Soon after the 2011 Tohoku-oki event, approximately 1300 tsunami deposit thickness data were collected spatially by the governors to cover the entire tsunami affected area (Sendai Plain) along the ...Sendai Bay coastline. This dataset, along with high-resolution and high-precision data of flow depth and pre-tsunami and post-tsunami elevation, enables us first to conduct a direct comparison of the sedimentation and erosion volumes as well as the tsunami hydrodynamic features (e.g., flow depth) and sediment thickness. The total balance of sedimentation and erosion volumes revealed that the volume of tsunami-deposited sediments can be explained roughly using the erosion volumes at the beach and sand dunes for sandy deposits and at rice paddy fields for muddy deposits. Both the flow depth and sediment thickness showed positive correlations with the distance from the shoreline while sediment thickness is no correlation to the elevation except in the zone closest to the shoreline where erosion is present. In addition, a statistical relation was found between the flow depth and sediment thickness. In fact, the frequency distribution of sediment concentration, defined here as the sediment thickness divided by the maximum flow depth at each survey site, fits well with the logarithmic normal distribution with geometric average of about 2%. This fit indicates that the tsunami deposits on the Sendai Plain can be explained generally if we simply assume that the saturated level of the sediment concentration in the flow is limited to about 2% on average, irrespective of the grain size. Such a simple explanation might be applicable only for the tsunami deposits on the Sendai Plain because the topography is remarkably flat and low. Therefore, the tsunami inundation process is relatively simple. Nevertheless, a possible relation between tsunami flow depth and sediment thickness suggested here would be very useful to consider the ideal sedimentary process of the tsunami deposits and to improve forward and inverse modelings.
•About 1300 thickness data for the Sendai Plain were collected by governors.•Volumes of tsunami deposits and erosion are of comparable order.•Sediment thickness shows correlation with distance from the shoreline.•The saturated level of the sediment concentration was limited: about 2%.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The critical roles of heat shock protein 90 (HSP90) in immune reactions associated with viral infection and autoimmune disease are well known. To date, however, its roles in the alloimmune response ...and the immunosuppressive effect of HSP90 inhibitors in allotransplantation have remained unknown. The purpose of this study was to examine the therapeutic efficacy of the HSP90 inhibitor 17-DMAG in allotransplantation models. C57BL/6 (H-2b) and BALB/c (H-2d) mice were used as donors for and recipients of skin and heart transplantation, respectively. Treatment with 17-DMAG (daily i.p.) or a vehicle was initiated 3 days before transplantation. Immunological outcomes were assessed by histopathological examinations, flow cytometric analysis, quantitative RT-PCR, ELISA, ELISPOT assay, and MLR. 17-DMAG treatment significantly prolonged the survival of both skin and heart allografts. In 17-DMAG-treated mice, donor-reactive splenocytes producing IFN-γ were significantly reduced along with the intragraft mRNA expression level and serum concentration of IFN-γ. Intragraft mRNA expression of cytokines and chemokines associated with both innate and adaptive immunity was suppressed in 17-DMAGtreated group. MLR showed suppression of the donor-specific proliferation of CD4 + T and CD19 + B cells in the spleens of 17-DMAG-treated mice. 17-DMAG treatment also reduced the number of activated NK cells. Furthermore, the treatment lowered the titers of donor-specific antibodies in the serum and prolonged a second skin allograft in mice sensitized by previous skin transplantation. HSP90 inhibition by 17-DMAG can affect various immune responses, including innate immunity, adaptive immunity, and humoral immunity, suggesting its therapeutic potential against acute rejection in allotransplantation.
Purpose
Postoperative complications have a significant impact on perioperative outcomes; however, their association with the long-term prognosis remains unclear. We evaluated the impact of ...postoperative complications on the long-term outcomes after curative surgery in lung cancer patients.
Methods
This study included 1129 patients with primary lung cancer who underwent lobectomy between April 2011 and March 2017. Univariate and multivariate analyses were performed to assess the association of postoperative complications with the overall and recurrence-free survival.
Results
Postoperative complications were observed in 147 (13.0%) patients over a median follow-up period of 5-years. Compared to patients without complications, those with complications showed had worse long-term outcomes, including the 5-year overall survival (75.3% vs. 86.1%,
p
< 0.001) and 5-year recurrence-free survival (64.2% vs. 74.4%,
p
= 0.004). A multivariate analysis revealed that the incidence of postoperative complications was significantly associated with the overall survival (hazard ratio = 1.665,
p
= 0.006) and recurrence-free survival (hazard ratio = 1.416,
p
= 0.025) in all patients. The prognostic influence was greater in patients with pathological stages II and III cancer (overall survival: hazard ratio = 2.019,
p
= 0.005; recurrence-free survival: hazard ratio = 1.90,
p
= 0.001) than in those with pathological stage I cancer.
