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| 1 | Regional lymphadenectomy for gallbladder cancer: Rational extent, technical details, and patient outcomes显示文摘AIM: To define the rational extent of regional lymphadenectomy for gallbladder cancer and to clarify its effect on long-term survival. METHODS: A total of 152 patients with gallbladder cancer who underwent a minimum of 'extended' portal lymph node dissection (defined as en bloc removal of the first-and second-echelon nodes) from 1982 to 2010 were retrospectively analyzed. Based on previous studies, regional lymph nodes of the gallbladder were divided into first-echelon nodes (cystic duct or pericholedochal nodes), second-echelon nodes (node groups posterosuperior to the head of the pancreas or around the hepatic vessels), and more distant nodes. RESULTS: Among the 152 patients (total of 3352 lymph nodes retrieved, median of 19 per patient), 79 patients (52%) had 356 positive nodes. Among nodepositive patients, the prevalence of nodal metastasis was highest in the pericholedochal (54%) and cystic duct (38%) nodes, followed by the second-echelon node groups (29% to 19%), while more distant node groups were only rarely (5% or less) involved. Disease-specific survival after R0 resection differed according to the nodal status (P < 0.001): most node-negative patients achieved long-term survival (median, not reached; 5-year survival, 80%), whereas among nodepositive patients, 22 survived for more than 5 years (median, 37 mo; 5-year survival, 43%). CONCLUSION: The rational extent of lymphadenectomy for gallbladder cancer should include the first-and second-echelon nodes. A considerable proportion of node-positive patients benefit from such aggressive lymphadenectomy. | Yoshio Shirai Toshifumi Wakai Jun Sakata Katsuyoshi Hatakeyama | 2012 | World Journal of Gastroenterology2012，18，22： | 35 |
| 2 | Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma显示文摘AIM: To estimate the incidence of catheter tract implantation metastasis among patients undergoing percutaneous transhepatic biliary drainage (PTBD) for extrahepatic cholangiocarcinoma, and to provide data regarding the management of this unusual complication of PTBD by reviewing cases reported in the literature.METHODS: A retrospective analysis of 67 consecutive patients who underwent PTBD before the resection of extrahepatic cholangiocarcinoma was conducted. The median follow-up period after PTBD was 106 mo. The English language literature (PubMed, National Library of Medicine, Bethesda, MD, USA), from January 1966through December 2004, was reviewed.RESULTS: Catheter tract implantation metastasis developed in three patients. The cumulative incidence of implantation metastasis reached a plateau (6%)at 20 mo after PTBD. All of the three patients with implantation metastasis died of tumor progression at 3, 9, and 20 mo after the detection of this complication. Among the 10 reported patients with catheter tract implantation metastasis from extrahepatic cholangiocarcinoma (including our three patients), two survived for more than 5 years after the excision of isolated catheter tract metastases.CONCLUSION: Catheter tract implantation metastasis is not a rare complication following PTBD for extrahepatic cholangiocarcinoma. Although the prognosis for patients with this complication is generally poor, the excision of the catheter tract may enable survival in selected patients with isolated metastases along the catheter tract. | Jun Sakata Yoshio Shirai Toshifumi Wakai Tatsuya Nomura Eiko Sakata Katsuyoshi Hatakeyama | 2005 | World Journal of Gastroenterology2005，11，44： | 31 |
