Objective We have developed a novel bronchoscopic multiple marking technique to assist resection of hardly palpable lung tumors. Because 3-dimensional virtual images were used and multiple markings ...made on the lung surface to provide “geometric” information, we termed this technique “virtual assisted lung mapping” (VAL-MAP). The safety and efficacy of VAL-MAP were evaluated. Methods Virtual bronchoscopy was used to select 2 to 4 appropriate bronchial branches for marking. Bronchoscopy was conducted with the patient under local anesthesia. A metal-tip catheter was inserted into a selected bronchus and advanced to the pleura. The location of the catheter tip was fluoroscopically confirmed, and 1 mL of indigo carmine was injected. This procedure was repeated to complete all the planned markings. Post–VAL-MAP computed tomography was used to visualize the localization of the multiple markings on 3-dimensional virtual images, which were used as references in the subsequent operation. Results Of the 95 marking attempts made for 37 tumors in 30 patients, 88 (92.6%) were identified and contributed to the surgery. No clinically evident complications were associated with the procedure. A total of 15 wedge resections and 18 segmentectomies were thoracoscopically conducted, with a successful resection rate of 100%. Multiple markings of the VAL-MAP were complementary, enabling us to achieve complete resection even when 1 of the markings failed. The markings were visible even on interlobar fissures, at the apex, and on the diaphragm, which conventional percutaneous marking can hardly reach. Conclusions VAL-MAP was safely conducted with satisfactory outcomes in our early experience. Additional confirmation of its safety and efficacy is necessary.
Objective The study objective was to examine the incidence, risk factors, and mortality rate of acute exacerbation of interstitial lung diseases in patients with lung cancer undergoing pulmonary ...resection in a large-scale multi-institutional cohort. Methods We retrospectively analyzed 1763 patients with non–small cell lung cancer who had undergone pulmonary resection and presented with a clinical diagnosis of interstitial lung diseases between January 2000 and December 2009 at 61 hospitals in Japan. The incidence and outcomes of acute exacerbation within 30 days from the operation were investigated. Univariate and multivariate logistic regression analyses were used to identify independent risk factors of acute exacerbation. Results Acute exacerbation occurred in 164 patients (9.3%; 95% confidence interval, 8.0-10.8), with a mortality rate of 43.9%, and was the top cause of 30-day mortality (71.7%). The following 7 independent risk factors of acute exacerbation were identified: surgical procedures, male sex, history of exacerbation, preoperative steroid use, serum sialylated carbohydrate antigen KL-6 levels, usual interstitial pneumonia appearance on computed tomography scan, and reduced percent predicted vital capacity. Surgical procedures showed the strongest association with acute exacerbation (using wedge resection as the reference, lobectomy or segmentectomy: odds ratio, 3.83; 95% confidence interval, 1.94-7.57; bi-lobectomy or pneumonectomy: odds ratio, 5.70; 95% confidence interval, 2.38-13.7; P < .001). The effect of perioperative prophylactics, such as steroids and sivelestat, was not confirmed in this study. Conclusions Pulmonary resection for patients with lung cancer with interstitial lung diseases may provoke acute exacerbation at a substantially high rate and has high associated mortality. Surgical procedures that proved to be a risk factor for acute exacerbation should be chosen cautiously for these high-risk patients.
Health insurance claims (ie, receipts) record patient health care treatments and expenses and, although created for the health care payment system, are potentially useful for research. Combining ...different types of receipts generated for the same patient would dramatically increase the utility of these receipts. However, technical problems, including standardization of disease names and classifications, and anonymous linkage of individual receipts, must be addressed.
In collaboration with health insurance societies, all information from receipts (inpatient, outpatient, and pharmacy) was collected. To standardize disease names and classifications, we developed a computer-aided post-entry standardization method using a disease name dictionary based on International Classification of Diseases (ICD)-10 classifications. We also developed an anonymous linkage system by using an encryption code generated from a combination of hash values and stream ciphers. Using different sets of the original data (data set 1: insurance certificate number, name, and sex; data set 2: insurance certificate number, date of birth, and relationship status), we compared the percentage of successful record matches obtained by using data set 1 to generate key codes with the percentage obtained when both data sets were used.
The dictionary's automatic conversion of disease names successfully standardized 98.1% of approximately 2 million new receipts entered into the database. The percentage of anonymous matches was higher for the combined data sets (98.0%) than for data set 1 (88.5%).
The use of standardized disease classifications and anonymous record linkage substantially contributed to the construction of a large, chronologically organized database of receipts. This database is expected to aid in epidemiologic and health services research using receipt information.
