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BackgroundLung transplantation is the final option for end-stage respiratory diseases. Postoperative monitoring of patients’ physical condition and performance of appropriate interventions for any abnormalities are important to improve the long-term success of lung transplantation. In Japan, patients’ handwritten self-management charts are widely used to record data for home spirometry, vital signs, and medication dosages. However, handwritten data are not suitable for assessment. We developed an internet-based real-time monitoring system (LT-FollowUp) that can easily assess patient data and detect any abnormalities that arise without delay. The aim of this pilot study was to examine the acceptability of LT-FollowUp to patients.MethodsThis was a prospective single-arm pilot cohort study. Lung transplant patients were recruited consecutively at regular outpatient visits from October 2020. Patients were instructed to enter their self-measurements (pulmonary functions and vital signs) and immunosuppressant dosages twice a day.Acceptability was assessed by the data filling rate. The changes in filling rate over time were evaluated using a linear mixed-effects model for repeated measurements.ResultsA total of 19 patients were included in the study. There were no significant differences in the filling rates between the handwritten charts and LT-FollowUp.ConclusionLT-FollowUp is an acceptable system for patients. Further development of the LT-FollowUp system may lead to better long-term clinical outcomes of lung transplantation.

Background Redundant publication of systematic reviews and meta-analyses (SRs/MAs) on the same topic presents an increasing burden for clinicians. The aim of this study was to describe variabilities in effect size and methodological quality of overlapping surgery-related SRs/MAs and to investigate factors associated with their postpublication citations. Methods PubMed/MEDLINE was searched to identify SRs/MAs of RCTs on thoracoabdominal surgeries published in 2015. Previous SRs/MAs on the same topics published within the preceding 5 years (2011–2015) were identified and 5-year citation counts (through to 2020) were evaluated. Discrepancies in pooled effect sizes and their methodological quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) among overlapping SRs/MAs were assessed. The SR/MA-level factors associated with 5-year citation counts were explored, using a mixed-effects regression model with a random intercept for surgical topics. Results A total of 57 surgery-related SRs/MAs (48 topics) published in 2015 were identified, and 146 SRs/MAs had overlapping publications on 29 topics (60.4 per cent of all topics) in the preceding 5 years. There was considerable variability in methodological quality of SRs/MAs and coverage probability for relevant RCTs, resulting in discrepant effect size estimates for the same topic. High quality (AMSTAR score 8–11) was independently associated with higher 5-year citation counts (coefficient = 32.82; 95 per cent c.i. 15.63 to 50.02; P Conclusion Overlapping SRs/MAs with high variability in results and methodological quality were common in surgery. A high-quality SR/MA score was an independent predictor of more frequent citations. Researchers and journal editors should concentrate their efforts on limiting publications to higher-quality reviews.

OBJECTIVES The short-term efficacy of virtual-assisted lung mapping (VAL-MAP), a preoperative bronchoscopic multi-spot lung-marking technique, has been confirmed in 2 prospective multicentre studies. The objectives of this study were to analyse the local recurrence and survival of patients enrolled in these studies, long-term. METHODS Of the 663 patients enrolled in the 2 studies, 559 patients’ follow-up data were collected. After excluding those who did not undergo VAL-MAP, whose resection was not for curative intent, who underwent concurrent resection without VAL-MAP, or who eventually underwent lobectomy instead of sublobar resection (i.e. wedge resection or segmentectomy), 422 patients were further analysed. RESULTS Among 264 patients with primary lung cancer, the 5-year local recurrence-free rate was 98.4%, and the 5-year overall survival (OS) rate was 94.5%. Limited to stage IA2 or less (≤2 cm in diameter; n = 238, 90.1%), the 5-year local recurrence-free and OS rates were 98.7% and 94.8%, respectively. Among 102 patients with metastatic lung tumours, the 5-year local recurrence-free rate was 93.8% and the 5-year OS rate was 81.8%. Limited to the most common (colorectal) cancer (n = 53), the 5-year local recurrence-free and OS rates were 94.9% and 82.3%, respectively. CONCLUSIONS VAL-MAP, which is beneficial in localizing small barely palpable pulmonary lesions and determining the appropriate resection lines, was associated with reasonable long-term outcomes. Subj collection 152, 1542

OBJECTIVES The availability of new techniques may affect surgeons’ procedure selection and thereby affect clinical outcomes. This study aimed to evaluate the effect of the availability of virtual-assisted lung mapping (VAL-MAP) on the selection of lung resection methods. METHODS Members of the Japanese Association for Chest Surgeons were invited to participate in a web-based survey. Participants were divided into those who had never used VAL-MAP (group 0), those who had used only VAL-MAP 1.0 (multiple dye marks on the pleural surface; group 1) and those who had used VAL-MAP 2.0 (multiple dye marks and intrabronchial microcoils for three-dimensional mapping; group 2). Participants were shown chest computed tomography images of 6 ground-glass opacity nodules and asked to choose surgical procedures to resect the nodules with sufficient resection margins greater than the lesion diameter or 2 cm. RESULTS There were 197 surgeons in group 0, 49 in group 1 and 26 in group 2. All groups showed a similar trend of avoiding wedge resection for deeply located nodules. However, group 1 showed a trend of disagreeing with the selection of wedge resection compared with group 0 as measured by a Likert scale (1–5) by −0.21 points (95% confidence interval, −0.41 to −0.008 points, P = 0.042). This tendency disappeared in group 2. CONCLUSIONS The availability of VAL-MAP 1.0 led to the selection of segmentectomy, while the availability of VAL-MAP 2.0 led to aggressive deep wedge resection.