| 3 | Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment:A case report and review of the literature显示文摘A 69-year-old man was diagnosed as having myasthenia gravis (MG) in September 2004,and treated with thymectomy and prednisolone. He was then diagnosed as having steroid-induced diabetes mellitus,and received sulfonylurea (SU) therapy in May 2005. An alpha-glucosidase inhibitor (αGI) was added in March 2006,resulting in good glycemic control. He experienced symptoms of abdominal distention,increased flatus,and constipation in October 2007,and was admitted into our hospital in late November with hematochezia. Plain abdominal radiography revealed small linear radiolucent clusters in the wall of the colon. Computed tomography (CT) showed intramural air in the sigmoid colon. Colonoscopy revealed multiple smooth surfaced hemispherical protrusions in the sigmoid colon. The diagnosis of pneumatosis cystoides intestinalis (PCI) was made on the basis of these findings. As the αGI voglibose was suspected as the cause of this patient's PCI,treatment was conservative,ceasing voglibose,with fasting and fluid supplementation. The patient progressed well,and was discharged 2 wk later. Recently,several reports of PCI associated with αGI therapy have been published,predominantly in Japan where αGIs are commonly used. If the use of αGIs becomes more widespread,we can expect more reports of this condition on a global scale. The possibility of PCI should be considered in diabetic patients complaining of gastrointestinal symptoms,and the gastrointestinal tract should be thoroughly investigated in these patients. | Tatsuhiro Tsujimoto Erika Shioyama Kei Moriya Hideto Kawaratani Yasuyo Shirai Masahisa Toyohara Akira Mitoro Jun-ichi Yamao Hisao Fujii Hiroshi Fukui | 2008 | World Journal of Gastroenterology2008，14，39： | 16 |
| 4 | Reduced hemoglobin and increased C-reactive protein are associated with upper gastrointestinal bleeding显示文摘AIM: To investigate the early upper gastrointestinal endoscopy(endoscopy) significantly reduces mortality resulting from upper gastrointestinal(GI) bleeding. METHODS: Upper GI bleeding was defined as 1a, 1b, 2a, and 2b according to the Forrest classification. The hemoglobin(Hb), and C-reactive protein(CRP) were examined at around the day of endoscopy and 3 mo prior to endoscopy. The rate of change was calculated as follows:(the result of blood examination on the day of endoscopy- the results of blood examination 3 mo prior to endoscopy)/(results of blood examination 3 mo prior to endoscopy). Receiver operating characteristic curves were created to determine threshold values. RESULTS: Seventy-nine men and 77 women were enrolled. There were 17 patients with upper GI bleeding: 12 with a gastric ulcer, 3 with a duodenal ulcer, 1 with an acute gastric mucosal lesion, and 1 with gastric cancer. The area under the curve(AUC), threshold, sensitivity, and specificity of Hb around the day of endoscopy were 0.902, 11.7 g/dL, 94.1%, and 77.1%, respectively, while those of CRP were 0.722, 0.5 mg/dL, 70.5%, and 73%, respectively. The AUC, threshold, sensitivity, and specificity of the rate of change of Hb were 0.851,-21.3%, 76.4%, and 82.6%, respectively, while those of CRP were 0.901, 100%, 100%, and 82.5%, respectively. CONCLUSION: Predictors for upper GI bleeding were Hb < 11.7 g/dL, reduction rate in the Hb > 21.3% and an increase in the CRP > 100%, 3 mo before endoscopy. | Minoru Tomizawa Fuminobu Shinozaki Rumiko Hasegawa Akira Togawa Yoshinori Shirai Noboru Ichiki Yasufumi Motoyoshi Takao Sugiyama Shigenori Yamamoto Makoto Sueishi | 2014 | World Journal of Gastroenterology2014，20，5： | 13 |
