Language：Japanese  

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Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

Objective

This study was performed to explore the association between circulating B-type natriuretic peptide (BNP) and other mortality-related factors in patients undergoing cardiovascular surgery.

Methods

In this observational study, multilevel linear regression analysis and multilevel survival analysis were performed to measure the log-transformed BNP (lnBNP) value at four time points in 197 patients with 788 repeated data measurements. Effects of the interaction between the time points and the two intervention groups (cardiac surgery and vascular surgery) were also investigated. Six models were evaluated to identify the best fit for the data. Stata/MP® version 14.2 (Stata Corp., College Station, TX, USA) was used to analyze the two-level variance component model fitting.

Results

There were significant differences in the fixed-effect parameters of lnBNP, such as the time point, age, body mass index, emergency operation, prognostic nutritional index, and estimated glomerular filtration rate. According to the multilevel survival analysis for all-cause death and vascular death, lnBNP significantly differed and was a common prognostic marker.

Conclusion

As lnBNP increased by 1 point, all-cause death increased 2.07 times and vascular death increased 3.10 times. lnBNP is an important prognostic predictor and quantitative biochemical marker in patients undergoing cardiovascular surgery.

DOI： 10.1177/0300060518809238

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

Objective: It is unclear whether epidermal growth factor receptor (EGFR) mutation status is a risk factor for postoperative recurrence of surgically resected lung adenocarcinoma (ADC). Therefore, we conducted a multi-institutional study employing matched-pair analysis to compare recurrence-free survival (RFS) and overall survival (OS) of patients with lung ADC according to EGFR mutation status. Methods: We collected the records of 909 patients who underwent surgical resection for lung ADC between 2005 and 2012 at five participating institutions and were also examined their EGFR mutation status. For each patient with an EGFR mutation, we selected one with the wild-type EGFR sequence and matched them according to institution, age, gender, smoking history, pathological stage (pStage), and adjuvant treatment. We compared RFS and OS of the matched cohort.
Results: The patients were allocated into groups (n = 181 each) with mutated or wild-type EGFR sequences. Both cohorts had identical characteristics as follows: institution, median age (68 years), men (85, 47%), ever smokers (77, 43%), and pStage (IA, 108, 60%; IB, 48, 27%; II, 14, 8%; III, 11, 6%). The 3-and 5-year RFS rates of patients with mutated or wild-type EGFR sequence were 79%, 68% and 77%, 68%, respectively (p = 0.557). The respective OS rates were 92%, 81%, and 89%, 79% (p = 0.574).
Conclusion: Matched-pair and multi-institutional analysis reveals that an EGFR mutation was not a significant risk factor for recurrence of patients with surgically resected lung adenocarcinoma.

DOI： 10.1016/j.lungcan.2017.09.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER INDIA  

Although pulmonary function was better after video-assisted thoracoscopic surgery (VATS) lobectomy than after open thoracotomy lobectomy, it is unclear whether postoperative pulmonary function after VATS lobectomy is better than that after mini-thoracotomy lobectomy. The aim of this study is to determine whether the former is better than the latter. VATS lobectomies were performed using endoscopic techniques through a 3-4-cm skin incision spread by a silicon rubber retractor and two or three trocars. Mini-thoracotomy lobectomies were performed through a 7-12-cm skin incision spread by rib retractors made of metal and one or two trocars. Pulmonary function tests were performed a week before surgery and 3 months after surgery. There were 14 males and 11 females in VATS lobectomy and 32 males and 30 females in mini-thoracotomy lobectomy. For lobe location (right upper/right lower/left upper/left lower), there were 12/1/8/4 in VATS lobectomy and 16/19/13/14 in mini-thoracotomy lobectomy, respectively. The percent predicted postoperative forced vital capacity (FVC) (postoperative FVC/predicted postoperative FVC x 100) (110 +/- 15 %) of VATS lobectomy was significantly higher than that (101 +/- 16 %) of mini-thoracotomy lobectomy (P = 0.0124). The percent predicted postoperative forced expiratory volume in 1 s (FEV1) (postoperative FEV1/predicted postoperative FEV1 x 100) (110 +/- 15 %) of VATS lobectomy was not significantly higher than that (104 +/- 15 %) of mini-thoracotomy lobectomy (P = 0.091). Multiple regression analysis revealed that operative procedure (VATS lobectomy or mini-thoracotomy lobectomy) was the only significant variable contributing to percent predicted postoperative FVC (P = 0.0073) and percent predicted postoperative FEV1 (P = 0.0180). Postoperative FVC after VATS lobectomy is better than after mini-thoracotomy lobectomy.

DOI： 10.1007/s12262-016-1510-1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：HUMANA PRESS INC  

The International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society (IASLC/ATS/ERS) proposed a new histologic classification of lung adenocarcinoma in 2011. While several studies have already validated the prognostic value of this new classification of lung adenocarcinoma, we conducted own investigation in the present study. This study included 197 patients with invasive lung adenocarcinoma who underwent complete resection. Pathologic diagnoses were made in accordance with the new IASLC/ATS/ERS classification for lung adenocarcinoma. The lepidic/acinar/papillary group had a significantly better prognosis than the micropapillary/solid/ invasive mucinous adenocarcinoma group (5-year recurrence- free survival [RFS] 73 vs. 21%: p < 0.01, 5-year overall survival 85 vs. 52%: p < 0.01). Age (hazard ratio [HR], 1.898; p = 0.03), CEA (HR, 1.873; p = 0.03), pStage (HR, 6.149; p < 0.01), and histologic subtype (HR, 2.342; p = 0.01) were independent prognostic factors for the RFS. Furthermore, age (HR, 3.242; p = 0.04), CEA (HR, 3.405; p = 0.03) and histologic subtype (HR, 11.108; p < 0.01) were independent prognostic factors for the progression-free survival in pStage I. The histologic subtype correlated with the prognosis of pStage I of lung adenocarcinoma. Patients in the high-grade group of lung adenocarcinoma, which included solid, micropapillary and invasive mucinous adenocarcinoma with pStage I, should be considered candidates for postoperative adjuvant therapy.