With the increased detection of early-stage lung cancer and the technical advancement of minimally invasive surgery (MIS) in the field of thoracic surgery, lung segmentectomy using MIS, including ...video- and robot-assisted thoracic surgery, has been widely adopted. However, lung segmentectomy can be technically challenging for thoracic surgeons due to (1) complex segmental and subsegmental anatomy with frequent anomalies, and (2) difficulty in localizing deep, small, and impalpable tumors, leading to difficulty in obtaining adequate margins. In this review, we summarize the published evidence and discuss key issues related to MIS segmentectomy, focusing on preoperative planning/simulation and intraoperative tumor localization. We also demonstrate two of our techniques: (1) three-dimensional computed tomography (3DCT)-based resection planning using a novel 3DCT processing software, and (2) tumor localization using a novel radiofrequency identification technology.
AADC deficiency causes severe motor and intellectual disability as a result of reduced catecholamine levels. Kojima et al. report beneficial effects of gene therapy in six patients with heterogeneous ...genetic backgrounds. Gene delivery into putamen improved motor function in all patients, plus verbal and cognitive skills in one moderate-phenotype patient.
Abstract
In patients with aromatic l-amino acid decarboxylase (AADC) deficiency, a decrease in catecholamines and serotonin levels in the brain leads to developmental delay and movement disorders. The beneficial effects of gene therapy in patients from 1 to 8 years of age with homogeneous severity of disease have been reported from Taiwan. We conducted an open-label phase 1/2 study of population including adolescent patients with different degrees of severity. Six patients were enrolled: four males (ages 4, 10, 15 and 19 years) and one female (age 12 years) with a severe phenotype who were not capable of voluntary movement or speech, and one female (age 5 years) with a moderate phenotype who could walk with support. The patients received a total of 2 × 1011 vector genomes of adeno-associated virus vector harbouring DDC via bilateral intraputaminal infusions. At up to 2 years after gene therapy, the motor function was remarkably improved in all patients. Three patients with the severe phenotype were able to stand with support, and one patient could walk with a walker, while the patient with the moderate phenotype could run and ride a bicycle. This moderate-phenotype patient also showed improvement in her mental function, being able to converse fluently and perform simple arithmetic. Dystonia disappeared and oculogyric crisis was markedly decreased in all patients. The patients exhibited transient choreic dyskinesia for a couple of months, but no adverse events caused by vector were observed. PET with 6-18Ffluoro-l-m-tyrosine, a specific tracer for AADC, showed a persistently increased uptake in the broad areas of the putamen. In our study, older patients (>8 years of age) also showed improvement, although treatment was more effective in younger patients. The genetic background of our patients was heterogeneous, and some patients suspected of having remnant enzyme activity showed better improvement than the Taiwanese patients. In addition to the alleviation of motor symptoms, the cognitive and verbal functions were improved in a patient with the moderate phenotype. The restoration of dopamine synthesis in the putamen via gene transfer provides transformative medical benefit across all patient ages, genotypes, and disease severities included in this study, with the most pronounced improvements noted in moderate patients.
10.1093/brain/awy331_video1
awy331media1
5991361892001
Purpose
Anastomotic leakage after low anterior resection for rectal cancer is a critical problem. Many risk factors have been suggested and surgical techniques have improved, but anastomotic leakage ...remains a major postoperative challenge. This study sought to create a nomogram for precise prediction of anastomotic leakage after low anterior resection for rectal cancer.
Methods
We used data of 936 patients that had been prospectively collected by the Japanese Society for Colon and Rectal Cancer between June 2010 and February 2013. Risk factors for anastomotic leakage were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots.
Results
Sex, preoperative serum albumin, tumor location and diameter, and simultaneous resection of other organs were identified as significantly associated factors that could be combined for accurate prediction of anastomotic leakage. We created a nomogram for anastomotic leakage by using these risk factors. The area under the curve was 0.72 (95% confidence interval 0.67–0.76). The nomogram had a bootstrapped-concordance index of 0.72 and was well calibrated.
Conclusions
Our nomogram was a useful tool for precise prediction of anastomotic leakage after low anterior resection for rectal cancer.
Although robotic-assisted surgery has the advantages of low patient burden and high precision without unsteady hand movements, the lack of tactile sensations may result in unexpected iatrogenic organ ...damage. The Saroa (Riverfield Inc., Tokyo, Japan) is a pneumatically driven robot that provides real-time haptic feedback to the surgeon. Using the Saroa robot, six examinees performed puffed rice transfer and four of them performed pig lung resection tasks with the feedback function turned on and off. The puffed rice transfer task consisted of transferring 20 grains of puffed rice from the left to the right compartment in the training box. The mean grasping forces during the puffed rice transfer task with the haptic feedback function turned off and on were 2.14 N and 0.63 N, respectively (P = 0.003). The mean grasping forces during the pig lung resection task were lower with the feedback turned on than turned off. The force that the forceps exerted on the grasping object was weaker in both tasks when the haptic feedback function was turned on, suggesting that the feedback function allows gentler handling of tissues, improving patient safety during robotic surgery.