| 5 | 'Extended' radical cholecystectomy for gallbladder cancer:Long-term outcomes, indications and limitations显示文摘AIM:To delineate indications and limitations for 'ex tended' radical cholecystectomy for gallbladder cancer:a procedure which was instituted in our department in 1982. METHODS:Of 145 patients who underwent a radi cal resection for gallbladder cancer from 1982 through 2006, 52 (36%) had an extended radical cholecystec tomy, which involved en bloc resection of the gallblad der, gallbladder fossa, extrahepatic bile duct, and the regional lymph nodes (first-and second-echelon node groups). A retrospective analysis of the 52 patients was conducted including at least 5 years of follow up. Residual tumor status was judged as no residual tumor (R0) or microscopic/macroscopic residual tumor (R1 2). athological findings were documented according tothe American Joint Committee on Cancer Cancer Stag ing anual (7th edition). RESULTS:he primary t mor as classified as patho-logical T1 (pT1) in 3 patients, pT2 in 36, pT3 in 12, and pT4 in 1. Twenty three patients had lymph node metastases; 11 had a single positive node, 4 had two positive nodes, and 8 had three or more positive nodes. None of the three patients with pT1 tumors had nodal disease, whereas 23 of 49 (47%) with pT2 or more advanced tumors had nodal disease. One patient died during the hospital stay for definitive resection, giv ing an in hospital mortality rate of 2%. Overall survival (OS) after extended radical cholecystectomy was 65% at 5 years and 53% at 10 years in all 52 patients. OS differed according to the p classification ( < 0.001) and the nodal status ( = 0.010). All of 3 patients with pT1 tumors and most (29 of 36) patients with pT2 tu mors survived for more than 5 years. Of 12 patients with pT3 tumors, 8 who had an R1 2 resection, distant metastasis, or extensive extrahepatic organ involve ment died soon after resection. Of the remaining four pT3 patients who had localized hepatic spread through the gallbladder fossa and underwent an R0 resection, 2 survived for more than 5 years and another survived for 4 years and 2 mo. The only patient with pT4 tumor died of disease soon after resection. Among 23 node positive patients, 11 survived for more than 5 years, and of these, 10 had a modest degree of nodal disease (one or two positive nodes). CONCLUSION:Extended radical cholecystectomy is indicated for pT2 tumors and some pT3 tumors with localized hepatic invasion, provided that the regional nodal disease is limited to a modest degree (up to two positive nodes). Extensive pT3 disease, pT4 disease, or marked nodal disease appears to be beyond the scope of this radical procedure. | Yoshio Shirai Jun Sakata Toshifumi Wakai Taku Ohashi Katsuyoshi Hatakeyama | 2012 | World Journal of Gastroenterology2012，18，34： | 11 |
| 6 | Contractile apparatus dysfunction early in the pathophysiology of diabetic cardiomyopathy显示文摘Diabetes mellitus significantly increases the risk of cardiovascular disease and heart failure in patients.Independent of hypertension and coronary artery disease,diabetes is associated with a specific cardiomyopathy,known as diabetic cardiomyopathy(DCM).Four decades of research in experimental animal models and advances in clinical imaging techniques suggest that DCM is a progressive disease,beginning early after the onset of type 1 and type 2 diabetes,ahead of left ventricular remodeling and overt diastolic dysfunction.Although the molecular pathogenesis of early DCM still remains largely unclear,activation of protein kinase C appears to be central in driving the oxidative stress dependent and independent pathways in the development of contractile dysfunction.Multiple subcellular alterations to the cardiomyocyte are now being highlighted as critical events in the early changes to the rate of force development,relaxation and stability under pathophysiological stresses.These changes include perturbed calcium handling,suppressed activity of aerobic energy producing enzymes,altered transcriptional and posttranslational modification of membrane and sarcomeric cytoskeletal proteins,reduced actin-myosin cross-bridge cycling and dynamics,and changed myofilament calcium sensitivity.In this review,we will present and discuss novel aspects of the molecular pathogenesis of early DCM,with a special focus on the sarcomeric contractile apparatus. | Mark T Waddingham Amanda J Edgley Hirotsugu Tsuchimochi Darren J Kelly Mikiyasu Shirai James T Pearson | 2015 | World Journal of Diabetes2015，6，7： | 10 |
