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Hemoglobin vesicles (HbVs), liposomes containing concentrated hemoglobin extracted from outdated human red blood cells (RBC), are artificial oxygen carriers with a small particle size. To evaluate the reperfusion of capillaries with HbVs in a tracheal transplant model and compare it with that of RBC. Isogenic mice were used as donors and recipients in a parallel trachea transplant model. Both ends of the donor trachea were anastomosed end-laterally to the recipient trachea to form in parallel. After transplantation, 0.3 mL of HbV solution (Hb concentration, 10 g/dL) was administered via the tail vein. The recipients were euthanized 1, 4, 6, and 8 h after surgery (n = 5 in each group). The tracheas were harvested, and tracheal subepithelial capillaries (SEC) reperfusion was histologically evaluated. A significant number of particles defined as HbV by electron microscopy were observed in the SEC of the grafted tracheas 4 h after the transplant surgery and HbV administration when no RBC were found in the SECs. The number increased 6 and 8 h later. Our findings suggest that HbVs, which are smaller than RBC, can reperfuse the capillaries of grafts earlier than RBCs after transplantation and contribute to the oxygenation of transplanted tissues.

Thymic adenocarcinoma is a rare disease and enteric-type thymic adenocarcinoma is even more rarely found. We report a resected case of a non-mucinous, enteric-type thymic adenocarcinoma in a 53-year-old woman. The operation was performed by median sternotomy, and the tumor was stage II in the Masaoka classification. Six months after the operation, recurrence-free follow-up is currently underway. Knowledge of enteric-type thymic adenocarcinoma can prevent misdiagnosis of metastatic tumors. We also determined the prognosis of enteric-type thymic adenocarcinoma based on histological subtypes through our literature review.

The molecular mechanisms underlying the development of pulmonary fibrosis remain unknown, and effective treatments have not yet been developed. It has been shown that oxidative stress is involved in lung fibrosis. Oxidized diacylglycerol (DAG) produced by oxidative stress is thought to play an important role in lung fibrosis. This study assessed the effect of oxidized DAG in an animal model of pulmonary fibrosis induced by aspiration of bleomycin (BLM) into the lungs. The inhibitory effect of ebselen on pulmonary fibrosis was also investigated. In lung fibrotic tissue induced by BLM, an increase in lipid peroxides and collagen accumulation was observed. Moreover, the levels of oxidized DAG, which has strong protein kinase C (PKC) activation activity, were significantly increased over time following the administration of BLM. Western blotting showed that phosphorylation of PKCα and δ isoforms was increased by BLM. Oral administration of ebselen significantly suppressed the increase in oxidized DAG induced by BLM and improved lung fibrosis. PKCα and δ phosphorylation were also significantly inhibited. The mRNA expression of α-smooth muscle actin and collagen I (marker molecules for fibrosis), as well as the production of transforming growth factor-β and tumor necrosis factor-α(a potentially important factor in the fibrotic process), were increased by BLM and significantly decreased by ebselen. The administration of BLM may induce lipid peroxidation in lung tissue, while the oxidized DAG produced by BLM may induce overactivation of PKCα and δ, resulting in the induction of lung fibrosis.

We developed a Subclinical Dissociation Scale by comparing healthy controls with patients with post-traumatic stress disorder (PTSD) or dissociative disorder. The Dissociative Experiences Scale, Subclinical Dissociation Scale, and General Health Questionnaire were completed by 441 healthy Japanese adolescents (mean age, 19.9 years) and 23 psychiatric inpatients (mean age, 28.8 years) diagnosed with PTSD or dissociative disorder. The initial Subclinical Dissociation Scale included 52 items grouped into five factors: F1, absentmindedness (14 items); F2, immersion or preoccupation (15 items); F3, temporary amnesia (10 items); F4, feelings of unreality (eight items); and F5, feelings of alienation (five items). Factor and correlation analyses revealed the validity and reliability of the Subclinical Dissociation Scale. The final version of the scale that comprised three factors (F1, F2, and F4) and 37 items underwent logistic regression and receiver operating characteristic (ROC) curve analyses to compare healthy controls with patients with PTSD or dissociative disorder. The ROC curve analysis using the Youden Index indicated a cut-off score of 18 for the borderline or abnormal range, which was calculated using the following formula: "(F1) + (F4) - (F2)." This study provides evidence of the partial test-retest reliability and con current validity of the Subclinical Dissociation Scale.

