Search

Background: There are no available clinical data on immunotherapy and the risk of herpes zoster. Materials & methods: This retrospective study included patients with recurrent or advanced lung cancer who were inoperable and ineligible for radiotherapy and were treated with either a PD-1/PD-L1 antibody (136 patients) or an EGFR tyrosine kinase inhibitor (149 patients) at Jichi Medical University Hospital between January 2016 and December 2018. Results: Herpes zoster-free survival was significantly shorter in the PD-1/PD-L1 antibody-treated group compared with the EGFR tyrosine kinase inhibitor-treated group (hazard ratio: 0.20; 95% CI: 0.048–0.84; p = 0.016). PD-1/PD-L1 antibody administration was independently and significantly associated with herpes zoster occurrence. Conclusion: Clinicians should anticipate herpes zoster in patients with lung cancer during treatment with PD-1/PD-L1 antibodies.

Objective: Pulmonary mycobacterium avium complex (MAC) disease is increasing significantly worldwide. Several studies have investigated the clinical features of pulmonary MAC disease in the setting of cancer. Here, we aimed to clarify the clinical characteristics of patients with cancer with recent onset of pulmonary MAC disease and the effect of cancer on the onset of this disease. Patients and Methods: Of the 323 consecutive Japanese patients newly diagnosed with pulmonary MAC disease at Jichi Medical University Hospital between and 2006-2017, we retrospectively reviewed 79 consecutive patients with cancer. Results: Seventeen patients had lung cancer (21.0%), while 62 had non-lung cancer. Of the 17 patients with lung cancer, 16 had adenocarcinoma of which 10 had stage I to III disease; 8 of the 10 patients had not received chemotherapy. Sixteen patients with lung cancer had a MAC infection in the ipsilateral lung. Notably, 9 of the 11 lung cancer patients who did not undergo surgery had a MAC infection in the affected lobe. Of the 39 patients with the most common types of non-lung cancer (14 had gastric cancer, 13 had colorectal cancer, and 12 had breast cancer), 22 had stage I to III disease, and 18 of these 22 had not received chemotherapy. Conclusion: Lung cancer may act as a local factor contributing to the onset of pulmonary MAC disease in the ipsilateral lung. However, the underlying mechanism by which a history of cancer might affect the onset of pulmonary MAC disease remains unclear. Further investigation into this mechanism is needed.

The quantum size effect of CdTe quantum dots (QDs) has been one of the targets of extensive research concerning the optical spectroscopy of semiconductors, but little is known about their effects on electrochemiluminescence (ECL) behavior, especially in the anodic potential range. In this present study, water-soluble CdTe QDs with different sizes were synthesized with a microwave-assisted hydrothermal method. Upon electrochemical oxidation of the CdTe QD in the presence of tri-n-propylamine (TPrA) as a coreactant, two ECL signals, called ECL1 and ECL2, were observed at potentials corresponding to the oxidation of TPrA (at +0.8 V) and CdTe QDs (at +1.2 V), respectively. The relative intensity of ECL1 significantly increased with increasing the particle size of CdTe QDs, and disappeared when the particle size was less than 2.4 nm. Upon an anodic potential of +0.8 V, TPrA is oxidized at the electrode surface, where the intermediate radical species like TPrA•+ radical cation and CdTe QDs•- radical anion are supposed to be formed to give the excited chemical species of CdTe QDs*. Possible ECL mechanisms are proposed from a view point of thermodynamics.

The aim of this study is to reveal the morphological property about the loose bodies (LBs) of temporomandibular joint (TMJ) by scanning electron microscope (SEM). We obtained specimens from two female cases of released loose body by surgical operation. These specimens were fixed by soaking in a mixture of 5% glutaraldehyde or 4% formaldehyde for one week. They were cut into half pieces. These specimens were observed at an accelerating voltage of 3 kV under a SEM (JSM-5500, JEOL, Tokyo). In the electron microscopic findings, it seems to be separated into two different parts as inside part and outside part. On the inside part, collagen fibers were running very densely in the same direction in an orderly neatly manner. Whereas, we observed waved collagen fibers running irregularly with many spaces on the outside part. Outside part seems to be porous pattern compared with inside part. It might be that the surface and outside part included many active fibroblasts. As results, it seems that the LBs might develop in a multi-layer style, in which fibrous tissues were piled up loosely around the inside part. The proliferating activity of LBs grows from the inside to outside of SC in TMJ.