| 7 | Genetic changes of p53,K-ras,and microsatellite instability in gallbladder carcinoma in high-incidence areas of Japan and Hungary显示文摘AIM: To disclose geographic differences in genetic changes involved in gallbladder carcinogenesis between two distinct high-incidence areas of Japan and Hungary.METHODS: We examined 42 cases of gallbladder carcinoma: 22 Japanese and 20 Hungarian cases. p53 mutations at exons 5 to 8 and K-ras mutations at codon 12 were tested by direct sequencing. Microsatellite instability was determined from fluorescent dye-labeled PCR amplifications of five-microsatellite markers (BAT-25, BAT-26, D2S123, D5S346, and D17S250).RESULTS: Mutations of p53 were detected in 11 of 22 Japanese cases and 6 of 18 Hungarian cases (11/22 vs 6/18, P = 0.348). Transition at CpG sites was found in none of 11 Japanese cases and 2 of 6 Hungarian cases; the difference was marginally significant (0/11 vs 2/6, P = 0.110). K-ras mutations were detected in only one of the Hungarian cases. Eight of 19 (42.1%) Japanese cases were MSI-high (presence of novel peaks in more than one of the five loci analyzed), whereas only 1 of 15 (6.7%) Hungarian cases was MSI-high (P = 0.047).CONCLUSION: It appears that the p53 mutations and MSI differ in patients with gallbladder carcinoma between two distinct high-incidence areas. Geographic variation might exist in the process of gallbladder carcinogenesis. | Masayuki Nagahashi Yoichi Ajioka Istvan Lang Zoltan Szentirmay Miklos Kasler Hiroto Nakadaira Naoyuki Yokoyama Gen Watanabe Ken Nishikura Toshifumi Wakai Yoshio Shirai Katsuyoshi Hatakeyama Masaharu Yamamoto | 2008 | World Journal of Gastroenterology2008，14，1： | 9 |
| 8 | Crosstalk between angiogenesis, cytokeratin-18, and insulin resistance in the progression of non-alcoholic steatohepatitis显示文摘AIM: To elucidate the possible crosstalk between angiogenesis, cytokeratin-18 (CK-18), and insulin resistance (IR) especially in patients with non-alcoholic steatohepatitis (NASH).METHODS: Twenty-eight patients with NASH and 11 with simple fatty liver disease (FL) were enrolled in this study and underwent clinicopathological examination. The measures of angiogenesis, CK-18, and IR employed were CD34-immunopositive vessels, CK-18immunopositive cells, and homeostasis model assessment of IR (HOMA-IR), respectively. The correlations of these factors with NASH were elucidated.RESULTS: Significant development of hepatic neovascularization was observed only in NASH, whereas almost no neovascularization could be observed in FL and healthy liver. The degree of angiogenesis was almost parallel to liver fibrosis development, and both parameters were positively correlated. Similarly, CK-18expression and HOMA-R were signifi cantly increased in NASH as compared with FL and healthy liver. Furthermore, CK-18 and HOMA-IR were also positively correlated with the degree of neovascularization. CONCLUSION: These results indicate that the crosstalk between angiogenesis, CK-18, and IR may play an important role in the onset and progression of NASH. | Mitsuteru Kitade Hitoshi Yoshiji Ryuichi Noguchi Yasuhide Ikenaka Kosuke Kaji Yusaku Shirai Masaharu Yamazaki Masahito Uemura Junichi Yamao Masao Fujimoto Akira Mitoro Masahisa Toyohara Masayoshi Sawai Motoyuki Yoshida Chie Morioka Tatsuhiro Tsujimoto Hideto Kawaratani Hiroshi Fukui | 2009 | World Journal of Gastroenterology2009，15，41： | 9 |