The Janus kinase/signal transducers and activators of transcription signaling pathway induces programmed death ligand-1 (PD-L1) expression. JAK2 mutation at position 617 (JAK2V617) is a frequent driver of myeloproliferative neoplasms (MPN) through PD-L1 expression. Although PD-1 inhibitors should be effective against MPN with JAK2V617F mutation, this has not yet been reported in humans. Thus, we assessed the efficacy of a PD-1 inhibitor in a lung cancer patient with JAK2V617F-positive essential thrombocythemia (ET). A 71-year-old man was diagnosed with ET, and with lung carcinoma 3 years later. After right lobectomy and postoperative chemotherapy, pembrolizumab [a PD-1 inhibitor (200 mg, every 3 weeks)] was initiated for refractory lung carcinoma. Lung cancer progression did not occur for 1.5 years under treatment. Most megakaryocytes were PD-L1-positive, and after pembrolizumab initiation, platelet count remained below 45 × 104/μL without the need for other cytoreductive therapies for ET. The JAK2V617F allele burden gradually decreased from 11.5% at diagnosis to 2.9% after 17 months of pembrolizumab treatment. Other peripheral blood lineages did not decrease, and pembrolizumab treatment was continued without any adverse events. This is the first report demonstrating the effectiveness of pembrolizumab in an MPN patient with JAK2V617F mutation.

Highlights • Granulation or cicatrization on the tracheal lumen increases after injury or ischemia caused by tubes or cuffs, results in narrowing of the trachea within a few months after extubation. • We have described a case of tracheal stenosis that manifested 35 years after endotracheal intubation for neonatal resuscitation. • The scar tissue was ablated using argon plasma coagulation, and no recurrence has been observed for more than 3 years. • Delayed postintubation tracheal stenosis should be taken into consideration, when a patient suffers from suffocating tracheal stenosis., Introduction Postintubation tracheal stenosis involves granulation or cicatrization of the tracheal epithelium. It is progressive and can become life-threatening within a few months after extubation. Presentation of case We here report a case of tracheal stenosis with a delayed manifestation, presenting 35 years after endotracheal intubation for neonatal resuscitation. A female patient complained of dyspnea during pregnancy. Bronchoscopy revealed 75% constriction of the tracheal lumen by cicatrization, from the 2nd to 4th tracheal rings. After child-birth, the scar tissue was ablated using argon plasma coagulation. Discussion The patient had no significant medical history, such as severe airway infection or cervical/chest trauma, which might have caused the circumferential cicatricial tracheal stenosis, other than the endotracheal intubation she had undergone for neonatal resuscitation. Therefore, we considered this to reflect postintubation tracheal stenosis with delayed manifestation. Conclusion Delayed postintubation tracheal stenosis should be taken into consideration, when a patient suffers from suffocating tracheal stenosis.

We report an extremely rare case of 42-year-old man, d iagnosed with thymic dedifferentiated liposarcoma (DDL) having a leiomyosarcomatous dedifferentiated component. The tumor was composed of atypical spindle cells. The morphological atypia was also observed around thymic adipose tissue. Immunohistochemically, the spindle cells were positive for desmin, smooth muscle actin, MDM2 and CDK4. MDM2 and CDK4 were also positive for the thymic adipose tissue.