Conclusion
Postoperative complications are independent predictors of the overall and recurrence-free survival in lung cancer patients, especially advanced-stage cancer patients.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We describe the case of a patient who underwent tracheal resection for post-tracheostomy stenosis following T-tube stenting for 10 years. A 32-year-old female patient with a T-tube in the trachea was ...referred to us. She had brain surgery for intracranial hemorrhage 10 years ago and developed a post-tracheostomy tracheal stenosis, for which she had been treated with a T-tube. At the time of referral, she was ambulatory with a cane and otherwise independent in her daily life. We assessed her stenosis and determined that it was amenable to tracheal resection as a definitive treatment. We resected the tracheal stenosis including the stoma site and performed an end-to-end tracheal anastomosis. The anastomosis was widely patent at 6 months follow-up. Long-term treatment of tracheal stenosis with T-tube does not preclude tracheal resection as a definitive treatment. A careful review of airway stenosis for resectability on a case-by-case basis is imperative.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objectives
To clarify the incidence of postoperative hydronephrosis and verify the validity of diagnostic and therapeutic approaches for hydronephrosis after cystectomy and urinary diversion for ...bladder cancer.
Methods
Totally, 290 patients receiving urinary diversion from 2005 through 2017 with complete data were enrolled, including 258 (89.0%) with an ileal conduit and 32 (11.0%) with an ileal neobladder. Postoperative radiographic images were reviewed. In patients with postoperative hydronephrosis, antegrade pyelography and ureteroscopy were performed to exclude malignant etiology. Balloon dilation and open surgical revision were performed according to the conditions.
Results
Forty‐six patients (58 renal units) developed postoperative hydronephrosis. The cumulative incidence was 11.4% by a median follow‐up of 59.5 months. Ureteral recurrence was detected by antegrade examinations in two patients, whereas malignant strictures were subsequently revealed in three patients. Thus, malignant etiology was found in hydronephrosis in five renal units (12.8%) of five patients (16.1%). The median times to diagnosis of hydronephrosis were 0 (interquartile range IQR 0–4) and 14 months (IQR 9–12) for benign and malignant strictures, respectively (p = 0.003). Of them, 31 patients (39 renal units) received interventions. Balloon dilation was performed in 13 renal units with benign strictures, and was successful in two (15.4%). Open surgical revision was performed in eight patients (11 renal units), including two with failed balloon dilation, all of which was successful.
Conclusions
Postoperative hydronephrosis is potentially associated with recurrent disease. Accurate differential diagnosis is challenging although antegrade procedures may be helpful in some cases. Open surgical revision is highly effective to treat benign strictures.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Background and purpose: Several recent randomized controlled trials
(RCTs) in non-metastatic castration resistant prostate cancer
(nmCRPC) have demonstrated a significant improvement in ...metastasis-free survival
(MFS); however, an improvement in overall survival (OS) is not
reported yet. Since the surrogacy of MFS to OS has not been formally investigated in nmCRPC in
Japan, this study evaluated the correlation between MFS and OS among a nmCRPC population in
Japan.
Methods: This is a retrospective longitudinal observational cohort study in
patients with nmCRPC using the Japanese Medical Data Vision (MDV) database
covering over 20 million patients. A total of 1236 patients with CRPC who had no prior medical
history of cancer except prostate cancer and no distant metastasis, and who fulfilled PCWG2
criteria, were identified. Following the identification of nmCRPC, patients' medical
records were investigated for subsequent events of metastasis and death.
Results: The median follow-up time was 24 months. Median MFS was
28 months (95% CI: 24.0 to 33.0 months) and median OS could
not be estimated (95% CI: not estimated). There was a statistically
significant correlation between MFS and OS (Pearson's correlation
coefficient = 0.62; 95% CI: 0.58-0.65;
p < .0001, Spearman's correlation
coefficient = 0.62; 95% CI: 0.58-0.65;
p < .0001 and Kendall's τ
statistic = 0.53; 95% CI: 0.49-0.56;
p < .0001).
Conclusions: The results of this study indicate a significant correlation
between MFS and OS. It may justify the usefulness of MFS as surrogate for OS in nmCRPC.
Trial registration:
ClinicalTrials.gov identifier: NCT01946204.
Trial registration:
ClinicalTrials.gov identifier: NCT02200614.