BACKGROUND The number of mobile health (mHealth) apps continues to rise each year. Widespread use of the Mobile App Rating Scale (MARS) has allowed objective and multidimensional evaluation of the quality of these apps. However, no Japanese version of MARS has been made available to date. OBJECTIVE The purposes of this study were (1) to develop a Japanese version of MARS and (2) to assess the translated version’s reliability and validity in evaluating mHealth apps. METHODS To develop the Japanese version of MARS, cross-cultural adaptation was used using a universalist approach. A total of 50 mental health apps were evaluated by 2 independent raters. Internal consistency and interrater reliability were then calculated. Convergent and divergent validity were assessed using multitrait scaling analysis and concurrent validity. RESULTS After cross-cultural adaptation, all 23 items from the original MARS were included in the Japanese version. Following translation, back-translation, and review by the author of the original MARS, a Japanese version of MARS was finalized. Internal consistency was acceptable by all subscales of objective and subjective quality (Cronbach α=.78-.89). Interrater reliability was deemed acceptable, with the intraclass correlation coefficient (ICC) ranging from 0.61 to 0.79 for all subscales, except for “functionality,” which had an ICC of 0.40. Convergent/divergent validity and concurrent validity were also considered acceptable. The rate of missing responses was high in several items in the “information” subscale. CONCLUSIONS A Japanese version of MARS was developed and shown to be reliable and valid to a degree that was comparable to the original MARS. This Japanese version of MARS can be used as a standard to evaluate the quality and credibility of mHealth apps.

Although the global market of Mobile Health Apps (mHealth apps) continues to grow dramatically, most mHealth apps still not only lack evidence base but have even not been evaluated for the basic usability or functionality. The User Version of the Mobile App Rating Scale (uMARS) was developed to allow end users to assess mHealth apps objectively and subjectively. However, there is no Japanese version of uMARS to date.The purpose of this study is (1) to develop a validated Japanese version of uMARS and (2) to assess the translated version's reliability and validity in evaluating mHealth apps.The original uMARS was adapted for Japanese use by four specialists using universalist cross-cultural methods. Translation/back-translation was reviewed by the author of the original version of uMARS, and confirmed. Its reliability and validity were further evaluated as part of a prospective cohort study of postoperative patients using a new mHealth app.Conceptual equivalence was analyzed and all items in all subcategories of the original uMARS were included in the Japanese version. Internal consistency was deemed acceptable for all subscales of objective and subjective quality with a Cronbach's alpha of 0.75-0.85. Test-retest reliability of all subscales was also acceptable with intraclass correlation coefficients (ICCs) of 0.57-0.88. Convergent/divergent validity and concurrent validity were also considered acceptable.A Japanese version of uMARS was cross-culturally validated and found to be as reliable as the original uMARS. This Japanese version of uMARS is expected to become a standard tool in assessing the quality of mHealth apps in Japan.

IntroductionWe are witnessing an explosive increase in redundant and overlapping publications of systematic reviews and meta-analyses (SRs/MAs) on the same topic, which often present conflicting results and interpretations, in the current medical literature. They represent wasted efforts on the part of investigators and peer reviewers and may confuse and possibly mislead clinicians and policymakers. Here, we present a protocol for a meta-epidemiological investigation to describe how often there are overlapping SRs/MAs on the same topic, to assess the quality of these multiple publications, and to investigate the causes of discrepant results between multiple SRs/MAs in the field of major surgery.Methods and analysisWe will use MEDLINE/PubMed to identify all SRs/MAs of randomised controlled trials (RCTs) published in 2015 regarding major surgical interventions. After identifying the ‘benchmark’ SRs/MAs published in 2015, a process of screening in MEDLINE will be carried out to identify the previous SRs/MAs of RCTs on the same topic that were published within 5 years of the ‘benchmark’ SRs/MAs. We will tabulate the number of previous SRs/MAs on the same topic of RCTs, and then describe their variations in numbers of RCTs included, sample sizes, effect size estimates and other characteristics. We will also assess the differences in quality of each SR/MA using A Measurement Tool to Assess Systematic Reviews (AMSTAR) score. Finally, we will investigate the potential reasons to explain the discrepant results between multiple SRs/MAs.Ethics and disseminationNo formal ethical approval and informed consent are required because this study will not collect primary individual data. The intended audiences of the findings include clinicians, healthcare researchers and policymakers. We will publish our findings as a scientific report in a peer-reviewed journal.Trial registration numberIn PROSPERO CRD42017059077, March 2017.