DOI： 10.1007/s12032-017-0962-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Ltd  

Introduction An anomalous systemic arterial supply to the normal basal segment without sequestration is a rare congenital vascular malformation. The discovery age is relatively young, and the most common clinical symptom is hemoptysis due to pulmonary hypertension or heart failure. We herein describe a case of endovascular embolization of in an elderly and asymptomatic patient with an anomalous systemic arterial supply to the normal basal segment. Presentaition of case An 80-year-old male was referred to our hospital due to an abnormal chest shadow. The patient was diagnosed with an anomalous systemic arterial supply to normal basal segment. We performed coil embolization via the catheterization. Discussion The application of coil embolization via catheterization results in a low risk of infection and small burden on the body compared with surgery. There are few report of the coil embolization for an anomalous systemic arterial supply to the normal basal segment. Hence, it is necessary to accumulate additional cases. Conclusion The outcome of thie case indicates that coil embolization is a very useful treatment method for elderly patients with an anomalous systemic arterial supply to the normal basal segment.

DOI： 10.1016/j.ijscr.2017.03.030

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BACKGROUND:The aim of the study was to examine the influence of the changes in the atmospheric temperature (ATemp) and the atmospheric pressure (APres) on the occurrence of a spontaneous pneumothorax (SP).;PATIENTS AND METHODS:From January 2000 to March 2014, 192 consecutive SP events were examined. The ATemp and APres data at the onset of SP, as well as those data at 12, 24, 36, 48, 60, and 72 h prior to the onset time, were analyzed.;RESULTS:The frequencies of SP occurrence were not statistically different according to the months or seasons, but were statistically different according to the time period (P < .01) and SP events occurred most frequently from 12:00 to 18:00. SP events frequently occurred at an ATemp of 25 degrees Celsius or higher. There was a significantly negative correlation between the APres and the ATemp at the SP onset time. The values of change in the APres from 36 to 24 h prior to SP onset were significantly lower than the preceding values.;CONCLUSIONS:In this study, we observed that a SP event was likely to occur in the time period from 12:00 to 18:00, at an ATemp of 25 degrees Celsius or higher, and at 24-36 h after a drop of APres.

DOI： 10.1111/crj.12562

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Objective. According to the Clinical Cancer Guidelines for lung cancer, which were established by the Japan Lung Cancer Society, lobectomy is recommended for patients with clinical stage IA non-small cell lung cancer (NSCLC). Although patients who are poor candidates for lobectomy may be offered limited resection or stereotactic body radiotherapy (SBRT), there are few reports comparing the prognosis of patients undergoing these therapeutic modalities. We herein performed a retrospective analysis to compare the therapeutic efficacy of limited resection with that of SBRT in patients with clinical stage IA NSCLC who were ineligible for lobectomy. Methods. Patients who underwent limited resection or SBRT for clinical stage IA NSCLC from January 2009 to March 2015 were included in the present study. Results. Twenty patients underwent limited resection (all patients received wedge resection), and 20 patients underwent SBRT. The mean follow-up period was significantly longer in the limited resection group (limited resection, 1385 days; SBRT, 851 days; P<0.01). The mean age of the patients in the SBRT group was significantly older (73.9 years versus 78.9 years; P=0.05), and the Eastern Coo

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DOI： 10.1007/s00384-015-2198-6

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BACKGROUND: Precise staging of lung cancer is usually evaluated by PET-CT and brain MRI. Recently, however, whole-body diffusion-weighted magnetic resonance imaging (WB-DWI) has be applied. The aim of this study is to determine whether the diagnostic performance of lung cancer staging by WB-DWI is superior to that of PET-CT+brain MRI. MATERIALS AND METHODS: PET-CT + brain MRI and WB-DWI were used for lung cancer staging before surgery with 59 adenocarcinomas, 16 squamous cell carcinomas and 6 other carcinomas. RESULTS: PET-CT + brain MRI correctly identified the pathologic N staging in 67 patients (82.7%), with overstaging in 5 (6.2%) and understaging in 9 (11.1%), giving a staging accuracy of 0.827. WB-DWI correctly identified the pathologic N staging in 72 patients (88.9%), with overstaging in 1 (1.2%) and understaging in 8 patients (9.9%), giving a staging accuracy of 0.889. There were no significant differences in accuracies. PET-CT + brain MRI correctly identified the pathologic stages in 56 patients (69.1%), with overstaging in 7 (8.6%) and understaging in 18 (22.2%), giving a staging accuracy of 0.691. WB-DWI correctly identified the pathologic stages in 61 patients (75.3%), with overstaging in 4 (4.9%) and understagings in16(19.7%), giving a staging accuracy of 0.753. There were no significant difference in accuracies. CONCLUSIONS: Diagnostic efficacy of WB-DWI for lung cancer staging is equivalent to that of PET-CT + brain MRI.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asian Pacific Organization for Cancer Prevention  

Background: The Glasgow Prognostic Score (GPS) is calculated from measured CRP and albumin levels. We here evaluated the significance of the GPS in patients with resected pulmonary adenocarcinoma. Materials and Methods: The present study included 156 patients with lung adenocarcinoma who underwent lobectomy at Kanazawa Medical University between 2002 and 2012. Classification was into three groups: those with normal albumin ( &gt
=3.5 g/dl) and C-reactive protein (CRP) ( &lt
=1.0 mg/dl) levels were classified as GPS 0 (n =136), those with low albumin ( &lt
3.5 g/ dl) or elevated CRP ( &gt
1.0 mg/dl) levels as GPS 1 (n = 16), and those with low albumin ( &lt
3.5 g/dl) and elevated CRP ( &gt
1.0 mg/dl) levels as GPS 2 (n = 4). We retrospectively investigated relationships between the patient characteristics including the GPS, and disease-free survival and cancer-specific survival. Results: The pathological stages of the patients were as follows: IA (n=78, 50%), IB (n=31, 19.9%), IIA (n=20.0, 12.8%), IIB (n=9.0, 5.7%), and IIIA (n=18.0, 11.5%). Lobectomy was performed in all cases. The average GPS was 0.15 (0-2) and showed significant relationships with stage and tumor size. The 2-year survival rates in patients with GPS0, 1 and 2 were 81.4%, 38.4%, and 25.0%, respectively. Clear correlations were noted with both cancer-specific survival and disease-free survival. Furthermore, multivariate analysis revealed that GPS was a significant prognostic factor. Conclusions: The GPS could be a prognostic factor for patients with resected pulmonary adenocarcinoma.