The objective of this study is to construct mathematical expressions to estimate the optimum cycle time which maximizes the specific cooling power (SCP) of adsorption chillers with silica gel-water pair. The operating temperature conditions of hot water, cooling water and chilled water, as well as the design parameters such as heat transfer coefficient and heat capacities of the adsorbent heat exchanger and silica-gel, are taken into account to estimate the optimum cycle time. Totally 729 cases were examined to calculate the optimum cycle times from which mathematical expressions were derived. The empirical method reflecting the six parameters successfully estimates the optimum cycle time of the simulations with the coefficient of determination as high as 0.98. The performance for estimating the maximum SCP through the optimum cycle time is even better.

Liquefied Natural Gas (LNG) is a valuable exergetic source due to its low-temperature (−162 °C). However, LNG is regasified using seawater as heat source and without exergy recovery in most of LNG terminals worldwide. In this paper we model a polygeneration plant that recovers the low-temperature and pressure exergy from LNG-regasification to generate simultaneously power and refrigeration in a District Cooling network at three different temperature levels. The plant is divided into different subsystems arranged in cascade. The objective of this research is the selection of the most suitable working fluids and heat transfer fluids for operating in each subsystem. The performance of the system is analyzed from the thermodynamic and environmental point of view. Although neither of the candidate fluids satisfies all the desirable features, the selected fluids are: methane, carbon dioxide and propane. The plant achieves an equivalent electricity production of 125 kWh for metric ton of LNG regasified with an exergetic efficiency of 40.6%. Besides, the seawater utilized in the plant is 60% lower than the required by the common LNG regasification process and an annual emission of 75 thousand tons of CO2 is avoided.

Healthcare workers performing bronchoscopy, especially in urgent cases, may be at risk of aerosol-transmitted infection with severe acute respiratory syndrome coronavirus 2. Therefore, such healthcare workers require thorough protection from aerosol droplets. To this end, we developed a novel handmade protective barrier enclosure for performing flexible bronchoscopy. The use of this enclosure did not entail any special technique for handling the bronchoscope during bronchoscopy. The enclosure may be helpful in protecting bronchoscopists from the risk of aerosol-transmitted infections, including coronavirus disease 2019.

Fiberoptic tracheal intubation (FTI) in bronchoscopy is widely performed with a conventional Portex tracheal tube (PTT). Occasionally, it is difficult for pulmonologists with limited experience to insert a tube beyond the vocal cords and advance it into the trachea. A new endotracheal tube, the Parker Flex-Tip tube (PFT), was recently designed. We compared the usefulness and safety of PFT versus PTT for FTI in bronchoscopy performed by pulmonologists with limited experience.Forty consecutive patients were enrolled and randomly assigned to either the PFT group (n = 20) or PTT group (n = 20). The time required for the tip of the endotracheal tube to pass from the mouth to the carina, the number of vomiting reflexes, the number of attempts to pass the tube through the vocal cords during intubation, complications, and technical difficulty of intubation were evaluated.Both the PFT and PTT groups exhibited high intubation success rates (100% vs. 90%, respectively). The PFT group was intubated faster than the PTT group (11.5 [5-45] s vs. 22.5 [8-270] s, respectively, p 0.01). The PFT group showed fewer vomiting reflexes and tube impingements than the PTT group (p 0.05). Operators felt it was easier to intubate with PFT versus PTT (p 0.01). Complications were not significantly different between the two groups.For pulmonologists with limited experience who perform FTI in bronchoscopy, intubation using PFT versus PTT is faster and easier, without an increase in complications.

Background Bird antigens are some of the most relevant antigens in hypersensitivity pneumonitis (HP). Possible sources of bird antigens are bird breeding, feather products and fertilizer with fowl droppings. For the screening and diagnosis of HP, the measurement of bird-specific antibodies should be standardized. The aim of this study was to clarify the utility of serum IgG (sIgG) and IgA (sIgA) antibodies to bird antigens in screening and diagnosing acute/chronic bird-related HP with ImmunoCAP® in multi-centre clinical research. Methods We executed a clinical performance test by conducting a multi-institutional study to measure the levels of sIgG/sIgA against pigeon, parrot and budgerigar antigens by the ImmunoCAP® system in 29 acute and 46 chronic bird-related HP patients. Results The levels of sIgG/sIgA against the bird antigens of the three species were significantly higher in subjects with acute bird-related HP and chronic bird-related HP with acute episodes (recurrent type) than in the control subjects. For sIgG, the optimal cutoff values by receiver operating characteristic (ROC) analysis were 24.6 mgA/L for pigeon, 14.0 mgA/L for parrot, and 8.7 mgA/L for budgerigar. By measuring multiple bird antigens and combining sIgG values of two species, the sensitivity and specificity for acute and recurrent-type chronic bird-related HP patients were 85–91% and 73–80%, respectively. For recurrent and insidious types of chronic bird-related HP, the sensitivity and specificity were 48–61% and 73–80%, respectively. Conclusions Measurement of the levels of sIgG/sIgA against pigeon, budgerigar and parrot antigens by ImmunoCAP® was useful for screening and diagnosis in bird-related HP.