Background The management of pediatric laryngotracheal stenosis (LTS) can be challenging, and laryngotracheal reconstruction (LTR) with cartilage interposition grafting remains the mainstay of surgical treatment for pediatric LTS in most experienced centers. The purpose of this study was to report the results of this procedure in a center where primary cricotracheal resection is frequently performed. Methods A retrospective chart review was performed on 45 patients who underwent LTR in our hospital between October 1997 and July 2012. Demographic characteristics and information on the preoperative status, stenosis, and operation were collected. Primary outcomes were measured as overall (ODR) and operation-specific (OSDR) decannulation rates and secondary outcomes as morbidity, mortality, and postoperative functional results. Results ODR and OSDR were 86.7% (39/45) and 66.7% (30/45), respectively. Re-stenosis was observed in 11/45 (24%) patients, all of whom were endoscopically or surgically treated. Revision surgery was performed in 10 patients, 6 for re-stenosis and 2 for peristomial tracheomalacia. Two children died of mucous obstruction of tracheostomy tube at 3 and 6 months postoperatively (4.4%). Respiratory, voice, and swallowing functions were excellent or good in 86, 75, and 84% of patients, respectively. Conclusions LTR for pediatric LTS has high decannulation rates with acceptable morbidity and mortality in selected patients. Most LTR procedures were double-stage for lower grade subglottic stenoses associated with glottic involvement that required stenting. Careful preoperative evaluation and adequate surgical indications are extremely important to achieve high decannulation rates.

OBJECTIVES: Partial cricotracheal resection (PCTR) is widely accepted for treating severe paediatric laryngotracheal stenosis (LTS). However, it remains limited to a few experienced centres. Here we report an update of the Lausanne experience in paediatric PCTR performed or supervised by a senior surgeon (Philippe Monnier). METHODS: An ongoing database of 129 paediatric patients who underwent PCTR for benign LTS between March 1978 and July 2012 at our hospital was retrospectively reviewed. Demographic characteristics and information on preoperative status, stenosis and surgery were collected. Primary outcomes were measured as overall and operation-specific decannulation rates (ODR and OSDR, respectively), and secondary outcomes as morbidity, mortality and postoperative functional results. RESULTS: A total of 129 paediatric patients [79 males and 50 females; mean age, 4.1 years (1 month-16 years, median age of 2 years old)] underwent PCTR during the study period. ODR and OSDR were 90 and 81%, respectively. The decannulation rates were significantly superior for single-stage PCTR compared with double-stage PCTR in both ODR and OSDR. Eight patients died postoperatively for reasons unrelated to surgery. Partial anastomotic dehiscence was seen in 13 patients, 9 of whom were successfully treated by revision surgery. Respiratory, voice and swallowing functions were near normal or only minimally impaired in 86, 65 and 81% of patients, respectively. CONCLUSIONS: PCTR is effective and feasible with good ODR and OSDR for highgrade / severe LTS. Glottic involvement and the presence of comorbidities were negative predictive factors of decannulation. Early detection and reintervention of postoperative incipient dehiscence contribute to avoiding the progress to late restenosis; however, voice improvement remains a challenge.

SUMMARY No conservative treatments for chylothorax have yet been established, and surgical ligation of the thoracic duct is required in many cases. In the present study, we investigated the management of body fluid in a canine chylothorax model. Twelve beagle dogs were divided evenly into three groups: A, B, and C. Under general anesthesia, the thoracic duct was cut and opened, and the amount of lymph fluid leakage was measured. Intravenous extracellular fluid infusion was started at 5 mL/kg/h for the first 2 h, and then between 2 and 4 h, the infusion rate was increased to 10 mL/kg/h in group A and to 20 mL/kg/h in group B. During the first 2 h after cutting the thoracic duct, the mean lymph fluid leakage rates in groups A, B, and C were 0.466, 0.635, and 0.575 mL/kg/h, respectively. The rates of leakage did not differ significantly among the groups. Between 2 and 4 h, the mean rates of leakage were 0.750, 1.43, and 0.544 mL/kg/h, respectively, being significantly higher in groups A and B than in group C. The amount of lymph fluid ascending the thoracic duct correlates with the amount of intravenous fluid infusion. For the management of chylothorax, it is important to avoid fluid overload.