DOI： 10.7314/APJCP.2016.17.10.4677

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DOI： 10.1164/rccm.201501-0122IM

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OBJECTIVE: In cancer screening programs, performing appropriate further work-up is essential. In order to elucidate whether the further work-up for the subjects with positive screening results by sputum cytology was performed appropriately, the present study was conducted as the first large-scale thorough survey in Japan. METHODS: All of the lung cancer screening records from 2007 to 2012 in Ishikawa Prefecture were reviewed. Additional investigations about the further work-up were performed. RESULTS: In total, 2 234 984 people were invited to undergo lung cancer screening, and 494 424 people participated in the screening. Of these, 25 264 people underwent sputum cytology, and 68 positive cases were identified. Three of these 68 cases did not undergo further work-up, and another three cases had already been diagnosed to have lung cancer. Forty-five of the remaining 62 cases did not have suspicious chest shadows, and bronchoscopic examinations were performed in 36 cases. Seventeen of these 36 cases were diagnosed as having cancer, whereas none of the nine cases who did not receive the examination was diagnosed (P = 0.038). A bronchoscopic examination was not performed due to other medical conditions in three cases, due to the patient's refusal in another three cases and in the remaining three cases, the reasons were unknown. CONCLUSION: The participation rate for further work-up was very high. However, there are some issues to be resolved regarding the transmission of information. With our new registered hospital system, the quality assurance of our screening program will be improved.

DOI： 10.1093/jjco/hyu214

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BACKGROUND: Diffusion-weighted magnetic resonance imaging (DWI) makes it possible to detect malignant tumors based on the diffusion of water molecules. It is uncertain whether DWI is more useful than positron emission tomography-computed tomography (PET-CT) for distinguishing benign from malignant mediastinal tumors and mass lesions. MATERIALS AND METHODS: Sixteen malignant mediastinal tumors (thymomas 7, thymic cancers 3, malignant lymphomas 3, malignant germ cell tumors 2, and thymic carcinoid 1) and 12 benign mediastinal tumors or mass lesions were assessed in this study. DWI and PET-CT were performed before biopsy or surgery. RESULTS: The apparent diffusion coefficient (ADC) value (1.51±0.46x10(-3) mm2/sec) of malignant mediastinal tumors was significantly lower than that (2.96±0.86x10(-3) mm2/sec) of benign mediastinal tumors and mass lesions (P<0.0001). Maximum standardized uptake value (SUVmax) (11.30±11.22) of malignant mediastinal tumors was significantly higher than that (2.53±3.92) of benign mediastinal tumors and mass lesions (P=0.0159). Using the optimal cutoff value (OCV) 2.21x10(-3) mm2/sec for ADC and 2.93 for SUVmax, the sensitivity (100%) by DWI was not significantly higher than that (93.8%) by PET-CT for malignant mediastinal tumors. The specificity (83.3%) by DWI was not significantly higher than that (66.7%) for benign mediastinal tumors and mass lesions. The accuracy (92.9%) by DWI was not significantly higher than that (82.1%) by PET-CT for mediastinal tumors and mass lesions. CONCLUSIONS: There was no significant difference between diagnostic capability of DWI and that of PET-CT for distinguishing mediastinal tumors and mass lesions. DWI is useful in distinguishing benign from malignant mediastinal tumors and mass lesions.

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A bronchial fistula is one of the most serious complications that can occur following pulmonary lobectomy. We herein report a case of bronchial fistula that was successfully treated by endobronchial embolization using an Endobronchial Watanabe Spigot (EWS). A 72-year-old male underwent right lower lobectomy of the lung with nodal dissection for a pulmonary squamous cell carcinoma. A bronchial fistula developed 53 days after surgery. Tube drainage was performed, and air leakage was apparent. Under endoscopic observation, intrathoracic injection of indigo carmine revealed that a fistula existed at the peripheral site of the B(2)ai bronchus. After one EWS (small) was inserted into the B(2)a bronchus tightly using a bronchoscope, the air leakage was stopped. Pleurodesis was further carried out, the thoracostomy tube was subsequently removed, and the patient was discharged. Endobronchial embolization using an EWS is an option for the treatment of a bronchial fistula after pulmonary resection.

