polypectomy (CSP), hot snare polypectomy (HSP), and underwater endoscopic mucosal resection (UEMR), but the indications for using these methods are unclear. We retrospectively assessed the efficacy of CSP, HSP, and UEMR for small polyps, focusing on the depth of the resected specimens. Patients and methods Outpatients with non-pedunculated small polyps (endoscopically diagnosed as 6 to 9 mm), resected by two endoscopists between July 2019 and September 2020, were enrolled. We histologically evaluated the specimens resected via CSP, HSP, and UEMR. The main outcome was the containment rate of the muscularis mucosa (MM) and submucosa (SM) tissues. Results Forty polyps resected via CSP (n = 14), HSP (n = 12), or UEMR (n = 14) were enrolled after excluding 13 polyps with resection depths that were difficult to determine. The rates of specimens containing MM and SM tissue differed significantly (57 % and 29 % for CSP, 92 % and 83 % for HSP, and 100 % and 100 % for UEMR, respectively ( P = 0.005 for MM and P < 0.001 for SM tissue). Multiple logistic regression analysis showed UEMR was an independent factor relating to the containment of SM tissue. The thickness of SM tissue by CSP, HSP, and UEMR were 52 μm, 623 μm, and 1119 μm, respectively ( P < 0.001). The thickness by CSP was significantly less than those by HSP and UEMR ( P < 0.001, Bonferroni correction). Conclusions UEMR could be the best method to contain SM tissue without injection. Further studies are needed to evaluate the indication of UEMR for small polyps.

DOI： 10.1055/a-1785-8616

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Nonrecurrence Rate of Underwater EMR for ≤20-mm Nonampullary Duodenal Adenomas: A Multicenter Prospective Study (D-UEMR Study)

Yasushi Yamasaki, Noriya Uedo, Takuji Akamatsu, Tomo Kagawa, Reiji Higashi, Osamu Dohi, Masanori Furukawa, Yu Takahashi, Takuya Inoue, Shouichi Tanaka, Ryuta Takenaka, Mikitaka Iguchi, Takuji Kawamura, Takao Tsuzuki, Tomoaki Yamasaki, Takeshi Yamashina, Junichiro Nasu, Tomohiko Mannami, Atsushi Yamauchi, Kazuhiro Matsueda, Shigeyuki Aizawa, Toshiharu Mitsuhashi, Hiroyuki Okada, Hiromitsu Kanzaki, Shuntaro Inoue, Muneaki Miyake, Masayasu Ohmori, Yoji Takeuchi, Yasuhiro Tani, Nobuyuki Harada, Nobukazu Agatsuma, Keijirou Okada, Maiko Ikenouchi, Yasuki Nakatani, Yoshito Uenoyama, Yukitaka Yamashita, Shigenao Ishikawa, Tomoki Inaba, Koji Miyahara, Yuki Moritou, Masahiro Nakagawa, Hiroaki Kitae, Tsugitaka Ishida, Yuji Naito, Akiyoshi Nishio, Masaaki Shimatani, Ryo Kato, Shinya Taki, Koichiro Mandai, Kasumi Sanada, Kojiro Nakase, Hiroko Nebiki, Shunsuke Saito, Toshiyuki Wakatsuki, Naoyuki Nishimura

Clinical Gastroenterology and Hepatology 20 ( 5 ) 1010 - 1018.e3 2022年5月

掲載種別：研究論文（学術雑誌）

Background and aims: Endoscopic resection of nonampullary duodenal adenoma is often challenging, and its technique has not yet been standardized. To overcome the practical difficulty of conventional endoscopic mucosal resection, underwater endoscopic mucosal resection (UEMR) was recently developed; therefore, we investigated the effectiveness and safety of UEMR for nonampullary duodenal adenoma. Methods: A multicenter, prospective cohort study was conducted at 21 institutions in Japan. We enrolled patients with no more than 2 nonampullary duodenal adenomas ≤20 mm in size, who were planned to undergo UEMR. After UEMR, follow-up endoscopies were scheduled at 2 and 12 months after the procedure, and biopsy specimens were taken from the post-UEMR scars. The primary endpoint was the proportion of patients with histologically proven nonrecurrence at follow-up endoscopy and biopsy. Results: A total of 155 patients with 166 lesions underwent UEMR. One patient with a non-neoplastic lesion in the resected specimen and 10 patients with 10 lesions who were lost to follow-up were excluded. Finally, 144 patients with 155 lesions who received all follow-up endoscopies were analyzed for the primary endpoint. The proportion of patients with proven nonrecurrence was 97.2% (n = 140 of 144; 95% confidence interval, 92.8%–99.1%) which exceeded the predefined threshold value (92%). Two cases of delayed bleeding (1.2%) occurred and they were successfully managed by clips. All recurrences were successfully treated by additional endoscopic treatment. Conclusions: This multicenter, prospective cohort study demonstrated effectiveness and safety of UEMR for nonampullary duodenal adenomas ≤20 mm in size. (University Hospital Medical Network Clinical Trials Registry, Number: UMIN000030414).