In this study the enhancement effect of adsorption mass transfer by acoustic wave is investigated to understand how the acoustic wave influences the adsorption performance. The experimental data were obtained to show the behavior of silica-gel adsorption with/without acoustic field. The experimental results showed the adsorption speed with acoustic wave became higher than that without acoustic wave although the equilibrium adsorption amount was kept to be the same. From the viewpoint of acoustic wave conditions, the adsorption speed was increased with increasing the velocity amplitude, while the pressure amplitude had no effect on the enhancement. The maximum adsorption speed attained five times as high as the case without acoustic wave when the velocity amplitude was 1.35 m/s. Background air flow velocity is also an influential factor. The experimental results support that the non-dimensional ratio of the velocity amplitude to the background flow velocity is essential to describe the enhancement effect. Based on the observed data, an empirical formula was estimated to express the relationship between the enhancement effect and the non-dimensional velocity amplitude. The liner regression showed the good agreement and gave the critical non-dimensional velocity amplitude of 1.9 over which acoustic wave is effective to amplify the mass transfer rate of adsorption.

The aim of this study was to assess knowledge, attitude, behavior, and compliance concerning infection control among dental practitioners in a dental university hospital in Japan. A 12‐item questionnaire about infection control during radiographic procedures was distributed to 686 dental personnel working at Osaka Dental University. The questionnaire collected information on occupation and the use of gloves, holders, door handles, control panels, dental chairs, protectors, tube head, tube arms, tube cones, and keyboards for personal computers. To identify misunderstandings about, and thus noncompliance with, current infection control practices, the percentage of correct answers (PCA) was calculated. Understanding and compliance with the current practices was considered low when

This paper presents static analyses of two stage adsorption cycle using FAM Z01 and FAM Z05 as the adsorbents. The conventional two stage system consists of four adsorbent beds. In contrast, in new scheme three beds were used assigning FAM Z01 and FAM Z05 combination for low and high pressure sides, respectively. The objectives of this study were to evaluate the performance of two stage cycle with the Z01 and Z05 combination of adsorbent pair, and to compare the performance with that of the conventional two stage cycle using Silica-gel. Static analysis based on Duhring diagram was employed to estimate the performances of specific cooing effect (SCE) and COP. It was found that the cycle with new combination gives SCE more than twice compared with the conventional Silica-gel–water system at the heat source temperature of 55 °C. The sensitivity analysis was also performed for optimal mass allocation to adsorbent beds.

Background Several studies have reported that viral infections are related to lung cancer. We previously reported the involvement of Torque teno virus (TTV) in patients with lung cancer and idiopathic pulmonary fibrosis. However, the role of TTV in lung cancer growth, and its influence on changes in TTV DNA titers due to idiopathic pulmonary fibrosis (IPF) in lung cancer patients are poorly understood. Methods Serum TTV DNA titers were measured in serum samples obtained from patients with lung cancer. Forty-eight patients with primary lung cancer, including 8 patients with IPF, were enrolled. Serum TTV DNA titers were quantitated before and after chemotherapy. In addition, patients were classified into two groups according to the presence or absence of IPF, and clinical characteristics were compared between these two groups. Results Among the 33 patients with partial response to treatment or stable disease in the lung cancer, the mean TTV DNA titer in 28 patients without IPF had significantly decreased after chemotherapy. In contrast, the mean TTV DNA titer in the 5 patients with IPF tended to increase after chemotherapy. In the 15 patients with progressive lung cancer, TTV DNA titers were significantly elevated in those with and without IPF. Conclusion In lung cancer patients without IPF, changes in TTV titers may be correlated with tumor growth. However, in lung cancer patients with IPF, TTV titers were not consistently associated with chemotherapy responses. Therefore, IPF may have an influence on changes in TTV DNA titers.