Background Treatment for adult subglottic stenosis is technically demanding and no therapeutic algorithm exists. We performed the present meta-analysis of treatment for this condition in an attempt to compare efficacy on the basis of type of procedure. Methods We identified 24 eligible retrospective studies reporting the therapeutic results for inclusion criteria. Meta-analysis was performed by combining the results of the reported success rates; success is defined as a condition requiring no further treatment. The relative risk was used as a summary statistic. Results Pooled success rates of laryngotracheal resection and anastomosis (12 articles) and laryngoplasty with or without grafting (7 articles) were 95% and 76%, respectively, using a random-effects model. Success rates of endoscopic dilatation and laser resection (6 articles) varied between 40% and 82%. Meta-regression analysis showed a significant difference in the success rates between laryngotracheal reconstruction and laryngoplasty and between laryngotracheal reconstruction and an endoscopic procedure. When the indication for endoscopic management was a lesion size less than 1 cm, the results were significantly better. Conclusions The success rate of laryngotracheal reconstruction is significantly higher than that of laryngoplasty or endoscopic intervention; however, endoscopic intervention is worth trying for lesions smaller than 1 cm without framework destruction.

Intralesional or systemic steroid administration is a promising strategy for the prevention of esophageal stricture after endoscopic therapy. The aim of this study was to evaluate the influence of steroid therapy on the process of healing of defects in the esophageal mucosa after endoscopic mucosal resection (EMR).Nine beagle dogs were divided into three equal groups: group A, intralesional injection (n = 3), group B, peroral administration (n = 3), and group C, untreated control (n = 3). In group A, triamcinolone acetonide 1 ml (10 mg) was injected directly into the exposed submucosal layer immediately after EMR, and again on postoperative day (POD) 7. In group B, dogs were administered prednisolone 0.5 mg/kg/day orally for 14 days after EMR. In group C, 1 ml normal saline was injected by the same method as that used for group A. On POD 28, histological examination was performed to evaluate epithelialization, inflammation, angiogenesis, and atrophy of the muscularis propria.In groups A, B, and C, the mean ulcer area was 50.1, 22.7, and 7.4 mm(2), respectively. The difference between groups A and C was significant (p 0.01). Inflammatory cells were significantly more evident in the lesions of group A than in those of group C (p 0.05). In all groups, atrophy of the muscularis propria was evident. However, transmural destruction and fibrosis were observed only in group A.It was speculated that the esophageal ulcer causes the fibrosis of the submucosa and atrophy of the muscularis propria during process of healing. Intralesional steroid injection deepened the esophageal ulcers and delayed epithelialization, whereas systemic administration did not clearly improve the lesion healing process.

当院では，治療に難渋することが多い声門下狭窄に対して積極的に外科的治療を行い良好な成績を認めている．本論文では，狭窄の部位・性質により異なる術式を要した声門下狭窄3症例を報告する．症例1：19歳女性．外傷性気管断裂術後吻合部狭窄に対し，喉頭截開術を用いた喉頭気管吻合施行．術後5ヵ月間Tチューブを留置後抜去した．症例2：52歳女性．挿管後声門下狭窄に対し，輪状軟骨亜全摘・喉頭気管吻合を施行．声門上浮腫のため術後気管切開を要したが，半年後に抜去・気管口閉鎖した．症例3：63歳男性．気管切開後声門下狭窄に対し，輪状軟骨弓切除・喉頭気管吻合施行．術後問題なく経過．まとめ：声門下狭窄に対する外科的療法は病変の部位により術式選択が異なり経験を要するが適切に対処されれば有効であると考えられた．

This report presents a case of bilateral multiple sclerosing hemangiomas of the lung in a 73-year-old woman. A computed tomography (CT) scan of the chest showed a total of three well-defined small nodules in the right and left lower lobes of the lung. Because malignant metastatic lung tumors were highly suspected, a wedge resection of the left lower lobe was performed to obtain a definitive diagnosis. Histopathologically, two tumors of the left lower lobe were composed of epithelial-like cuboidal cells covering the surface of papillary protrusions and sheets of round to polygonal cells underneath the epithelial-like cells. The final diagnosis was that both tumors were sclerosing hemangiomas. After surgery the residual lesion of the right lower lobe was carefully followed by chest CT. The size of the right lung nodule did not change over the course of 9 years, and no new lesion has emerged.

Background We developed a novel technique for carinal reconstruction, one of the most challenging procedures and associated with high morbidity and mortality. Here, we review the results of a surgical study utilizing our technique. Methods Between 1989 and 1999, we performed carinal resection and reconstruction on 14 patients using a technique we developed originally. With this method, two thirds of the circumference of the trachea and the left main bronchus are anastomosed first. After one ring of cartilage is trimmed from the remaining one third of the circumference, the right bronchus is anastomosed end to side to this trimmed site. Results Carinal resection plus right upper lobectomy was performed in 12 patients and carinal resection plus right upper-middle bilobectomy was performed in 2 patients. Superior vena cava resection was combined in 4 patients. One patient (7.1%) died postoperatively of dehiscence and bronchoarterial fistula. Major anastomotic complications occurred in 4 patients (dehiscence in 1 and stenosis in 3 [28.5%]). One of three stenoses resolved with ballooning, and this patient survived 5 years; however, the remaining 2 patients died of respiratory problems caused by stenosis. Early and late anastomosis-related death occurred in 3 patients (21%). Overall survival was 57.1% at 2 years and 28.5% at 5 years. Survival was better in patients with N0 disease (n = 9) than those with N2 disease (n = 5; 44.4% versus 0% at 5 years, respectively). Conclusions Our technique for carinal reconstruction can be an alternative to other methods if patients are carefully selected. Anastomotic complications are related to high mortality. Positive N2 disease should be considered a potential contraindication to this technique.