DOI： 10.1016/j.cgh.2021.06.043

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新型コロナウイルスワクチン副反応調査の報告

松本尚美, 樋口千草, 三橋利晴, 萩谷英大, 高尾総司, 頼藤貴志

岡山医学会雑誌 134 ( 1 ) 35 - 42 2022年4月

Effect of mRNA Vaccines in Preventing COVID-19 Severe Pneumonia Among COVID-19 Patients in Japan

Rumi Matsuo, Naomi Matsumoto, Tomoka Kadowaki, Toshiharu Mitsuhashi, Soshi Takao, Takashi Yorifuji

Journal of Epidemiology 32 ( 3 ) 151 - 152 2022年3月

Causal Effect of the Tokyo 2020 Olympic and Paralympic Games on the Number of COVID-19 Cases under COVID-19 Pandemic: An Ecological Study Using the Synthetic Control Method 査読

Norio Yamamoto, Toshiharu Mitsuhashi, Yuuki Tsuchihashi, Takashi Yorifuji

Journal of Personalized Medicine 12 ( 2 ) 209 - 209 2022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：MDPI AG

Previous studies have not assessed the causal effect of the Olympic Games on the spread of pandemics. Using the synthetic control method and the national public city data in Japan recorded from February to September 2021, we estimated the causal effects of the Tokyo 2020 Olympic and Paralympic Games on the number of coronavirus disease 2019 (COVID-19) cases. The difference between the number of COVID-19 cases in Tokyo and a counterfactual “synthetic Tokyo” (created using synthetic control method) after the opening of the Tokyo 2020 Games (23 July 2021) widened gradually and then considerably over time. It was predicted that the Tokyo 2020 Games increased the number of COVID-19 cases in Tokyo by approximately 469.4 per 100,000 population from the opening of the event to 30 September. However, sensitivity analysis of the ratio of the pre- and post-game root mean square prediction errors using regression weights did not suggest robustness. Our results showed that the Tokyo 2020 Games probably increased the number of COVID-19 cases even under preventive regulations; however, the extent of this increase was difficult to estimate clearly due to an overlap with the fifth wave associated with the Delta variant.

DOI： 10.3390/jpm12020209

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In Vivo Microwave Ablation of Normal Swine Lung at High-power, Short-duration Settings.

Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Tomohiro Toji, Mayu Uka, Koji Tomita, Toshiyuki Komaki, Noriyuki Umakoshi, Toshiharu Mitsuhashi, Susumu Kanazawa

Acta medica Okayama 76 ( 1 ) 57 - 62 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

To evaluate the volume and heat-sink effects of microwave ablation (MWA) in the ablation zone of the normal swine lung. MWA at 100 W was performed for 1, 2, and 3 min in 7, 5, and 5 lung zones, respectively. We assessed the histopathology in the ablation zones and other outcome measures: namely, length of the longest long and short axes, sphericity, ellipsoid area, and ellipsoid volume. The mean long- and short-axis diameters were 22.0 and 14.1 mm in the 1-min ablation zone, 27.6 and 20.2 mm in the 2-min ablation zone; and 29.2 and 21.2 mm in the 3-min ablation zone, respectively. All measures, except sphericity, were significantly less with 1-min ablation than with either 2- or 3-min ablation. There were no significant differences between the 2- and 3-min ablation zones, but all measures except sphericity were larger with 3-min ablation. Although there were no blood vessels that resulted in a heat-sink effect within the ablation zones, the presence of bronchi nearby in 5 lung ablation zones resulted in reduced ablation size. In high-power, short-duration MWA, the lung ablation volume was affected by ablation time. Some ablations showed that a heat-sink effect by a neighboring bronchus might occur.