Purpose
Capecitabine-based adjuvant chemotherapy for colorectal cancer patients often causes adverse events (AEs), such as diarrhea, stomatitis, anorexia, and hand-foot syndrome (HFS). Cystine and ...theanine were reported to attenuate some chemotherapy-associated AEs, and hence are also expected to attenuate capecitabine-induced AEs. Therefore, we aimed to investigate the safety and efficacy of cystine/theanine treatment in colorectal cancer patients undergoing capecitabine-based adjuvant chemotherapy after surgery.
Methods
A total of 100 colorectal cancer patients treated with capecitabine as an adjuvant chemotherapy after surgery were randomly allocated into the cystine/theanine group (
n
= 52) or the placebo group (
n
= 48). The primary endpoint was incidence rate of diarrhea of grade 1 or higher in accordance with the Common Terminology Criteria for AEs (CTCAE) v.4.0, Japanese Clinical Oncology Group (JCOG) version. The secondary endpoints included incidence rates of other AEs (CTCAE v.4.0-JCOG), as well as the incidence rate of HFS according to the HFS grading scale.
Results
There were no significant differences in capecitabine-induced AEs between the two groups. However, the incidence rate of diarrhea of grade 1 or higher tended to be lower in the cystine/theanine group than the placebo group (18.4% vs. 28.9%,
p
= 0.169) as well as the incidence rate of HFS of grade 1 or higher (CTCAE v.4.0-JCOG or HFS grading scale) (67.4% vs. 77.8%,
p
= 0.185, 67.3% vs. 80.0%,
p
= 0.124, respectively).
Conclusion
This trial demonstrated that cystine/theanine treatment of colorectal cancer patients undergoing capecitabine-based adjuvant chemotherapy after surgery is safe and has the tendency to reduce the incidence rate of diarrhea or HFS.
Trial registration
UMIN000024784
Abstract
Introduction
Sleep loss can cause various kinds of behavioral and psychological problems. It has been reported that sleep loss may even influence academic performance. To examine the ...relationship between nighttime sleep and academic performance, we conducted a questionnaire study targeting university students majoring in social sciences.
Methods
To recruit undergraduates for participation, we selected a few psychology-related classes at a university in Nagano Prefecture, Japan, and went to the classroom to ask the students to respond to a questionnaire that dealt with nighttime sleep and grade point average (GPA) as a measure of their academic performance. We approached 116 students, of whom 109 consented to participate and completed the questionnaire. The mean age of the final sample was 20.11 years old.
Results
The participants were divided into six groups: three groups based on grade and two based on sex. A two-factor analysis of variance (ANOVA) indicated that students with worse grades reported significantly shorter sleep durations than those with intermediate and better grades. It is also suggested that the male students with better grades tended to report delayed sleep schedules, that is, a later bedtime and waking time, compared to the two other male groups, while the females with better grades did not.
Conclusion
The finding strongly suggests that sleep duration may affect the academic performance of undergraduates. Sufficient sleep may result in a better academic performance and might improve the quality of our lives. In this regard, the results may be consistent with a previous study targeted high school students (Wolfson & Carskadon, 1998). In sleep hygiene education, the students should be taught to have enough sleep in every night. In addition, the finding also suggets that the Japanese male students with better grades may have a tendency to stay up late to study more, while the female with better grades may not.
Support (if any)
Purpose To clarify the three-dimensional nature of foot mobility and its interrelationships within the foot due to bodyweight bearing. Participants and Methods Data regarding left foot mobility due ...to body weight bearing were collected from 31 healthy adults. Foot shape differences while sitting and standing, and their interrelationship were examined. The same examiner reapplied the landmark stickers when misaligned during measurement position changes. Results The foot length, heel width, forefoot width, hallux valgus angle, and calcaneus eversion angle were significantly larger in the standing than in sitting position. The digitus minimus varus angle was significantly smaller in the standing than in sitting position. The medial and lateral malleoli, navicular, and dorsum of the foot were displaced medially and inferiorly; the other indices, except for the midfoot, were displaced anteriorly. The interrelationships within the foot showed a positive correlation between the calcaneus eversion angle and the medial displacement of the medial and lateral malleoli, navicular, and dorsum of the foot points. There was a negative correlation between the calcaneus eversion angle and inferior displacement of the medial malleolus, navicular, and dorsum of the foot. Conclusion The intra-foot coordination relationship in response to bodyweight bearing was clarified.
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