Carinal resection is a technically demanding procedure that is associated with significant morbidity and mortality. We review our experience of carinal resection and analyze its surgical results.Between 1987 and 2004 a total of 35 patients underwent carinal resection for carcinoma involving tracheal carina. Surgical indications are primary non-small-cell lung cancer (NSCLC) in 29 patients, recurrence of NSCLC in 5, and tracheal cancer in 1. Operative procedures were divided into two groups: a reconstruction group (modified montage method in 14, one-stoma type in 2, montage type in 1); and a pneumonectomy group (tracheal sleeve in 10, wedge pneumonectomy in 8). Postoperative complications and survival of the two groups were evaluated.Three patients died postoperatively (8.5%). Major complications were noted in eight patients (22.8%), including three anastomotic stenoses, two pneumonias with respiratory failure, one dehiscence, one cardiac herniation, and one empyema. Six of these eight patients were in the reconstruction group. The overall survival was 42.5% at 2 years and 28.3% at 5 years. In patients with primary NSCLC, 7 of 16 patients with NO disease survived more than 5 years, but all 13 patients with N1 or N2 disease died within 3 years. In the pneumonectomy group, 9 of 13 patients died within 2 years.Carinal resection for tracheobronchial carcinoma is feasible with acceptable morbidity and mortality. Nodal involvement can be a potential contraindication for carinal resection. Careful selection of patients is crucial, especially when pneumonectomy is required.

Carinal reconstruction is one of the most difficult operations, and postoperative complications occur frequently. Two patients were treated surgically using this new technique. With this technique, bronchial end to side anastomosis was added to the tracheobronchial end to end anastomotic site. No postoperative complications occurred. This new technique is technically easy and causes few complications. We think this technique is superior to other methods in suitable patients.

In principle, a stabilization-splint covers the entire dental arch, and the occlusal contact should be equally distributed around the arch, but in our clinic, we sometimes make solid posterior contact at the specific area by adding self-curing resin on the occlusal surface of the splint. Since a stabilization splint that covers the entire dental arch is comparatively large, it is not easy to make equally distributed occlusal contact due to inaccurate impression, polymerization shrinkage, and technical errors on occlusal adjustment.It seems that the condyle motion in wearing an occlusal splint is a factor that infers the prognosis of temporomandibular disorders, but it is not entirely clear. When the splint does not have equally distributed occlusal contact, the temporomandibular joint may possibly have an excess load. To solve this problem, our experiment was conducted to study the displacement of the mandibular condyle during clenching, with a stabilization splint and with a device whose occlusal surface was modified.The results of the experiment were the following: When the subject clenched on the right first molar with the stabilization splint, with a 1.0-mm-thick pivot by adding self-cure resin on the occlusal surface at this area, the right mandibular condyle significantly moved latero-inferiorly. When the subject clenched on the right second molar with the stabilization splint, with a 0.5-mm-thick pivot, the right mandibular condyle significantly moved antero-superiorly. There was no significant difference except for the above two conditions.

Objective The surgical procedure for subglottic stenosis is technically challenging when the vocal cords are involved and concomitant management for glottic involvement is required. After total cricoidectomy and laryngotracheal anastomosis, T-tube placement for 3 to 6 months is recommended. Bone grafts might shorten this period. We report the histologic and endoscopic changes after total cricoidectomy with or without bone grafts in a canine model to suggest an appropriate period for T-tube placement and the necessity for bone grafts. Methods Ten dogs underwent total cricoidectomy and laryngotracheal anastomosis with or without bone grafts harvested from the ribs. Endoscopic examination was performed monthly, and 1 dog from both groups was humanely killed at 1, 2, 3, 6, and 12 months. The T-tube was removed before death in the dogs killed at 1, 2, and 3 months and at 3 and 6 months in those killed at 6 and 12 months, respectively. Results Endoscopically, the glottic opening was in good condition in all dogs, except for 1 that had glottic stenosis. Histologically, active lymphocyte infiltration was observed in dense collagen fibers at the anastomosis at 1 month. At 2 and 3 months, fibroblasts were evident, suggesting active collagen fiber production. At 6 and 12 months, the collagen fibers had become looser. The bone grafts were intact and did not influence the surrounding tissue. Conclusions In the canine model, 6 months of T-tube placement is probably sufficient; however, 3 months of placement might not be. Additionally, no difference was found between the dogs with and without a bone graft.