The lung develops an unique epithelial barrier system to protect host from continuous invasion of various harmful particles. Interleukin (IL-)33 released from epithelial cells in the lung drives the type 2 immune response by activating ST2− expressed immune cells in various allergic diseases. However, the involvement of memory-type ST2+CD4+ T cells in such lung inflammation remains unclear. Here we demonstrated that intratracheal administration of IL-33 resulted in the substantial increase of numbers of tissue-resident memory-type ST2+CD4+ T cells in the lung. Following enhanced production of IL-5 and IL-13, eosinophilic lung inflammation sequentially developed. IL-33-mediated eosinophilic lung inflammation was not fully developed in T cell-deficient Foxn1 nu mice and NSG mice. Dexamethasone treatment showed limited effects on both the cell number and function of memory-type ST2+CD4+ T cells. Thus our study provides novel insight into the pathogenesis of eosinophilic lung disease, showing that memory-type ST2+CD4+ T cells are involved in IL-33-induced eosinophilic inflammation and elicited steroid-resistance.

Rationale: Despite a lack of beneficial evidence in idiopathic pulmonary fibrosis (IPF), long-term oxygen therapy (LTOT) is currently prescribed for many patients with IPF. Little is known about clinical course of them. Aim: To clarify the overall survival and prognostic factors of IPF patients after prescription of LTOT. Method: A prospective cohort multicenter study, enrolling patients with IPF who started LTOT between December 1, 2012 and November 30, 2015 from 21 institutes in Japan. The decision for starting LTOT depended on each site. Clinical data at starting LTOT and three-year follow-up data including death and cause of death were studied. Results: 147 eligible patients were recruited. 117 were male and the mean (SD) age was 71.2 (8.1) years. The mean (SD) percentage predicted FVC was 61.7 (15.6)%. 111 (76%) died with a median follow-up of 479 days. Causes of death were chronic respiratory insufficiency in 52%, acute exacerbation in 27%, and lung cancer in 5%. The median survival from starting LTOT was 537 days. By COX univariate analysis, low FVC, high COPD assessment test (CAT) score, resting hypoxemia (SpO2 This study was partially supported by a grant to the Diffuse Lung Diseases Research Group from the Ministry of Health, Labor and Welfare, Japan.

This study aimed to investigate whether using a wearable robot applying interactive rhythmic stimulation on the upper limbs of patients with Parkinson's disease (PD) could affect their gait. The wearable robot presented tactile stimuli on the patients' upper limbs, which was mutually synchronized with the swing of their upper limbs. We conducted an evaluation experiment with PD patients (n = 30, Modified Hoehn-Yahr = 1-3, on-state) to investigate the assistance effect by the robot and the immediate after-effect of intervention. The participants were instructed to walk 30 m under four different conditions: (1) not wearing the robot before the intervention (Pre-condition), (2) wearing the robot without the rhythm assistance (RwoA condition), (3) wearing the robot with rhythm assistance (RwA condition), and (4) not wearing the robot immediately after the intervention (Post-condition). These conditions were conducted in this order over a single day. The third condition was performed three times and the others, once. The arm swing amplitude, stride length, and velocity were increased in the RwA condition compared to the RwoA condition. The coefficient of variance (CV) of the stride duration was decreased in the RwA condition compared to the RwoA condition. These results revealed that the assistance by the robot increased the gait performance of PD patients. In addition, the stride length and velocity were increased and the stride duration CV was decreased in the Post-condition compared to the Pre-condition. These results show that the effect of robot assistance on the patient's gait remained immediately after the intervention. These findings suggest that synchronized rhythmic stimulation on the upper limbs could influence the gait of PD patients and that the robot may assist with gait rehabilitation in these patients.

Combined cooling, heat and power supply systems (CCHP) are expected as a method of efficient use of energy, and gas engines are installed for power and heat supply for them in many cases of District heat and power supply (DHC). Conventionally, it presupposed that the same type of multiple gas engines is installed in a site, and considering the terms of maintenance is only calculate the cost by simple multiplication with assumed unit price. There are two types for gas engines for CCHP such as High-speed type and Medium-speed type depending on the rated rotation speed. The characteristics are different in terms of initial cost, efficiency, and maintenance, and it is possible to install them on one site. Therefore, the objectives of this research are to model the optimal operation of CCHP combining High-speed type and Medium-speed type with the detail maintenance process that several stages are determined by operation hours for each type and to verify the effectiveness of vicarious combinations of different type gas engines and their operation from the economical point of view considering actual maintenance schedule. It is necessary to consider not only the load balance of each equipment but also the elapsed time axis to optimize actual maintenance activities because the maintenance timing is determined by the accumulation of operation hours. In this study, developed the methodology to solve the optimum operation plan of CCHP and the optimum maintenance plan of the gas engines at the same time, and the examined case was a DHC with 3 units of 3800 kW gas engines for the operation of 1 year. The results indicate that the proposed methodology is useful since the annual operation cost is decreased compared with the conventional method. By the optimization considering detail maintenance, engines’ operation hours are controlled to optimize the number of maintenance work even among the same types. A combination of the two types would be better than the system with one type. It implies that the proposed methodology is effective to derive the optimal configuration of CCHP.