| 9 | Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding显示文摘AIM: To examine characteristics of patients with blood urea nitrogen(BUN) levels higher and lower than the normal limit.METHODS: Patient records between April 2011 and March 2014 were analyzed retrospectively. During this time, 3296 patients underwent upper endoscopy. In total, 50 male(69.2 ± 13.2 years) and 26 female(72.3 ± 10.2 years) patients were assessed. Patients were divided into two groups based on BUN levels: higher than the normal limit(21.0 mg/d L)(H) and lower thanthe normal limit(L). One-way analysis of variance was performed to reveal differences in the variables between the H and L groups. Fisher's exact test was used to compare the percentage of patients with gastric ulcer or gastric cancer in the H and L groups.RESULTS: White blood cell count was higher in the H group than in the L group(P = 0.0047). Hemoglobin level was lower in the H group than in the L group(P = 0.0307). Glycated hemoglobin was higher in the H group than in the L group(P = 0.0264). The percentage of patients with gastric ulcer was higher in the H group(P = 0.0002). The H group contained no patients with gastric cancer.CONCLUSION: Patients with BUN ≥ 21 mg/d L might have more severe upper gastrointestinal bleeding. | Minoru Tomizawa Fuminobu Shinozaki Rumiko Hasegawa Yoshinori Shirai Yasufumi Motoyoshi Takao Sugiyama Shigenori Yamamoto Naoki Ishige | 2015 | World Journal of Gastroenterology2015，21，24： | 8 |
| 10 | Low preoperative platelet counts predict a high mortality after partial hepatectomy in patients with hepatocellular carcinoma显示文摘AIM: To assess the validity of our selection criteria for hepatectomy procedures based on indocyanine green disappearance rate (KICG), and to unveil the factors affecting posthepatectomy mortality in patients with hepatocellular carcinoma (HCC).METHODS: A retrospective analysis of 198 consecutive patients with HCC who underwent partial hepatectomies in the past 14 years was conducted. The selection criteria for hepatectomy procedures during the study period were KICG≥0.12 for hemihepatectomy, KICG≥0.10 for bisegmentectomy, KICG≥0.08 for monosegmentectomy, and KICG ≥0.06 for nonanatomic hepatectomy. The hepatectomies were categorized into three types: major hepatectomy (hemihepatectomy or a more extensive procedure),bisegmentectomy, and limited hepatectomy. Univariate (Fishers exact test) and multivariate (the logistic regression model) analyses were used.RESULTS: Postoperative mortality was 5% after major hepatectomy, 3% after bisegmentectomy, and 3% after limited hepatectomy. The three percentages were comparable (P = 0.876). The platelet count of ≤ 10x 104/μL was the strongest independent factor for postoperative mortality on univariate (P = 0.001) and multivariate (risk ratio,12.5; P= 0.029) analyses. No patient with a platelet count of >7.3x 104/μL died of postoperative morbidity, whereas 25% (6/24 patients) of patients with a platelet count of ≤7.3x 104/μL died (P<0.001).CONCLUSION: The selection criteria for hepatectomy procedures based on KICG are generally considered valid,because of the acceptable morbidity and mortality with these criteria. The preoperative platelet count independently affects morbidity and mortality after hepatectomy, suggesting that a combination of KICG and platelet count would further reduce postoperative mortality. | Kazuhiro Kaneko Yoshio Shirai Toshifumi Wakai Naoyuki Yokoyama Kohei Akazawa Katsuyoshi Hatakeyama | 2005 | World Journal of Gastroenterology2005，11，37： | 7 |
| 11 | 中日两国女性血压及心踝血管指数水平的比较研究显示文摘目的探讨中日两国健康女性血压和心踝血管指数(CAVI)的水平及其影响因素。方法中日两国参加健康体检的女性共3301例(中国籍1590例,日本籍1711例),应用动脉僵硬度自动检测装置测定CAVI作为反映动脉僵硬度的指标。结果中国女性的收缩压和舒张压均显著高于同年龄段的日本女性(P均<0.001),31~70岁年龄段的中国女性CAVI显著低于同年龄的日本女性(P均<0.001)。两国健康女性CAVI主要与年龄、收缩压、体质指数(BMI)有关,与舒张压无显著相关关系。结论 CAVI主要与年龄、收缩压、BMI有关。中国女性的血压水平高于同年龄段日本女性,而CAVI低于同年龄段的日本女性。 | 王宏宇 Kohji Shirai 芦娜 赵红薇 刘金波 | 2012 | 北京医学2012，34，11： | 6 |