DOI： 10.18926/AMO/63212

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Adverse reactions and attitudes toward vaccines among young populations one month after receiving a second dose of mRNA-1273 in Japan

Naomi Matsumoto, Chigusa Higuchi, Toshiharu Mitsuhashi, Hideharu Hagiya, Soshi Takao, Takashi Yorifuji

Global Health & Medicine 4 ( 2 ) 141 - 143 2022年

Effects of Tanden Breathing on Constipation: A Randomized Controlled Trial

Hiroshi Habu, Toshiharu Mitsuhashi, Akiko Tokinobu, Takashi Yorifuji, Soshi Takao

Acta Medica Okayama 76 ( 4 ) 391 - 398 2022年

掲載種別：研究論文（学術雑誌）

DOI： 10.18926/AMO/63893

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A single-center, single-arm, prospective, open-label trial to evaluate the efficacy and safety of percutaneous sclerotherapy with polidocanol for painful venous malformations (SCIRO-2001): study protocol 査読

Mayu Uka, Jun Sakurai, Yusuke Matsui, Toshihiro Iguchi, Koji Tomita, Noriyuki Umakoshi, Kazuaki Munetomo, Toshiharu Mitsuhashi, Hideo Gobara, Takao Hiraki

Nagoya J. Med. Sci. 84. 746–751, 2022 2021年12月

Trajectory of body mass index and height changes from childhood to adolescence: a nationwide birth cohort in Japan. 国際誌

Naomi Matsumoto, Toshihide Kubo, Kazue Nakamura, Toshiharu Mitsuhashi, Akihito Takeuchi, Hirokazu Tsukahara, Takashi Yorifuji

Scientific reports 11 ( 1 ) 23004 - 23004 2021年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

To investigate the dynamics of body mass index (BMI) and height changes in childhood leading to obesity in adolescents. BMI Z-scores were calculated using the LMS (lambda-mu-sigma) method based on yearly height and weight information (age 1.5-15 years) from a nationwide Japanese birth cohort that started in 2001 (n = 26,711). We delineated the trajectories of BMI and height changes leading to obesity at age 15 years using mixed effect models. Children who became obese at the age of 15 years kept relatively high BMI z-scores through childhood for both genders, and had an increasing trend over time as opposed to the normal weight group, with an increasing slope during puberty. Early adiposity rebound was associated with overweight or obesity at the age of 15 years. Age at peak height velocity (APHV) occurred earlier in the obese/overweight group at age 15 years than in the normal weight group, and occurred later in the underweight group. Obese adolescents experienced early adiposity rebound timing and maintained a serial BMI z-score increase throughout childhood, with a greater slope at puberty. An earlier peak in height gain during puberty may have contributed to the observed patterns of BMI change.

DOI： 10.1038/s41598-021-02464-z

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The Impact of KRAS Mutation in Patients With Sporadic Nonampullary Duodenal Epithelial Tumors. 国際誌

Hideaki Kinugasa, Hiromitsu Kanzaki, Takehiro Tanaka, Shumpei Yamamoto, Yasushi Yamasaki, Kazuhiro Nouso, Kouichi Ichimura, Masahiro Nakagawa, Toshiharu Mitsuhashi, Hiroyuki Okada

Clinical and translational gastroenterology 12 ( 11 ) e00424 2021年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: The genomic characterization of primary nonampullary duodenal adenocarcinoma indicates a genetic resemblance to gastric and colorectal cancers. However, a correlation between the clinical and molecular characteristics of these cancers has not been established. This study aimed to elucidate the clinicopathological features of sporadic nonampullary duodenal epithelial tumors, including their molecular characteristics and prognostic factors. METHODS: One hundred forty-eight patients with sporadic nonampullary duodenal epithelial tumors were examined in this study. Patient sex, age, TNM stage, tumor location, treatment methods, histology, KRAS mutation, BRAF mutation, Fusobacterium nucleatum, mucin phenotype, and programmed death-ligand 1 (PD-L1) status were evaluated. KRAS and BRAF mutations, Fusobacterium nucleatum, mucin phenotype, and PD-L1 status were analyzed by direct sequencing, quantitative polymerase chain reaction, and immunochemical staining. RESULTS: The median follow-up duration was 119.4 months. There were no deaths from duodenal adenoma (the primary disease). Kaplan-Meier analysis for duodenal adenocarcinoma showed a significant effect of TNM stage (P < 0.01). In univariate analysis of primary deaths from duodenal adenocarcinoma, TNM stage II or higher, undifferentiated, KRAS mutations, gastric phenotype, intestinal phenotype, and PD-L1 status were significant factors. In multivariate analysis, TNM stage II or higher (hazard ratio: 1.63 × 1010, 95% confidence interval: 18.66-6.69 × 1036) and KRAS mutation (hazard ratio: 3.49, confidence interval: 1.52-7.91) were significant factors. DISCUSSION: Only KRAS mutation was a significant prognostic factor in primary sporadic nonampullary duodenal adenocarcinoma in cases in which TNM stage was considered.