Objective Environmental and climatic changes have been occurring throughout the past 20 years in Japan. Correspondingly, the antigens that cause hypersensitivity pneumonitis might be changing. In an epidemiological survey of Japan in the 1980s, summer-type hypersensitivity pneumonitis (SHP) accounted for 74.4% of the cases of hypersensitivity pneumonitis. The epidemiological characteristics of this disease have not been reported since then. We investigated the annual changes in the number of cases of SHP and the factors affecting the results. Methods Cases that were diagnosed as SHP were retrieved from the medical records of our institute between 1990 and 2015. The diagnostic criteria proposed by the Japanese Ministry of Health, Labour and Welfare in 1990 were applied to obtain the definite diagnosis. Patients The study population included 25 diagnosed patients, including one intrafamilial case. The subjects were predominantly non-smoking women in their 50s and all lived in wooden houses that had been constructed more than 10 years previously. Results The number of cases that were diagnosed as SHP tended to decrease during the study period. However, temporal increases tended to occur in years with increased rainfall and decreased daylight hours. No relationship appeared to exist between the number of cases and high temperatures or humidity levels. Conclusion The incidence of SHP currently appears to be decreasing; however, the weather conditions in any given year might cause a temporal increase in the incidence rate.

Objective For lung cancer complicated with sarcoidosis, there are no exact features that indicate whether lymphadenopathy is metastatic. This makes the validity of surgery uncertain for clinicians. The aim of this study was to clarify the clinical features of pulmonary sarcoidosis complicated by lung cancer, especially from the viewpoint of evaluating lymphadenopathy. Methods We retrospectively reviewed medical records from 2004 to 2013 at our institution, and 18 patients who were diagnosed with sarcoidosis and lung cancer were thus found to be eligible. We investigated the relationship between the clinical and pathological findings of their swollen lymph nodes. Results Of 18 patients, 11 conducted surgery, and the postoperative pathological evaluation of swollen lymph nodes was done in 8 of the patients. Postoperative N factor in all these patients was 0, even though lymphatic metastasis had been suspected preoperatively because of the unbalanced distribution of lymphadenopathy or the accumulation of fluorodeoxyglucose. Conclusion In patients with lung cancer complicated by sarcoidosis, the clinical assessment of the state of lymphadenopathy is difficult to make. However, as many of them tend to be benign, we suggest that surgical resection should be considered for a complete cure in the absence of any remote metastasis.

In this study, a wall mounted solar concentrating collector with parabolic and involute mirrors combined with an evacuated glass tube is designed to boost the solar energy collection for domestic hot water supply during winter. To optimize the device, the mirrors' parameters are varied, and the amount of collected energy in each case compared through ray tracing simulation. The results show that with the optimal mirror shape, the amount of collected energy is 5.5 times bigger than when the evacuated glass tube is set alone. This system will be considered sufficiently useful as it can reduce the high cost component of the evacuated glass tubes by replacing them with inexpensive mirrors.

This study was focused on the evaluation of the adsorption kinetics of water vapor onto silica-gel with and without an acoustic field, in an objective to reveal the enhancement mechanisms of water vapor adsorption by an acoustic wave. Adsorption uptake curves of water vapor from humidified air onto the silica-gel with and without acoustic field were measured at room temperature under various conditions, after which the adsorption kinetic parameters (fluid film mass transfer coefficient and intraparticle diffusivity) were determined from the uptake curves with the aid of numerical calculations. The results demonstrated that the acoustic field exhibited no effect on the intraparticle diffusion, because the fluid film mass transfer was the rate-limiting step under the condition of this study. In contrast, the fluid film mass transfer was enhanced by the velocity amplitude of the acoustic field. However, the diminished mass transfer was also observed in some cases. For the enhancement and diminution of adsorption rate by the acoustic wave, it was suggested that the ratio of the oscillation flow (U) to the steady flow (u), U’ = U/u, was an important factor. Moreover, the enhanced adsorption kinetics was observed under the conditions of U’ > 2, whereas the adsorption rate was diminished or invariant under the condition of U’ 2.