DOI： 10.1155/2015/425694

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BACKGROUND: It is sometimes difficult to assess patients who have multiple hilar and mediastinal lymph nodes (MHMLN) with FDG accumulation in PET-CT. Since it is uncertain whether diffusion-weighted magnetic resonance imaging (DWI) is useful in the assessment of such patients, its diagnostic performance was assessed. MATERIALS AND METHODS: Twenty-three patients who had three or more stations of hilar and mediastinal lymph nodes with SUVmax of 3 or more in PET-CT were included in this study. RESULTS: For diagnosis of disease, there were 20 malignancies (lung cancers 17, malignant lymphomas 2 and metastatic lung tumor 1), and 3 benign cases (sarcoidosis 2 and benign disease 1). For diagnosis of lymph nodes, there were 7 malignancies (metastasis of lung cancer 7 and malignant lymphoma 1) and 16 benign lymphadenopathies (pneumoconiosis/silicosis 7, sarcoidosis 4, benign disease 4, and atypical lymphocyte infiltration 1). The ADC value (1.57±0.29x10(-3) mm2/sec) of malignant MHMLN was significantly lower than that (1.99±0.24x10(-3) mm2/sec) of benign MHMLN (P=0.0437). However, the SUVmax was not significantly higher (10.0±7.34 as compared to 6.38±4.31) (P=0.15). The sensitivity (86%) by PET-CT was not significantly higher than that (71%) by DWI for malignant MHMLN (P=1.0). The specificity (100%) by DWI was significantly higher than that (31%) for benign MHMLN (P=0.0098). Furthermore, the accuracy (91%) with DWI was significantly higher than that (48%) with PET-CT for MHMLN (P=0.0129). CONCLUSIONS: Evaluation by DWI for patients with MHMLN with FDG accumulation is useful for distinguishing benign from malignant conditions.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japan Society for Respiratory Endoscopy  

Objective. For safe flexible bronchoscopy, it is essential that the sedation level be evaluated accurately. A prospective study was undertaken to determine usefulness of the bispectral index (BIS) monitor system during flexible bronchoscopy and evaluate how much amnesia patients experienced. Methods. We performed flexible bronchoscopy in 42 patients. Injections of midazolam (2.5 mg) were administered until amnesia was achieved. BIS values were recorded continuously. Injection of midazolam (2.5 mg) was administered when BIS value remained over 85 for 30 seconds, but not for coughs or body movement when BIS value stayed below 80. Results. There were 31 patients (74%) who remembered nothing at all, 11 (26%) who remembered no details, and none (0%) who remembered some details, many details, or every detail. Regarding patient satisfaction, 25 patients (60%) felt "excellent" or "good" during premedication, 33 (79%) during the bronchoscopic procedure, 28 (67%) during the post-bronchoscopic procedure, and 34 (81%) during the total procedure. The mean BIS value of patients was 76.4±5.2 during the bronchoscopic procedure; the minimum mean BIS value was 65, and the maximum mean BIS value was 85. BIS values rose 7 to 40 (17.9±7.6) with coughs or body movement. BIS value (76.4±4.9) of patients who remembered nothing at all was similar to that (74.3±4.8) of patients who remembered no details. BIS values did not suggest the degree of patient memory or satisfaction. Conclusions. BIS value is useful in the administration of midazolam and keeps patients at an appropriate level of sedation. The BIS value taken during flexible bronchoscopy is not an indicator of patient memory or satisfaction.

DOI： 10.18907/jjsre.36.1_12

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ASIAN PACIFIC ORGANIZATION CANCER PREVENTION  

Background: Diffusion-weighted imaging (DWI) makes it possible to detect malignant tumors based on the diffusion of water molecules. However, it is uncertain whether DWI has advantages over FDG-PET for distinguishing malignant from benign pulmonary nodules and masses. Materials and Methods: One hundred-forty-three lung cancers, 17 metastatic lung tumors, and 29 benign pulmonary nodules and masses were assessed in this study. DWI and FDG-PET were performed. Results: The apparent diffusion coefficient (ADC) value (1.27 +/- 0.35x10(-3) mm(2)/sec) of malignant pulmonary nodules and masses was significantly lower than that (1.66 +/- 0.58x10(-3) mm(2)/sec) of benign pulmonary nodules and masses. The maximum standardized uptake value (SUVmax: 7.47 +/- 6.10) of malignant pulmonary nodules and masses were also significantly higher than that (3.89 +/- 4.04) of benign nodules and masses. By using optimal cutoff values for ADC (1.44x10(-3) mm(2)/sec) and for SUVmax (3.43), which were determined with receiver operating characteristics curves (ROC curves), the sensitivity (80.0%) of DWI was significantly higher than that (70.0%) of FDG-PET. The specificity (65.5%) of DWI was equal to that ( 65.5%) of FDG-PET. The accuracy (77.8%) of DWI was not significantly higher than that (69.3%) of FDG-PET for pulmonary nodules and masses. As the percentage of bronchioloalveolar carcinoma (BAC) component in adenocarcinoma increased, the sensitivity of FDG-PET decreased. DWI could not help in the diagnosis of mucinous adenocarcinomas as malignant, and FDG-PET could help in the correct diagnosis of 5 out of 6 mucinous adenocarcinomas as malignant. Conclusions: DWI has higher potential than PET in assessing pulmonary nodules and masses. Both diagnostic approaches have their specific strengths and weaknesses which are determined by the underlying pathology of pulmonary nodules and masses.

DOI： 10.7314/APJCP.2014.15.11.4629

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Background: The epidermal growth factor receptor (EGFR) mutation status of lung cancer is important because it means that EGFR-tyrosine kinase inhibitor treatment is indicated. The purpose of this prospective study is to determine whether EGFR mutation status could be identified with reference to preoperative factors. Materials and Methods: One hundred-forty eight patients with lung cancer (111 adenocarcinomas, 25 squamous cell carcinomas and 12 other cell types) were enrolled in this study. The EGFR mutation status of each lung cancer was analyzed postoperatively. Results: There were 58 patients with mutant EGFR lung cancers (mutant LC) and 90 patients with wild-type EGFR lung cancers (wild-type LC). There were significant differences in gender, smoking status, maximum tumor diameter in chest CT, type of tumor shadow, clinical stage between mutant LC and wild-type LC. EGFR mutations were detected only in adenocarcinomas. Maximum standardized uptake value (SUVmax:3.66 +/- 4.53) in positron emission tomography-computed tomography of mutant LC was significantly lower than that (8.26 +/- 6.11) of wild-type LC (p&lt;0.0001). Concerning type of tumor shadow, the percentage of mutant LC was 85.7% (6/7) in lung cancers with pure ground glass opacity (GGO), 65.3%(32/49) in lung cancers with mixed GGO and 21.7%(20/92) in lung cancers with solid shadow (p&lt;0.0001). For the results of discriminant analysis, type of tumor shadow (p=0.00036) was most significantly associated with mutant EGFR. Tumor histology (p=0.0028), smoking status (p=0.0051) and maximum diameter of tumor shadow in chest CT (p=0.047) were also significantly associated with mutant EGFR. The accuracy for evaluating EGFR mutation status by discriminant analysis was 77.0% (114/148). Conclusions: Mutant EGFR is significantly associated with lung cancer with pure or mixed GGO, adenocarcinoma, never-smoker, smaller tumor diameter in chest CT. Preoperatively, EGFR mutation status can be identified correctly in about 77 % of lung cancers.