We report on an 81-year-old male patient in whom chest computed tomography during follow-up for extramammary Paget's disease revealed a nodule in the right thoracic cavity. Because he had been taking methotrexate for rheumatoid arthritis, the possibility of methotrexate-associated lymphoproliferative lung disease was considered and methotrexate was discontinued as a precaution. No calcification was found inside the nodule, and there was no change in its size or position for 6 months. The patient had a history of malignant tumor, so thoracoscopic surgery was performed for diagnostic purposes. A free white nodule was found in the right thoracic cavity and was subsequently removed. The pathological diagnosis was thoracolithiasis; although the nodule had not moved since its discovery, movement was suspected to have occurred 3 years prior. Although thoracolithiasis is rare, it should be considered as a differential diagnosis for nodules at the end of the lung field and on the diaphragm.

Epithelial cells form epithelial tissue structures by joining together

Glomus tumors are rarely developed in the lung. We report a case of a pulmonary glomus tumor that was observed for a long period. The patient was a 50-year-old man. Chest computed tomography showed a 6 mm nodule in the left lower lobe. The patient requested follow-up observation. The nodule gradually increased and was resected 6 years later. Pulmonary partial resection was performed thoracoscopy. The lesion was diagnosed as a glomus tumor with no malignant features. Pulmonary glomus tumors are rare and difficult to diagnose before resection. However, care is necessary as they may be malignant.

To conduct a thorough online workshop on infection control under COVID-19 and to conduct a questionnaire survey on the online workshop.The Tokai University School of Medicine has held 39 workshops to acquire the curriculum planning ability required as a faculty member of the School of Medicine. Due to the COVID-19 pandemic, this year (2020) we were unable to hold a workshop. Therefore, we attempted an online workshop using Zoom.To shorten the amount of time required for the workshop, we excluded some content that was used the previous year. The day passed without any major problems, and both the participants and the individuals in charge of the workshop filled out a questionnaire at the end of the day.Conclusion: Online workshops appear to be a very useful tool in terms of infection control under the COVID-19 pandemic.

The incidence of synchronous multiple primary lung cancers has increased in recent years, however, there are few reports of cases involving small cell carcinoma. A 72-year-old man was referred to our department because of an abnormal shadow on chest radiography. He was receiving treatment for pulmonary fibrosis, emphysema, rheumatoid arthritis, and prostate cancer. Computed tomography revealed two lung nodules in the left lower lobe. A definitive diagnosis was unable to be made based on transbronchial lung biopsy. Positron emission tomography demonstrated abnormal fluorodeoxyglucose uptake in the two lung nodules and lung cancer (cT3N0M0) was suspected. Thoracoscopic partial resection of the left lower lobe was performed. As primary lung cancer was diagnosed using the frozen specimen, we performed left lower lobectomy with lymph node dissection. Pathological examination of the S9 and S6 tumors revealed combined small cell carcinoma and squamous cell carcinoma, respectively. Both tumors were separated and diagnosed as synchronous multiple primary lung cancers. No lymph node metastasis was found. We report a rare case of synchronous multiple primary lung cancers, including small cell carcinoma.

The risk factors for bleomycin-induced lung injury (BLI), a fatal complication of cancer chemotherapy, are not well-established. The renin-angiotensin-aldosterone system (RAAS) has recently been suggested to play a role in the development of lung injury. This study clarified the impact of hypertension (HTN) and the administration of RAAS inhibitors on BLI occurrence in patients treated with bleomycin-containing regimens.We retrospectively analyzed the data of 190 patients treated with a bleomycin-containing regimen for Hodgkin lymphoma or germ cell tumors at our institutions from 2004 to 2018.Overall, 190 patients received bleomycin, and symptomatic BLI occurred in 21 (11.1%) cases. In the multivariate analysis, age ≥ 65 years (odd ratio, 10.90; 95% confidence interval, 3.72-32.20; P .001) and history of HTN (odds ratio, 3.32; 95% confidence interval, 1.07-10.30; P = .04) were found to be significant risk factors for BLI onset. BLI occurred in 3.6% (n = 5) of patients with no risk, 11.8% (n = 2) of those whose only risk factor was HTN, 31.6% (n = 6) of those whose only risk factor was age ≥ 65 years, and 57.1% (n = 8) of those with both risk factors (P .001). BLI-induced mortality rates in each group were 0.0% (n = 0), 5.9% (n = 1), 10.5% (n = 2), and 42.9% (n = 6) (P .001), respectively. Among 31 patients with HTN, BLI incidence was 12.5% in patients who were administered RAAS inhibitors and 53.3% in those who were not (P = .02).Older age and history of HTN were independent risk factors for the development of BLI, and the administration of RAAS inhibitors might reduce the onset of BLI.