We present a case of subglottic stenosis involving the glottis with inflammatory destruction of the cricoid cartilage after prolonged endotracheal intubation. Total cricoidectomy and laryngotracheal anastomosis were performed with T-tube placement that was retained for five months postoperatively. After decannulation of the T-tube, the airway was well restored, with good vocal cord opening. Good respiratory and phonatory results were obtained during normal daily activity, although a slightly hoarse voice was present, but no aspiration was observed. Total cricoidectomy and laryngotracheal reconstruction may be considered suitable for subglottic stenosis with glottic involvement, if accompanied by inflammatory destruction of the cricoid cartilage.

TO THE EDITOR: An article by Kim et al 1 was recently published comparingthesurgicalandoncologicoutcomesbetweenlaparoscopic andopengastrectomyforgastriccancer.Theauthorsusedpropensity scorematchingtominimizetheselectionbiasinaretrospectivecohort of patients from multiple centers. Kim et al tried to adjust for confounding factors by using propensity score matching, and they concluded that laparoscopic gastrectomy for gastric cancer seems comparable with open surgery. However, we have several significant concernsaboutthecase-matchingmethodthatwasusedinthisstudy. The propensity score analysis was developed to minimize the differences in patients’ covariates, which could become confounding factors in the examination of treatment effects in observational stud

Background and study aims Resection of a large amount of the esophageal mucosa often causes esophageal ulcer and postoperative stricture. The aim of this study was to evaluate the process of healing of defects in the esophageal mucosa after endoscopic mucosal resection (EMR). Materials and methods Cap-assisted EMR was performed in the thoracic esophagus of six beagle dogs to prepare mucosal defects with a diameter ranging from 15 to 18 mm. The process of mucosal healing was assessed histologically immediately after EMR, and on postoperative day (POD) 2, 4, 7, 14, and 28. Results Immediately after EMR, a thin layer of the submucosa remained in the mucosal defect, and no damage to the muscularis propria was evident. Ulcer formation and inflammatory cell invasion were observed in the remaining submucosa on POD 2 and 4. Angiogenesis and collagen fiber hyperplasia were observed after POD 7. Complete epithelialization of the ulcer was observed on POD 28. In the muscularis propria, further destruction and atrophy were evident after POD 7. Fibrosis of the muscularis propria was observed on POD 28. Conclusion In the esophageal wall after epithelial loss resulting from EMR, atrophy and fibrosis of the muscularis propria remain even after epithelialization.

Objective: Prognostic factors in patients who underwent pulmonary angioplasty remain controversial. Here, we report a case-series study of this surgicalprocedure based on our 20-yearsingle-center experience.Methods:Medicalrecords of patients, who underwenta major lung cancer operation with pulmonary artery resection, were reviewed retrospectively. Results: From 1986 to 2006, 61 (3%) of 2296 patients required pulmonary artery resection to avoid pneumonectomy for lung cancer surgery. We performed 34 circumferential resections and 27 wedge resections accompanied by lobectomy or bilobectomy, and all repairs were performed with end-to-end anastomoses or direct suturing. Patch reconstruction, synthetic/biological prosthesis, and pericardial conduit were not used. Forty-nine patients (80%) underwent concomitant carinoplasty (n = 2)or bronchoplasty (n = 47). Aftersurgery, two patientsdied(mortality3.3%) and majorcomplications werenoted in14 patients (morbidity 23.0%). Although seven patients had local recurrences (four intrathoracic and three lymph nodes), no recurrence was observed along the pulmonary artery suture line. With a mean follow-up period of 46.0 40.5 months, overall and disease-free survival rates for all cases were 47.0% and 40.0% at 5 years, and 40.2% and 33.6% at 10 years. According to the nodal status, the 5-years’ overall and disease-free survivals were 76.0% and 62.9% for pN0 cases (n = 14), 45.7% and 43.5% for pN1 cases (n = 27), and 28.9% and 20.0% for pN2 + pN3 cases (n = 20), respectively (p = 0.014 and 0.036). Multivariate analysis indicated that nodal status was the only prognostic factor on both overall and disease-free survival. Conclusions:A major anatomical lung operation with pulmonary artery resection is feasible for selected patients with primary lung cancer. Longterm outcomes are significantly influenced by nodal status and are comparable to those of conventional lobectomy. Most operative complications are controllable with acceptable mortality and morbidity rates. The anastomosed site was not placed at risk for local recurrence. These data support pulmonary angioplasty as a valuable option in the treatment of lung cancer. # 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

A 37 year-old man with preoperative diagnosis of pulmonary mucosal associated lymphoid tissue (MALT) lymphoma underwent right middle lobectomy thoracoscopically followed by adjuvant chemotherapy since 18 days after the operation. The patient is free from recurrence 6 months after the operation. Pulmonary MALT lymphoma is rare and its treatment is controversial. This patient underwent surgical treatment and adjuvant chemotherapy because the tumor is limited to right middle lobe. Thoracoscopic lobectomy is less invasive and it was possible to perform adjuvant chemotherapy soon after the operation.