| 12 | Narrow portion of the terminal choledochus is a cause of upstream biliary dilatation in patients with anomalous union of the pancreatic and biliary ducts显示文摘AIM: To clarify the pathogenesis of biliary dilatation associated with anomalous union of the pancreatic and biliary ducts (AUPBD).METHODS: Direct cholangiopancreatograms of 350 adult patients with or with suspicion of hepatobiliary or pancreatic disorders were reviewed. AUPBD was diagnosed cholangiopancreatographically, when the pancreaticobiliary ductal union was located above the narrow distal segment of the bile duct, which represents the action of the sphincter of Oddi. The narrow portion of the terminal choledochus was defined as symmetrical stricture of the common bile duct just above the pancreaticobiliary ductal union.RESULTS: AUPBD was found in 36 patients. Among cholangiopancreatographic features, the narrow portion of the terminal choledochus was the most pathognomonic for AUPBD (accuracy, 98%); it was present in 29 (81%)patients with AUPBD, but was not found in any patients without AUPBD. Among patients with AUPBD, biliary dilatation (>10 mm) was more frequent in those with the narrow portion of the terminal choledochus (23/29)than in those without (2/7; P = 0.018) AUPBD. Among the patients with both AUPBD and the narrow portion of the terminal choledochus, there was a strong negative correlation between the minimum diameter of the narrow portion and the maximum diameter of the choledochus (r = -0.78, P<0.001), suggesting that the degree of biliary narrowing at the narrow portion correlates with that of upstream biliary dilatation.CONCLUSION: The narrow portion of the terminal choledochus, a pathognomonic radiologic feature of AUPBD, may be a cause of biliary dilatation in patients with AUPBD. | Tatsuya Nomura Yoshio Shirai Toshifumi Wakai Naoyuki Yokoyama Jun Sakata Katsuyoshi Hatakeyama | 2005 | World Journal of Gastroenterology2005，11，41： | 5 |
| 13 | Peroral cholangioscopy for non-invasive papillary cholangio-carcinoma with extensive superficial ductal spread显示文摘Papillary carcinoma arising from the extrahepatic bile duct often shows superficial ductal spread. We report herein the case of a patient with extensive superficial spread of non-invasive papillary cholangiocarcinoma,which was depicted with peroral cholangioscopy. A 65-year-old woman presented with the sudden-onset of severe epigastric pain. Ultrasonography revealed acute acalculous cholecystitis. Endoscopic retrograde cholangiography found small protruding lesions around the confluence of the cystic duct, suggestive of a cholangiocarcinoma. As the contour of the middle and upper bile ducts it was slightly irregular on the cholangiogram, the presence of superficial ductal spread was suspected. Peroral cholangioscopy revealed small papillary lesions around the confluence of the cystic duct and fine granular mucosal lesions in the middle and upper bile ducts and the right hepatic duct, suggesting a superficially spreading tumor. A right hepatectomy with bile duct resection was performed and no residual tumor was found. Histological examination revealed a non-invasive papillary carcinoma arising from the cystic duct with extensive superficial spread. Our experience of this case and a review of the literature suggest that a fine granular or fine papillary appearance of the ductal mucosae on cholangioscopy indicates superficial spread of papillary cholangiocarcinoma, for which peroral cholangioscopy is an efficient diagnostic option. | Toshifumi Wakai Yoshio Shirai Katsuyoshi Hatakeyama | 2005 | World Journal of Gastroenterology2005，11，41： | 3 |
| 14 | Electrocatalytic evolution of oxygen on NiCu particles modifying conductive alumina/nano-carbon network composite electrode显示文摘In this paper, a novel electrically conductive alumina/nano-carbon network (NCN) composite material was used as an electro- catalyst carrier. A NiCu/Al2O3 /NCN composite electrode was prepared by electrodepositing NiCu particles onto the surface of the conductive alumina/NCN composite. Morphology, composition, crystalline structure and electrochemical properties of the NiCu/Al2O3 /NCN composite electrode were investigated. The results showed that NiCu particles can be deposited onto the surface of the alumina/NCN composite by a coelectrodeposition method. NiCu particles in the form of solid solution with face-centered cubic (fcc) structure