DOI： 10.7314/APJCP.2014.15.2.657

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To expand postoperative residual lungs after pulmonary lobectomy, thoracic drainage with two chest tubes has been recommended. Several studies recently demonstrated that postoperative drainage with one chest tube (PD1) was as safe as that with two chest tubes (PD2). However, most of the patients in those studies underwent lobectomy by standard thoracotomy. Although the number of pulmonary lobectomies by video-assisted thoracic surgery (VATS) has been increasing in recent years, there have been no reports that compared PD1 with PD2 after pulmonary lobectomy, including that by VATS. To elucidate whether postoperative management with PD1 is as safe as that with PD2, we conducted a randomized controlled trial. Lung cancer patients who underwent lobectomies with mediastinal nodal dissection in our hospital were assigned to one of two groups: one chest tube placed in PD1 group and two chest tubes placed in PD2 group. A total of 108 patients were registered in the study. There were no signifcant differences in the age, gender, pathological stage or histological type between two groups. Since the residual lung expansion was good in both groups, there were no patients who needed thoracentesis. There were no signifcant differences in the number of cases with pleurodesis, the amount/duration of drainage or the pain of the patients between two groups. In conclusion, since PD1 has advantages in saving cost and time and in low risk of transcutaneous infection, PD1 is appropriate after pulmonary lobectomy by VATS and by open thoracotomy. © 2014 Tohoku University Medical Press.

DOI： 10.1620/tjem.232.55

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Background: Diffusion-weighted magnetic resonance imaging (DWI) is reported to be useful for detecting malignant lesions. The purpose of this study is to clarify characteristics of imaging, detection rate and sensitivity of DWI for recurrence or metastasis of lung cancer. Methods: A total of 36 lung cancer patients with recurrence or metastasis were enrolled in this study. While 16 patients underwent magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography-computed tomography (PET-CT), 17 underwent MRI and CT, and 3 underwent MRI and PET-CT. Results: Each recurrence or metastasis showed decreased diffusion, which was easily recognized in DWI. The detection rate for recurrence or metastasis was 100% (36/36) in DWI, 89% (17/19) in PET-CT and 82% (27/33) in CT. Detection rate of DWI was significantly higher than that of CT (p=0.0244) but not significantly higher than that of PET-CT (p=0.22). When the optimal cutoff value of the apparent diffusion coefficient value was set as 1.70x10(-3) mm(2)/sec, the sensitivity of DWI for diagnosing recurrence or metastasis of lung cancer was 95.6%. Conclusions: DWI is useful for detection of recurrence and metastasis of lung cancer.

DOI： 10.7314/APJCP.2014.15.16.6843

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Background: The purpose of this study was to determine the prognostic significance of the maximum standardized uptake value (SUVmax) on F-18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in patients undergoing surgical treatment for non-small cell lung cancer. Materials and Methods: Seventy-eight consecutive patients (58 with adenocarcinomas, 20 with squamous cell carcinomas) treated with potentially curative surgery were retrospectively reviewed. Results: The SUVmax was significantly higher in the patients with recurrent than with non-recurrent adenocarcinoma (p&lt;0.01). However, among the patients with squamous cell carcinoma, there were no differences with or without recurrence (p=0.69). Multivariate analysis indicated that the SUVmax of adenocarcinoma lesions was a significant predictor of disease-free survival (p=0.04). In addition, an SUVmax of 6.19, the cut-off point based on ROC curve analysis of the patients with pathological IB or more advanced stage adenocarcinomas, was found to be a significant predictor of disease-free survival (p&lt;0.01). Conclusions: SUVmax is a useful predictor of disease-free survival in patients with resected adenocarcinoma, but not squamous cell carcinoma. Patients with adenocarcinoma exhibiting an SUVmax above 6.19 are candidates for more intensive adjuvant therapy.

DOI： 10.7314/APJCP.2014.15.23.10171

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Association for Chest Surgery  

Background. The diagnosis of a cavitating pulmonary disease is occasionally difficult. Case. A 59-year-old male was noted to have an abnormal shadow on a chest radiograph. Chest CT showed a cavity lesion, as well as an infiltrative shadow that had first been noticed two years earlier. Transbronchial lung biopsy could not reveal any malignant cells; therefore, the cavity was suspected to be a lung abscess. However diffusion-weighted magnetic resonance imaging (DWI) suggested the possibility of malignancy. Histological examination of frozen sections obtained during the operation revealed adenocarcinoma. The patient underwent left lower lobectomy with hilar and mediastinal lymphadenectomy. The final pathological diagnosis was adenocarcinoma with mixed subtypes, predominantly acinar and mucinous bronchioloalveolar carcinoma. The pathological stage was T2aN2M0 stage IIIA. Conclusion. DWI may be useful for the diagnosis of a malignant lung tumor.