Despite its feasibility and safety, use of video-assisted thoracic surgery (VATS) lobectomy for malignancies has spread slowly during the past decade because no definitive conclusions have been reached regarding the oncologic validity of this approach for malignancies. Thus, the purpose of this study was to analyze the indications and long-term results of VATS major pulmonary resections for primary lung cancers.Of 502 patients who had surgical resections for primary lung cancers at the National Hospital Organization Himeji Medical Center from May 2000 to December 2003, the cases of the 325 patients who were originally scheduled for VATS major pulmonary resections (pneumonectomy, bilobectomy, lobectomy, and segmentectomy) were retrospectively reviewed. At this hospital, after an initial learning-curve period, indications for VATS were extended to all cases for which this approach was thought possible. For better analysis of long-term survival rates, patients whose follow-up periods were more than 5 years after surgery were analyzed.Of the 325 scheduled VATS resections, 21 procedures (6.4%) were eventually converted to open thoracotomies. In-hospital death occurred in 1 patient (0.3%). The average follow-up period for all censored cases was 66 months. Overall and disease-free 5-year survival rates were 85% and 83% for stage Ia (192 cases), 69% and 64% for stage Ib (50 cases), 48% and 37% for stage II (27 cases), and 29% and 19% for stage III (50 cases), respectively (p0.0001). Patients who were operated on using the VATS approach increased year by year, especially after 2002, when indications for using this method were extended (ratio of VATS to total cases, approximately 50% in the first 2 years and more than 80% in the latter 2 years). Long-term survival rates during the entire study period were comparable, especially in early stage lung cancer cases.Use of VATS major pulmonary resection for primary lung cancer is feasible, with long-term patient survival comparable to that of conventional thoracotomy. Thus, it is possible that this approach might become the standard in experienced surgical centers, especially for early stage lung cancer cases. Further investigation at multiple centers is required.

Dancing robots are a kind of performance robots. It is not only to be able to dance but also to be able to make spectartors feel familiar and mild. For this purpose, this dancing robot was manufactured after consideration factors of subjective judgement. Image design technique was adopted for familiar shape and SMA actuator was adopted for smooth action of arms and legs. It was investigated that spectators' image for this dancing robot with Semantic Defferential Technique what was one of subjective judgement technique in psychology. This dancing robot's achivement was finally evaluated with a respect to its familality. As a conclusion of this development, it was indecated that Semantic Defferential Technique gave basis of psycological engineering design of performance robots.

We report a rare case of biphasic pulmonary blastoma (BPB) with rapid progression in a 75-year-old man. Computed tomography (CT) of the chest revealed a well-defined tumor shadow measuring 8 × 6 cm in the right upper lobe. CT-guided lung biopsy revealed malignant cells with sarcomatous elements. Right upper lobectomy and systemic lymph node dissection with chest wall resection were performed. Histopathologically, the tumor was composed of immature embryoniclike mesenchymal and epithelial components that resembled embryonic lung tissue. The final diagnosis was BPB classified as pathological stage IIB (T3N0M0). Two months later, the tumor recurred in the right supraclavicular lymph nodes. The patient died of respiratory failure due to tumor progression 7 months after surgery.

Objective: The aim of this study was to evaluate the overall cancer-related survival in younger and elderly (over 70 years old) patients with stage I non-small cell lung cancer (NSCLC) together with prognostic factors in the elderly. Methods: The patient records of 797 patients who underwent surgery for stage I NSCLC were analyzed retrospectively. A total of 132 patients were over 70 years old. The clinical variables and overall cancer-related survival were compared between two groups. An analysis was performed to determine the risk factors that influenced the survival of elderly patients. Variables analyzed included sex, presence of symptoms, operative procedure, histopathology, size of tumor and tumor classification. Results: Between the two groups, the nature of the operation performed (pneumonectomy or not) and the presence of symptoms reached statistical significance (P , 0:001). Overall 5- and 10-year survival rates were 64.5% and 53.68% in younger patients and 58.23% and 52.24% in the elderly. There was no significant difference in survival between the groups (P ¼ 0:35). The only significant prognostic factor in the elderly patients was the size of the tumor in the multivariate analysis (P ¼ 0:0442, relative risk 2.28 (1.02–5.10 95% CI)). Conclusions: Surgical resection for stage I NSCLC in elderly patients over the age of 70 years results in a comparable overall cancer-related survival to that evident in younger patients. The size of the tumor is the only significant factor to influence the survival of elderly patients. Continued careful selection of elderly patients for surgical resection is important for acceptable operative results. q 2002 Elsevier Science B.V. All rights reserved.