Purpose
Most robot-assisted thoracoscopic surgery (RATS) is performed from the vertical view. This study evaluates the initial outcomes of our novel confronting RATS technique, in which the patient ...was viewed horizontally, as in open thoracotomy.
Methods
We reviewed data on patients who underwent thoracoscopic lobectomy between January, 2019 and April, 2022. Perioperative outcomes were compared between RATS and video-assisted thoracoscopic surgery (VATS), using propensity-score matching.
Results
RATS and VATS were performed for 83 and 571 patients, respectively. After propensity-score matching, data on 81 patients from each of the two groups were retrieved. The operative time was significantly longer for RATS than for VATS (199 ± 44 min vs. 173 ± 37 min,
p
< 0.001). There was no mortality or conversion to thoracotomy in either of the groups. The rates of overall complications and prolonged air leak did not differ significantly between the groups. The serum creatine phosphokinase level on postoperative day 4 was higher after RATS than after VATS. The number of resected lymph nodes and the rates of nodal upstaging did not differ significantly between the groups.
Conclusion
The initial perioperative outcomes of RATS using the confronting settings were comparable to those of VATS.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Smoking has a major role in the risk of postoperative pulmonary complications. This study aimed to elucidate the correlation between smoking status and pulmonary complications after thoracoscopic ...surgery for lung cancer.
A total of 1751 patients who underwent thoracoscopic lobectomy or segmentectomy for lung cancer between April 2011 and March 2020 were assessed. The rate of pulmonary complications was evaluated according to smoking status and preoperative duration of smoking cessation. Univariate and multivariate logistic regression analyses were performed.
Pulmonary complications were observed in 50 patients (2.9%), whereas 3 (0.2%) died within 90 days of surgery. The rate of pulmonary complications was higher in smokers than in nonsmokers (4.6% vs 0.9%; P < .001), and smoking history was an independent risk factor for pulmonary complications (odds ratio, 3.31; P = .007). The complication rate in patients with a cessation period of more than 2 months was significantly lower than that in patients who ceased smoking within 2 months (4.0% vs 8.5%; P = .043), but it was still higher than that in nonsmokers (4.0% vs 0.9%; P < .001). In the multivariable analysis for smokers, preoperative short-term smoking cessation within 2 months, male sex, histologic type, tumor size, and cardiopulmonary comorbidities were associated with pulmonary complications instead of pack-year smoking history.
Smoking habits and preoperative smoking cessation were independently associated with pulmonary complications after thoracoscopic surgery for lung cancer. A preoperative smoking cessation period of 2 months or more is preferable for reducing the risk of such complications.
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Objectives
To determine risk factors influencing the incidence of parastomal hernia (PH) associated with ileal conduit (IC).
Methods
A total of 194 Japanese patients who underwent IC diversion ...followed by regular postoperative radiographic follow-up from 2005 through 2016 were enrolled. The diagnosis of PH was determined by computed tomography (CT) for patients with and without related symptoms. The cumulative incidence of PH was assessed by the Kaplan–Meier method. The log-rank test and a multivariate Cox proportional hazards model were used to evaluate risk factors associated with the incidence of PH.
Results
PH was observed in 20 patients (10.3%) after a median follow-up of 25.5 months. Of the 20 patients, three were symptomatic. The cumulative incidences were 3.6%, 10.1% and 15.1% at 1, 2 and 5 years after operation, respectively. The median body mass index (BMI) was 23.1 kg/m
2
(IQR 20.4–24.6). The BMI and diameter of the passage through the rectus abdominis muscle for the IC (DPRAM) were significant predictors for PH (
p
= 0.04 and
p
< 0.001, respectively). In proportional hazards regression analysis, DPRAM ≥ 2.4 cm was the only independent risk factor for developing PH (HR 10.94, 95% CI 3.66–32.64).
Conclusions
The incidence of PH in the current Japanese series was relatively low. Even in the population with low BMI, higher BMI might have an impact on incidence of PH. Moreover, DPRAM was also significantly associated with the incidence, suggesting that the operative procedure for creation of the passage is critical for future development of PH.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Postoperative pneumatocele is a rare complication of lung surgery. Here we describe 2 cases of pneumatoceles arising from the unaltered bottom part of the lower lobe a month or more after upper ...lobectomy. Based on histopathologic findings, we speculated that (1) negative pressure created by the volumetric gap between the thoracic cavity and the remnant lung and (2) increased positive pressure by the check valve mechanism from kinking or flexion of the airway after an upward movement of the remnant lung play crucial roles in the pathogenesis of postoperative pneumatoceles.
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