DOI： 10.2995/jacsurg.27.632

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Association for Chest Surgery  

Although arrhythmias are important complications occurring after general thoracic surgery, there have so far been few reports concerning the relationship between postoperative arrhythmias and the value of brain natriuretic peptide (BNP), which is thought to be an indicator of heart failure. We herein examine the perioperative BNP values and postoperative arrhythmias in general thoracic surgery.From January 2008 to May 2010, 63 patients (40 lobectomies, 15 wedge resections of the lung, 5 pneumonectomies, 3 mediastinal tumor resections) underwent general thoracic surgery at our hospital, and both the pre- and postoperative BNP levels were measured. Thereafter, the relationships among the BNP values, preoperative comorbidities, and postoperative arrhythmias were analyzed.Regarding the preoperative comorbidities, heart failure, ischemic heart disease, arrhythmia, and renal failure were all associated with increased preoperative BNP values. The BNP values in the patients with normal preoperative BNP values increased on postoperative day 1 and then decreased to normal levels for about one week. However, the BNP values in the patients with high preoperative BNP values decreased at a slower rate. In the 54 patients with preoperative BNP values below 100 pg/ml, the difference between the postoperative (day 1) and preoperative BNP values in patients who suffered from postoperative arrhythmias were significantly larger than that of the patients who did not experience postoperative arrhythmias, thus suggesting that the difference in the post- and preoperative BNP values may be an indicator of postoperative arrhythmia.

DOI： 10.2995/jacsurg.27.3

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2013133823

Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.35.Special_S220_2

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A certified method for lung cancer screening in Japan is the combination of chest X-ray and sputum cytology. The chest X-ray examination is intended primarily for the detection of peripheral-type lung cancer. Interpretation of the films should be performed by two different physicians, and the films of screenees suspected to have abnormal shadow should be compared to the same screenee's films from previous screening visits. Sputum cytology is conducted for heavy smokers, and is useful for early detection of central lung cancer. The efficacy of this lung cancer screening method has been shown in several case-control studies. There are some problems to solve i. e., a low rate of attendance and inadequate quality control. Low-dose thoracic CT screening is performed with an exposure within a single breath hold, and its interpretation can be conducted with films, CRT, or a LCD monitor. Even when taken at low doses, the radiation exposure dose is large compared to a chest X-ray, being about 3-10 times greater than the absorbed dose and 20-40 times greater than the effective dose. Since the radiation dose in a usual clinical condition is much higher, the clinical condition is not recommended for screening. Concerning the efficacy of low-dose CT screening for heavy-smokers, a positive result was reported in June 2011, and further detailed analyses are required. There are still some problems to solve i. e., the management of undiagnosed shadows, harm caused by the screening, quality control, and efficacy in non-smokers.

Scopus

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japan Lung Cancer Society  

Objective. Aquaporins (AQPs) are a family of small (-28 kDa/monomer) channel-forming membrane proteins that function as osmotically driven transepithelial and transcellular water transporters. To date, 13 homologous members have been identified in mammals. Recent studies using several varieties of aquaporin-gene knock-out mice have indicated previously unanticipated roles for AQPs, including cell cycle control and migration. In this review, we summarize the recent data on the involvement of AQPs in the progression of adenocarcinoma of the lung. Results. AQP1, 3, 4 and 5 were demonstrated in normal lung tissue with cell type-specific and polarized patterns. AQP1, 3 and 5 were frequently expressed in lung adenocarcinoma tissue subtypes. There were 3 recognized AQP-expression patterns: 1) a polarized expression of AQP1 and 3 in accordance with the differentiation of normal lung cells; 2) a polarized but aberrant expression of AQP5, and 3) the overexpression in the absence of any polarity of AQP1 and 5. Pattern 1) was seen predominantly in bronchioloalveolar carcinoma cells, of either non-mucinous or mucinous type, and decreased according to the progression of the disease. Pattern 2) was detected not only in bronchioloalveolar carcinoma cells, but also in atypical adenomatous hyperplasia cells, which suggested a relationship between AQP5 expression and the tumorigenesis of adenocarcinoma. Pattern 3) has been increasingly observed in the areas with micro-invasion, becoming prominent in the areas with widespread invasion, and correlated significantly with the decreased survival rates observed in adenocarcinoma patients. The oncogenic roles of each pattern were determined by in vitro studies using tumor cells with the AQP cells either knocked-in or knocked-out. Overexpressed AQP1 facilitated lamellipodia formation at the front line of the invasion, and AQP5 activated intracytoplasmic signal molecules, which play critical roles in cellular proliferation and epithelial mesenchymal transition (EMT). The involvement of AQP5 in the secretion of mucin in mucinous tumors and AQP1 in the aggressiveness of micropapillary components were also observed. The level of AQP4 expression was high in lung adenocarcinoma, and correlated significantly with a more favourable prognosis in adenocarcinoma patients. Conclusion. Several studies indicate that AQP1 and 5 are vital activators of the EMT of lung adenocarcinoma, suggesting that AQP can be a novel target molecule for counteracting the aggressiveness of lung adenocarcinoma.<br>

DOI： 10.2482/haigan.52.17

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Other Link： http://search.jamas.or.jp/link/ui/2012192671

Language：Japanese   Publishing type：Research paper (scientific journal)  

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:The aim of this study was to interpret diffusion-weighted imaging (DWI) signals in lung cancers. They were converted into several three-dimensional DWI signals patterns, which represent the degree of DWI signal intensity by height and the degree of distribution by area: flat, low elevation, irregular elevation, single-peak elevation, multiple-peak elevation, and nodular elevation. There were 39 adenocarcinomas and 21 squamous cell carcinomas. Three-dimensional DWI signals decreased significantly in order of cell differentiation. Tumor cellular densities were increased according to the increase in three-dimensional DWI signals. DWI signal intensity and distribution can represent the amount of cancer cells and their distribution in the carcinoma.