DOI： 10.14309/ctg.0000000000000424

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COVID-19に対応した看護師の不安・看護上の課題の計量テキスト分析による探索

三橋利晴, 坂本陽子

日本公衆衛生学会総会抄録集 80回 306 - 306 2021年11月

Impact of lymph node dissection on clinical outcomes of intrahepatic cholangiocarcinoma: inverse probability of treatment weighting with survival analysis.

Yuzo Umeda, Toshiharu Mitsuhashi, Toru Kojima, Daisuke Satoh, Kenta Sui, Yoshikatsu Endo, Masaru Inagaki, Masahiro Oishi, Takahito Yagi, Toshiyoshi Fujiwara

Journal of hepato-biliary-pancreatic sciences 2021年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Lymph node metastasis (LNM) has been established as a critical risk factor for prognosis in intrahepatic cholangiocarcinoma (ICC). The clinical implications of lymph-node dissection (LND) have been debated. This study aimed to clarify the prognostic impact of LND by multicenter-retrospective analysis. METHODS: A total of 310 ICC patients who had undergone curative resection between 2000 and 2016 were retrospectively analyzed. The prognostic impact of LND was estimated under an inverse probability of treatment weighting (IPTW) approach using propensity scores. RESULTS: LND was performed for 224 patients (72%), with LNM pathologically confirmed in 90 patients (40%). Prognosis was poorer for patients with LNM (median survival, 16.9 months) than for those without (57.2 months; p<0.0001). One-, 3-, and 5-year overall survival rates (OS) were comparable among the LND+ (81.6%, 48.0%, and 37.5%, respectively) and the LND- groups (81.6%, 55.4%, and 44.6%, respectively). However, advanced tumor, as characterized by larger tumor, multinodular lesions, and serosal invasion, was significantly more frequent in the LND+ group than in the LND- group. After IPTW adjusting for imbalances, 1-, 3-, and 5-year OS were better in the LND+ group (83.5%, 52.2%, and 42.8%, respectively) than in the LND- group (71.9%, 32.4%, and 23.4%, respectively; p=0.046). LND thus showed significant prognostic impact (hazard ratio = 0.58, 95%CI = |0.39|-|0.84|, p=0.005). Especially in hilar ICC, LND showed significant prognostic impact. However, peripheral ICC displayed no therapeutic benefit from LND. CONCLUSIONS: LND could have significant role to improve oncologic outcomes. Therapeutic LND should be implemented on the basis of tumor location and tumor advancement.

DOI： 10.1002/jhbp.1038

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Early childhood exposure to maternal smoking and behavioral development. 査読国際誌

Makiko Ariyoshi, Toshiharu Mitsuhashi, Naomi Matsumoto, Kazue Nakamura, Takashi Yorifuji

Archives of environmental & occupational health 1 - 8 2021年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

We examined the association between early childhood exposure to maternal smoking and behavioral issues at 8 years old using a large nationwide population-based longitudinal survey in Japan that began in 2001. We included 46,737 children with information about maternal smoking taken from the 6-month survey. We used logistic regression analysis to examine the hypothesis. Early childhood exposure to maternal smoking increased the risk of behavioral problems related to attention and aggressive or disruptive behavior. The adjusted odds ratios (95% confidence intervals) were 1.37 (1.22-1.54) for inability to wait their turn during play and 1.40 (1.27-1.55) for destroying toys and, compared with children of nonsmoking mothers. Children of mothers who were heavy smokers were more likely to develop behavioral problems than others. Stopping early childhood exposure to maternal exposure can protect children's neurodevelopment.

DOI： 10.1080/19338244.2021.1972278

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