were relatively uniformly distributed over the carbon layer of the conductive ceramic between alumina grains. As-resulted NiCu/Al2O3 /NCN composite electrode had a remarkably enhanced electrochemical activity and high stabilization for oxygen evolution reaction, which indicated its potential application with enhanced performance to oxygen evolution reaction (OER). Moreover, based on the electrochemical measurement, the mechanism of the OER on the NiCu/Al2O3 /NCN composite electrode was discussed. | FUJI Masayoshi SHIRAI Takashi WATANABE Hideo TAKAHASHI Minoru | 2012 | Science China(Technological Sciences)2012，55，12： | 3 |
| 15 | Perimuscular connective tissue contains more and larger lymphatic vessels than the shallower layers in human gallbladders显示文摘AIM: To clarify whether perimuscular connective tissuecontains more lymphatic vessels than the shallowerlayers in human gallbladders.METHODS: Lymphatic vessels were stainedimmunohistochemically with monoclonal antibody D2-40,which is a specific marker of lymphatic endothelium, inrepresentative sections of 12 normal human gallbladdersobtained at the time of resection for colorectal carcinomaliver metastases. In individual gallbladder specimens,nine high-power (× 200) fields with the highestlymphatic vessel density (LVD), termed 'hot spots', wereidentified for each layer (mucosa, muscle layer, andperimuscular connective tissue). In individual hot spots,the LVD and relative lymphatic vessel area (LVA) weremeasured microscopically using a computer-aided imageanalysis system. The mean LVD and LVA values for thenine hot spots in each layer were used for statisticalanalyses.RESULTS: In the mucosa, muscle layer, andperimuscular connective tissue, the LVD was 16.1 ± 9.2,35.4 ± 15.7, and 65.5 ± 12.2, respectively, and the LVAwas 0.4 ± 0.4, 2.1 ± 1.1, and 9.4 ± 2.6, respectively.Thus, both the LVD and LVA differed significantly (P <0.001 and P < 0.001, respectively; Kruskal-Wallis test)among the individual layers of the wall of the gallbladder,with the highest LVD and LVA values in the perimuscularconnective tissue. Most (98 of 108) of the hot spotswithin the perimuscular connective tissue were locatedwithin 500 μm of the lower border of the muscle layer.CONCLUSION: The perimuscular connective tissuecontains more and larger lymphatic vessels than the shallower layers in the human gallbladder. This observation partly explains why the incidence of lymph node metastasis is high in T2 (tumor invading the perimuscular connective tissue) or more advanced gallbladder carcinoma. | Masayuki Nagahashi Yoshio Shirai Toshifumi Wakai Jun Sakata Yoichi Ajioka Katsuyoshi Hatakeyama | 2007 | World Journal of Gastroenterology2007，13，33： | 3 |
| 16 | Rabeprazole 10?mg q.d.s. decreases 24‐h intragastric acidity significantly more than rabeprazole 20 mg b.d. or 40?mg o.m., overcoming CYP 2 C 19 genotype显示文摘 | M. Sugimoto N. Shirai M. Nishino C. Kodaira T. Uotani M. Yamade S. Sahara H. Ichikawa K. Sugimoto H. Miyajima T. Furuta | 2012 | Aliment Pharmacol Ther2012，，7： | 3 |
| 17 | 利用双囊肠镜对遍及小肠的Peutz-Jeghers息肉进行无需剖腹的内镜下切除 | Ohmiya N. Taguchi A. Shirai K. 赵丽娜 | 2005 | 世界核心医学期刊文摘(胃肠病学分册)2005，0，6： | 2 |
| 18 | 从白湿革削匀革屑中制取明胶显示文摘本文介绍从白湿革削匀革屑中制取明胶的研究情况,以确定酸浸条件与脱铝效果的关系,以及脱铝削匀革屑(DAS)PH值对明胶浸出率的影响。 | Haruo MOTOI-OSHI Noritake ISHIHARA Kunio SHIRAI | 1994 | 陕西科技大学学报(自然科学版)1994，13，3： | 2 |
| 19 | Large cell neuroendocrine carcinoma of the gallbladder: long survival achieved by multimodal treatment显示文摘 | Chigusa Shimono Kazuhiro Suwa Morio Sato Shintaro Shirai Katsuyuki Yamada Yasushi Nakamura Masatoshi Makuuchi | 2009 | International Journal of Clinical Oncology2009，，4： | 2 |
| 20 | Ischemic colitis arising in watershed areas of the colonic blood supply: A report of two cases显示文摘 | Toshiyuki Yamazaki Yoshio Shirai Tetsuya Tada Masataka Sasaki Yasuo Sakai Katsuyoshi Hatakeyama | 1997 | Surgery Today1997，，5： | 2 |
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