Many power-assist wearable exoskeletons have been developed to provide walking support and gait rehabilitation for elderly subjects and gait-disorder patients. Most designers have focused on a direct power-assist to the wearer's lower limbs. However, gait is a coordinated rhythmic movement of four limbs controlled intrinsically by central pattern generators, with the upper limbs playing an important role in walking. Maintaining a normal gait can become difficult as a person ages, because of decreases in limb coordination, stride length, and gait speed. It is known that coordination mechanisms can be governed by the principle of mutual entrainment, in which synchronization develops through the interaction between nonlinear phase oscillators in biological systems. This principle led us to hypothesize that interactive rhythmic stimulation to upper-limb movements might compensate for the age-related decline in coordination, thereby improving the gait in the elderly. To investigate this hypothesis, we developed a gait-assist wearable exoskeleton that employs interactive rhythmic stimulation to the upper limbs. In particular, we investigated the effects on spatial (i.e., hip-swing amplitude) and temporal (i.e., hip-swing period) gait parameters by conducting walking experiments with 12 healthy elderly subjects under one control condition and five upper-limb-assist conditions, where the output motor torque was applied at five different upper-limb swing positions. The results showed a statistically significant increase in the mean hip-swing amplitude, with a mean increment of about 7% between the control and upper-limb-assist conditions. They also showed a statistically significant decrease in the mean hip-swing period, with a mean decrement of about 2.3% between the control and one of the upper-limb-assist conditions. Although the increase in the hip-swing amplitude and the decrease in the hip-swing period were both small, the results indicate the possibility that interactive rhythmic stimulation to the upper limbs might have a positive effect on the gait of the elderly.

Objective The influence of smoking on the pathogenesis and clinical course of interstitial pneumonia has recently attracted attention. To clarify the influence of smoking on the clinical patient characteristics and therapeutic effects in patients with interstitial pneumonia presenting with a non-specific interstitial pneumonia (NSIP) pattern, we compared the clinical patient characteristics and therapeutic effects in smokers and nonsmokers in this study. Methods We divided 31 NSIP (16 idiopathic nonspecific interstitial pneumonia and 15 collagen vascular disease-associated nonspecific interstitial pneumonia) patients into smoker and non-smoker groups for each case. The patient characteristics, pulmonary function tests, Krebs von den Lungen 6 (KL-6), surfactant protein D (SP-D), bronchoalveolar lavage fluid findings, and clinical courses for two years were compared between the smoker and non-smoker groups. Results The smoking subgroup (n=15) of NSIP patients had a significantly lower % diffusing capacity for carbon monoxide/ alveolar ventilation (DLCO/VA) and tended to have higher SP-D values than the nonsmoking subgroup (n=16). Although no difference was observed regarding the prognosis, 5 of 6 cases with NSIP, which had worsening of lung disease were heavy smokers with a pack-year history of 40 or greater. Conclusion Smoking is thus suggested to negatively influence the diffusing capacity caused by damage to alveolar epithelial cells. In addition, smoking may also be potentially related to resistance to therapy in NSIP cases.

Background and objective Physical activity is an important parameter in patients with chronic obstructive pulmonary disease, but has not been studied in detail in patients with interstitial lung disease. This study aimed to evaluate physical activity in patients with idiopathic pulmonary fibrosis (IPF). Methods Physical activity was monitored in 31 stable IPF patients using an accelerometer for 1 month. The following factors reflecting physical activity were measured: the number of steps, walking distance, the time spent at magnitude of movement (MM) 1–6, physical activity-related energy expenditure (PAEE) and total energy expenditure. We also measured the following clinical parameters: the modified Medical Research Council (MRC) scale, Krebs von den Lungen-6 (KL-6), pulmonary function parameters, 6-min walk test (6MWT) results and high-resolution computed tomography (HRCT) findings of the chest. We determined the relationship between these parameters and physical activity. Results We recorded 24 days of physical activity data. The time spent at MM 1 was approximately 1 h per day. The modified MRC scale, serum KL-6 levels, 6MWT distance, and the extent of honeycomb and reticular abnormality on HRCT were associated with several facets of physical activity. In particular, lower KL-6 levels were correlated with higher physical activity based on the number of steps, walking distance, the time spent at MM 1–4 and PAEE. Conclusions The modified MRC scale, 6MWT distance, extent of fibrosis on HRCT and serum KL-6 levels are strongly associated with physical activity.