DOI： 10.1016/j.clinimag.2012.04.026

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (international conference proceedings)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japan Society for Respiratory Endoscopy  

Background. Patients expect flexible bronchoscopy to be painless and completely safe. The purpose of this study was to show how patient satisfaction improved and how the lidocaine dose was reduced in a new bronchoscopy method. Methods. Group A was composed of 28 patients who underwent bronchoscopy as follows (conventional method): (1) lidocaine administration in the throat using jelly, by nebulizer and spray, (2) injection of midazolam until achieving amnesia, and (3) the bolus administration of lidocaine into the airway. Group B was composed of 29 patients who underwent bronchoscopy as follows (new method): (1) lidocaine administration by nebulizer, (2) injection of midazolam until achieving amnesia, and (3) lidocaine spray through a catheter to the throat, trachea and bronchi. Patient satisfaction was classified into 5 categories; very poor, poor, fair, good, excellent. Results. The mean dose of lidocaine (334±81mg) in group B was significantly lower than 450±67mg in group A. In group A, the percentage of patients who felt "excellent" or "good" was 21% during premedication, 89% during the bronchoscopic procedure, 75% after the bronchoscopic procedure, and 75% during the total procedure. In group B, the percentage of patients who felt "excellent" or "good" was 48% in premedication, 90% during the bronchoscopic procedure, 66% after the bronchoscopic procedure, and 86% during the total procedure. The degree of patient satisfaction during premedication in group B was significantly higher than in group A. Conclusion. Lidocaine administration to the throat during amnesia can improve patient satisfaction. Lidocaine dosage can be reduced by using lidocaine spray through a catheter in a bronchoscopy.

DOI： 10.18907/jjsre.32.5_409

CiNii Books

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (international conference proceedings)  

PURPOSE: The aim of this study was to determine if glucose transporter-1 (Glut1) expression correlates with (18)F-FDG ((18)F-fluoro-2-deoxyglucose) uptake on positron emission tomography (PET) in lung cancer and to examine the similarities and differences between them. METHODS: A total of 34 patients with resected primary lung cancers were investigated in this study. There were 17 adenocarcinomas, 12 squamous cell carcinomas, and 5 cancers of other cell types. Immunohistochemical Glut1 intensity was categorized into three groups: negative, positive, and strongly positive. Glut1 frequency was defined by the proportion of positive cells among all cancer cells, and it was graded on a semiquantitative scale as 0-100% in 10% increments. The data are expressed as the mean +/- SD. RESULTS: Maximum standardized uptake values (SUVmax) were 4.8 +/- 6.3 in "negative" Glut1 intensity cases, 4.7 +/- 3.1 in "positive" Glut1 intensity cases, and 11.2 +/- 5.2 in "strongly positive" Glut1 intensity cases. Although SUVmax correlated significantly with tumor size (correlation coefficient 0.58, P = 0.00033), Glut1 frequency did not correlate significantly with tumor size (correlation coefficient 0.18, P = 0.301). Cell type and cell differentiation correlated significantly with Glut1 expression and (18)F-FDG uptake. CONCLUSION: Glut1 expression correlates significantly with (18)F-FDG uptake. There are similarities in cell differentiation and cell type between Glut1 expression and (18)F-FDG uptake. (18)F-FDG uptake correlates significantly with tumor size, but Glut1 expression does not.

DOI： 10.1007/s11748-010-0603-1

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (international conference proceedings)  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japan Society for Respiratory Endoscopy  

Background. Patients expect that bronchoscopic examinations should be painless, and completely safe. Purpose. To examine patient satisfaction and the side effects of bronchoscopic examinations using midazolam. Methods. Between November 2007 and May 2008, 28 patients underwent bronchoscopic examinations. Fifteen patients were examined for bronchoscopic findings, 2 for histological examinations within the range of bronchoscopic visibility and 11 for histological examinations beyond the range of bronchoscopic visibility. The bronchoscopic examinations were performed as follows: (1) 2% viscous lidocaine (4ml) in pharynx, (2) after 2% lidocaine (3ml) inhalation, 1% lidocaine (10ml) spray to laryngeal area under lingual attraction, (3) intramuscular injection of pentazocine (15mg) (+atropine sulfate 0.5mg), (4) after an initial intravenous bolus injection (2.5mg) of midazolam, a subsequent bolus injection (2.5mg) was used to achieve adequate sedation and amnesia, and then a bronchoscope was inserted orally, (5) additional intra-airway bolus injection (2ml) of 1% lidocaine, (6) after the examination was finished, an intravenous injection of fulmazenil (0.5mg) was given to wake up the patients. In a questionnaire after bronchoscopy, patients' satisfaction was classified into 5 categories; great, good, normal, uncomfortable, and very uncomfortable. Results. There was a significant correlation between dose of midazolam and age (correlation coefficient: -0.589). Number (%) of patients who felt "great" or "good" were 6 (21%) on premedication, 25 (89%) during bronchoscopic examination, 21 (75%) after bronchoscopic examination, and 21 (75%) during the entire procedure. Lack of patient satisfaction was thought to be caused by the viscous lidocaine, lidocaine spray, or the pain of lingual attraction in premedication. During bronchoscopic examinations, 24 patients (86%) had amnesia, while the remaining 4 patients (14%) remembered a little of the examination. There were no cases of respiratory suppression or complication. Twenty-three patients (82%) agreed to have a re-bronchoscopic examination and the remaining 5 patients (18%) did not want a re-bronchoscopic examination in the future. Conclusion. A bronchoscopic examination with sedation by midazolam is recommended because midazolam reduces pain and increases patient satisfaction. Premedication is very important for patient satisfaction, and the method should be improved.

DOI： 10.18907/jjsre.32.2_133

CiNii Books

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (international conference proceedings)  

The efficacy of lung cancer screening should not be evaluated by the survival rate of lung cancer patients but by lung cancer mortality in a certain population because the survival rate can be greatly affected by several types of bias. Randomized controlled trials that were conducted during the 1970s and 1980s in Europe and the United States failed to prove the efficacy of lung cancer screening in decreasing the mortality rate; but recently the results of case-control studies in Japan have revealed that undergoing currently available screening decreases the risk of lung cancer deaths by 30%-60%. A system is now being created in Japan whereby the guidelines regarding cancer screening will continue to be updated. The preliminary reports concerning lung cancer screening using thoracic computed tomography revealed that not only the detection rate of lung cancer but also the survival rate of detected lung cancer patients were surprisingly high. However, the presence of some potential bias in these studies cannot be ignored; therefore, it is still unknown whether there is actual efficacy. Several randomized controlled trials are presently in progress overseas, but the interim results were not favorable. A randomized controlled trial should therefore immediately be started in Japan as well.