Mediastinal compression by a large metastatic lung tumor is a life-threatening condition and needs immediate decompression. We performed palliative surgical rescue for 2 patients aged 42 and 30 years with these conditions, and were able to control their symptoms. Patients were free of symptoms soon after the operation. Palliative surgical rescue can relieve the symptoms immediately and improve the general condition dramatically. We think that surgical rescue is worthwhile, especially for younger patients.

The objective of this study was to assess the pharmacologic effect of continuously released recombinant human interferon-alpha (rHuIFN-alpha) in the liver, the target organ of chronic hepatitis B and C, using 2',5'-oligoadenylate synthetase (2',5'-OAS) activity as an indicator of an antiviral state. A cylindrical matrix prepared from tetraglycerol dipalmitate (TGDP), a polyglycerol ester of fatty acids (PGEF), released rHuIFN-alpha in a pseudo-zero-order manner for about 1 week after implantation into mice, without any major loss of rHuIFN-alpha biologic activity during the release period. To evaluate the pharmacologic effect of the rHuIFN-alpha continuously released from this type of matrix, we established a murine test system. Bolus injections of rHuIFN-alpha solution at three doses increased 2',5'-OAS activities in murine liver extract and serum in a dose-dependent manner, indicating that this system is suitable for evaluating rHuIFN-alpha activity. After subcutaneous insertion of TGDP-matrix implants containing 5.5x10(7) IU rHuIFN-alpha per animal, 2',5'-OAS activities in both liver extracts and serum increased rapidly and remained high for over 1 week. Subcutaneous injections of an equivalent total dose (5.0x10(7) IU/animal per week) of rHuIFN-alpha solution in three or seven fractions prolonged 2',5'-OAS activities compared with a single bolus injection. Comparing 2',5'-OAS activity on day 7 and the portion of the area under the 2',5'-OAS activity-time curve above the normal level (deltaAUC) between the TGDP-matrix implant and multiple injections of the solution revealed that continuously released rHuIFN-alpha has an effect almost equivalent to that of three or seven injections of the solution per week.

We have read with interest the paper by Hanna et al. [1], comparing oncological outcomes between video-assisted thoracoscopic surgery (VATS) lobectomy and open lobectomy for non-small-cell lung cancer (NSCLC) using propensity score matching, to minimize selection bias in the retrospective cohort in their hospital. To date, more and more surgeons have performed VATS lobectomy for early NSCLC and concern for its long-term oncological outcomes is emerging. However, most of the reports on this issue are retrospective and only one randomized trial has been reported so far, as the authors correctly note [2]. Non-randomized comparisons between treatments are subject to selection bias, because we ‘select’ the cases for VATS lobectomy or for other approaches. Two systematic reviews and meta-analyses have been published [3, 4], but they are not exempt from the selection bias either, because they themselves are based on retrospective cohort studies. Hanna et al. tried to minimize this selection bias in the retrospective cohort by using propensity score matching, and this will be effective for this purpose when properly and ideally conducted. However, we find several important questions in statistical methods of this study. Propensity score is developed to minimize large differences of the observed covariates in observational studies, which would lead to biased results. Propensity score itself is defined as ‘the conditional probability of being treated given the individual’s covariates’ [5]. And, therefore, propensity score matching should be performed to match VATS lobectomy and open lobectomy with regard to similar patient backgrounds based on the preoperative information. The authors used five variables to construct their propensity score, three of which, however, derive from postoperative pathological information. These cannot logically influence the choice of a surgical procedure. And after matching the cases between VATS lobectomy and open lobectomy using propensity score based on these variables, they analysed the prevalence of preoperative comorbidities, rates of lymph node samplings and long-term oncological outcomes. We cannot help saying that such analysis is contradictory to the definition of propensity score matching, which predicts ‘the conditional probability of being treated given the individual’s covariates’. On the other hand, oncological outcomes between two groups may have no significant difference, because they matched the cases based on pathological T and N, which is defined to predict oncological prognosis. If the authors wish to compare the difference between two groups based on postoperative pathological results, simple multivariate analysis should be chosen, even though they themselves are not free from the selection bias in this retrospective cohort. We believe that more preoperative information should be adopted for propensity score such as preoperative comobidity, clinical information of the tumour including clinical TNM stage, histology and location, as we routinely use to decide upon the type of procedure preoperatively and, after matching the cases, oncological outcomes should be compared between two groups according to pathological TNM stagings.

A new method of finding a track is devised for the VENUS muon detector composed of eight-cell drift-tube modules, each cell having a rectangular cross section of 5×7 cm2. The new method, in which fourth-order equations are solved by the Ferarri-Cardano method, is especially powerful for a track having a large incident angle with respect to the line normal to the anode-wire plane of a drift tube, compared to the presently used method in which a track is determined by the intersecting points of an equi-drift-distance circle and the anode-wire plane. Cosmic-ray test data for the forward-backward part muon detector support these simulation results.