National surveys conducted in Japan between 1960 and 2004 suggest a gradually increasing incidence of sarcoidosis in women50 years old with increased involvement of the eye, skin, and heart. However, whether this involvement is due to the increased age at diagnosis is still unclear. We aimed here to identify the age-related differences in organ involvement in sarcoidosis in Japan, as well as the historical changes in clinical characteristics and the age-specific distribution of cases at diagnosis.We reviewed 588 consecutive Japanese patients newly diagnosed with sarcoidosis between 1974 and 2012 at Jichi Medical University Hospital. We compared organ involvement between subgroups differentiated by sex and age (45 years; n = 275; ≥45 years; n = 313) at diagnosis and identified historical changes in the age-specific distribution in 10-year intervals.Younger patients had more common involvement of extrathoracic lymph nodes, parotid/salivary gland, and liver, while older patients had more common involvement of non-lymphatic extrathoracic organs such as the eye, heart, muscle, and kidney. The age at diagnosis has consistently increased over the past four decades. The monophasic distribution in men has tended to become biphasic, and the biphasic distribution in women monophasic. Increasing trends were apparent for hypercalcemia and involvement of the gastrointestinal tract, skin, nervous system, muscle, and kidney.Elderly patients at diagnosis had various extrathoracic involvement including eye, skin, and cardiac lesions. Moreover, the age at diagnosis of sarcoidosis has continued to increase in both sexes, influencing the recent trends in clinical characteristics.

Background: It is difficult to simulate actual bronchoscopic operations using virtual bronchoscopic navigation. However, low-priced, three-dimensional (3D) printers can mold a bronchial model within a short time, and a bronchoscope can be inserted into the 3D model. In some cases, however, the lumen of the bronchial model that is supposedly molded at its actual size is smaller than the real bronchus, and thus it is difficult to insert the bronchoscope because of friction during the laminated step. Aims and objectives: We aimed to determine whether a bronchoscope could be inserted into a peripheral bronchial model similar to a real bronchus by changing the size of the 3D bronchial model and smoothing the ABS resin with resolvent. Methods: Using a 3D printer (UP-BOX, OPT), we molded two 3D models (1.25–2.00 times the actual size) of the involved bronchi of 16 patients who underwent bronchoscopy for peripheral pulmonary lesions. One of the two models was painted with resolvent. To determine the effect of the resolvent, we compared the accessibility of the branching bronchus with that of the real bronchus by inserting a bronchoscope in each model. Results: Bronchoscope insertion went smoothly in the model with resolvent. The average degrees of branching bronchoscopic insertion was 3.8° for the real bronchus and 2.3°/2.7°/3.4°/3.9° for the 1.25/1.50/1.75/2.00 times the actual size, resolvent-coated models, respectively. Conclusion: By molding a bronchial 3D model at 1.75–2.00 times the actual size and using resolvent, we may be able to perform simulation training that is similar to the actual bronchoscopic operation.

Pulmonary infection due to Mycobacterium heckeshornense (M. heckeshornense) in healthy adults without underlying diseases is very rare and optimal treatments have not yet been established. A 39-year-old woman was admitted to our hospital for further examinations following the identification of a pulmonary cavitary nodule. Acid-fast bacilli were cultured from specimens obtained by bronchofiberscopy, and identified with M. heckeshornense using nucleotide sequencing. Antimycobacterial chemotherapy was effective temporarily, while the nodular lesion subsequently worsened. The patient underwent lobectomy and has not relapsed thus far. A lung specimen showed marked granulomatous inflammation with extensive caseous necrosis and the preservation of some parts of alveolar septa within caseous necrosis, indicating an exudative process and resistance to chemotherapy. M. heckeshornense is strongly pathogenic and switching to surgical intervention needs to be considered when chemotherapy is insufficient.

In a previous study, we have developed a four-arm four-crawler disaster response robot called ‘OCTOPUS’. Advanced disaster response robots are expected to be capable of both mobility, such as entering narrow spaces over unstructured ground, and workability, such as preforming complex debris-removal work. We have confirmed experimentally that the four arms could make the robot perform complex tasks while ensuring stabilization when climbing steps while the four flippers could make it traverse rough terrain while avoiding toppling over when conducting manipulation task. OCTOPUS, renamed as H-OCTOPUS, is oil-hydraulically driven to perform outdoor demolition of heavy debris, and is teleoperated by two operators. In this study, we develop a prototype electrically-driven OCTOPUS, called E-OCTOPUS, to manipulate various light-objects mainly indoors such as valve operations in nuclear power plants. For reducing the size and weight while maximizing task performance, we introduced a mutual complementary strategy between its arms and flippers. To validate the capability of E-OCTOPUS, we performed preliminary experiments involving climbing high steps and manipulating and cutting wires by cooperating the four arms and four flippers. The results indicated that E-OCTOPUS could complete the tasks by coordinating its four arms and four flippers.