DOI： 10.1007/s11748-009-0448-7

PubMed

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Language：Japanese   Publishing type：Thesis (other)  

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CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2009296145

Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2009130296

Language：English   Publishing type：Research paper (scientific journal)   Publisher：TOHOKU UNIV MEDICAL PRESS  

Pure bronchioloalveolar carcinomas have no stromal, vascular or pleural invasion, and they are candidates for curative wedge resection, although standard operative procedure for lung cancer is a pulmonary lobectomy. Most lung cancers with ground glass opacity (GGO), namely faint homogeneous shadows with sharp margin, are pure bronchioloalveolar carcinomas. This report presents the results of a pilot study on wedge resection with candidate selection by high-resolution computed tomography and positron emission tomography with 18F-fluorodeoxyglucose (FDG). The criteria for wedge resection were; 1) clinically no nodal or distant metastasis, 2) the location of the tumor was peripheral enough to undergo wedge resection, 3) the diameter of the shadow was 8-20 mm, 4) GGO% (diameter of GGO area/diameter of whole tumor) was 80% or over, 5) FDG uptake of the tumor was less than that of the mediastinum, 6) the intraoperative pathological diagnosis was non-invasive bronchioloalveolar carcinoma, and 7) informed consent was obtained. Nine tumors from 8 patients were selected in the study. The maximum diameter of the tumors was 9-18 mm and GGO% was 82-100%. All of nine tumors were treated with a wedge resection under video-assisted thoracic surgery. The postoperative courses were uneventful and no recurrence has been detected after 19-50-month follow-up. The changes in pulmonary function before and after the surgery were minimal. In conclusion, wedge resections were safely performed without any recurrence, and the postoperative pulmonary function was well preserved, suggesting the advantage of wedge resections for non-invasive bronchioloalveolar carcinomas.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TOHOKU UNIV MEDICAL PRESS  

Pure bronchioloalveolar carcinomas have no stromal, vascular or pleural invasion, and they are candidates for curative wedge resection, although standard operative procedure for lung cancer is a pulmonary lobectomy. Most lung cancers with ground glass opacity (GGO), namely faint homogeneous shadows with sharp margin, are pure bronchioloalveolar carcinomas. This report presents the results of a pilot study on wedge resection with candidate selection by high-resolution computed tomography and positron emission tomography with 18F-fluorodeoxyglucose (FDG). The criteria for wedge resection were; 1) clinically no nodal or distant metastasis, 2) the location of the tumor was peripheral enough to undergo wedge resection, 3) the diameter of the shadow was 8-20 mm, 4) GGO% (diameter of GGO area/diameter of whole tumor) was 80% or over, 5) FDG uptake of the tumor was less than that of the mediastinum, 6) the intraoperative pathological diagnosis was non-invasive bronchioloalveolar carcinoma, and 7) informed consent was obtained. Nine tumors from 8 patients were selected in the study. The maximum diameter of the tumors was 9-18 mm and GGO% was 82-100%. All of nine tumors were treated with a wedge resection under video-assisted thoracic surgery. The postoperative courses were uneventful and no recurrence has been detected after 19-50-month follow-up. The changes in pulmonary function before and after the surgery were minimal. In conclusion, wedge resections were safely performed without any recurrence, and the postoperative pulmonary function was well preserved, suggesting the advantage of wedge resections for non-invasive bronchioloalveolar carcinomas.

Web of Science

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (international conference proceedings)  

Diabetic patients have a decreased incidence of acute respiratory distress syndrome, but the mechanism responsible for the decreased incidence is uncertain. Reabsorption of alveolar edema fluid (alveolar fluid clearance) has been considered to play an important role in resolution of acute respiratory distress syndrome. However, little is known regarding alveolar fluid clearance in diabetes mellitus. Since the obese Zucker rat has been used as an experimental model for diabetes mellitus, we determined if alveolar fluid clearance increased in the obese Zucker rat. First, we compared alveolar fluid clearance in obese Zucker rats with that in lean Zucker rats and Sprague-Dawley (SD) rats. Then, we determined the role of sodium channel, Na,K-ATPase, and beta(2)-adrenoceptor, which drives alveolar fluid clearance, in obese Zucker rats. Alveolar fluid clearance was estimated by the progressive increase in alveolar albumin concentrations in the isolated lungs. We found that basal alveolar fluid clearance in obese Zucker rats was two-fold greater than that in lean Zucker rats and SD rats. The mRNA expression of alpha(1)-, beta(1)-Na, K-ATPase and beta(2)-adrenoceptor, but not mRNA expression of sodium channel, increased in obese Zucker rats. A selective beta(2)-agrenergic antagonist, but not a Na, K-ATPase inhibitor, specifically inhibited the increase in alveolar fluid clearance in obese Zucker rats. These results indicate that overexpression of beta(2)-adrenoceptor primarily increases basal alveolar fluid clearance in the obese Zucker rat. We speculate that the stimulation of alveolar fluid clearance ameliorates acute respiratory distress syndrome in patients with diabetes mellitus.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.452_2

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：EUROPEAN RESPIRATORY SOC JOURNALS LTD  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER THORACIC SOC  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER THORACIC SOC  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：EUROPEAN RESPIRATORY SOC JOURNALS LTD  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：SPANDIDOS PUBL LTD  

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Language：Japanese   Publisher：(NPO)日本がん検診・診断学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER THORACIC SOC  

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