Background: Interleukin 33 (IL-33) works as a functional mediator in allergic disease by enhancing the activity of eosinophils and inducing expression of T helper 2 (Th2)-associated cytokines. However, the role of IL-33 in pulmonary eosinophilia has not been elucidated. We investigated the levels of IL-33 in eosinophilic pneumonia (EP) together with associated cytokines, and discussed the clinical significance of IL-33 in EP. Methods: Sera and bronchoalveolar lavage fluid (BALF) were obtained from 16 patients with EP, including acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia (CEP). Twelve patients with acute respiratory distress syndrome (ARDS) were also included for comparison. The concentration of IL-33 and Th2 cytokines (IL-4, IL-5, IL-13) were measured by enzyme-linked immunosorbent assay (ELISA). Results: The concentration of serum IL-33 was significantly higher in patients with AEP than in CEP. In CEP, only patients with atopic factors showed mild increase of serum IL-33. The concentration of BALF IL-33 was also significantly elevated in AEP, however, it remained quite low in CEP. Among Th2 cytokines, IL-5 was significantly increased in both serum and BALF in AEP, and the level of IL-5 was positively correlated with that of IL-33. ARDS showed no increase of serum and BALF IL-33. Conclusions: The remarkable increase of BALF IL-33 in AEP indicated the local production of IL-33 in lungs. IL-33 is considered to be a local key molecule for triggering pulmonary eosinophilia, together with IL-5. BALF IL-33 appears to be a useful marker for discriminating AEP from CEP and ARDS.

Pulmonary sarcoidosis is reported to have complication of lymphoproliferative disease such as malignant lymphoma, but the complication of multicentric Castleman's disease (MCD) is rarely reported. In our case of a 60‐year‐old woman, bilateral hilar lymphadenopathy was noted in her chest X‐ray. We performed a transbronchial lung biopsy. She was diagnosed as having pulmonary sarcoidosis (Stage II). The shadow on chest X‐ray disappeared without treatment. However, after 8 years, swelling of the mediastinal and abdominal lymph node, thickened bronchovascular bundle, and multiple nodular shadows were identified, and a thoracoscopic lung biopsy was performed. Based on the histopathological findings and elevated serum interleukin‐6 level (75.7 pg/mL), she was diagnosed with pulmonary sarcoidosis complicated by MCD. When a change in chest X‐ray findings are found during monitoring of pulmonary sarcoidosis, it is important to proceed with a thoracoscopic lung biopsy, because of the possibility of the rare complication of MCD.

A 51-year-old woman diagnosed with Crohn's disease developed drug-induced hypersensitivity syndrome (DIHS) 12 and six weeks after starting the oral intake of mesalazine and trimethoprim/sulfamethoxazole, respectively. Chest CT showed centrilobular nodular shadows and a transbronchial lung biopsy (TBLB) revealed infiltration of inflammatory cells predominantly in the small pulmonary artery walls and bronchiolar walls. Regarding pulmonary lesions of DIHS, infiltrative shadows have sometimes been reported, whereas nodular shadows have rarely been documented. This is a valuable case report for considering the mechanism underlying the development of pulmonary lesions in case of DIHS.

To investigate the effect of hyperglycemic state on the activation of alveolar macrophages (AMs) mediated via Toll-like receptors (TLRs) typically associated with bacterial infection.AMs obtained from normoglycemic control mice and streptozotocin-induced diabetic mice were stimulated ex vivo with the following: a TLR2 ligand, peptidoglycan (PGN); a TLR4 ligand, lipopolysaccharide (LPS); or a TLR5 ligand, flagellin (FLG). Cytokine production and mRNA expression were measured by ELISA and real-time PCR, respectively. TLR expression was assessed by real-time PCR and flow cytometry.AMs from diabetic mice produced significantly less TNF-α after PGN or FLG stimulation, and less IL-6 after FLG stimulation, compared with AMs from control mice. The decrease in the production of these cytokines was associated with reduced mRNA expression of the corresponding cytokines. In contrast, production of TNF-α and IL-6 after LPS stimulation did not differ between groups. Furthermore, there was no substantial difference in the expression of TLR2, TLR4, and TLR5 in AMs between the groups. The increased JNK phosphorylation induced by PGN or FLG stimulation was downregulated in AMs from diabetic mice.Hyperglycemic state impairs the reactivity of AMs to multiple TLR ligands. This effect might result from hyperglycemia-induced alteration of intracellular signaling and is unlikely due to the modulation of TLR expression.