BackgroundAlthough development of immune checkpoint inhibitors and various molecular target agents has extended overall survival time (OS) in advanced non-small cell lung cancer (NSCLC), a complete cure remains rare. We aimed to identify features and treatment modalities of complete remission (CR) cases in stages III and IV NSCLC by analyzing long-term survivors whose OS exceeded 3 years.MethodsFrom our hospital database, 1,699 patients, registered as lung cancer between 1stMar 2004 and 30thApr 2011, were retrospectively examined. Stage III or IV histologically or cytologically confirmed NSCLC patients with chemotherapy initiated during this period were enrolled. A Cox proportion hazards regression model was used. Data collection was closed on 13thFeb 2017.ResultsThere were 164 stage III and 279 stage IV patients, including 37 (22.6%) and 51 (18.3%) long-term survivors and 12 (7.3%) and 5 (1.8%) CR patients, respectively. The long-term survivors were divided into three groups: 3 ≤ OS < 5 years, 5 years ≤ OS with tumor, and 5 years ≤ OS without tumor (CR). The median OS of these groups were 1,405, 2,238, and 2,876 days in stage III and 1,368, 2,503, and 2,643 days in stage IV, respectively. The mean chemotherapy cycle numbers were 16, 20, and 10 in stage III and 24, 25, and 5 in stage IV, respectively. In the stage III CR group, all patients received chemoradiation, all oligometastases were controlled by radiation, and none had brain metastases. Compared with non-CR patients, the stage IV CR patients had smaller primary tumors and fewer metastases, which were independent prognostic factors for OS among long-term survivors. The 80% stage IV CR patients received radiation or surgery for controlling primary tumors, and the surgery rate for oligometastases was high. Pathological findings in the stage IV CR patients revealed that numerous inflammatory cells existed around and inside resected lung and brain tumors, indicating strong immune response.ConclusionsMultiple line chemotherapies with primary and oligometastatic controls by surgery and/or radiation might achieve cure in certain advanced NSCLC. Cure strategies must be changed according to stage III or IV.This study was retrospectively registered on 16thJun 2019 in UMIN Clinical Trials Registry (number UMIN000037078).

Congenital cystic adenomatoid malformation (CCAM) is a congenital pulmonary cystic disease that is mostly detected and diagnosed prenatally or during the neonatal period, while rarely being observed in adults. Here, we report an adult case of CCAM that was diagnosed following surgery for a recurrent pneumothorax. We further review 60 case reports on adult CCAM that have been previously published. The patient was a 29-year-old woman with a severe left pneumothorax. Her computed tomography scan showed the presence of multiple pulmonary cysts at the base of the left lower lobe. Since she had experienced a left pneumothorax twice previously, surgery was indicated. A wedge lung resection of the pulmonary cysts was performed thoracoscopically. The postoperative pathological diagnosis was type I CCAM. From the review, 7 adult CCAM patients (11.7%) out of 61, including the patient in the present case, presented with pneumothorax, while 21 patients (35%) presented with infection. Thirty-nine foci of CCAM (65%) were located in lower lobes. Moreover, malignancies were associated in 8 cases (13.3%). We propose that if multicystic lung lesions are found in pneumothorax patients, particularly in lower lobes, CCAM should be considered during the differential diagnosis, even in adults.

Background Recently, thoracoscopic resection of pulmonary sequestration has become more common, since resection of an aberrant artery using an end-stapler is a safe maneuver in many cases. However, injury of the vessels can lead to major hemorrhage. We reported our surgical experience based on thoracoscopic surgery, with five cases of interlobar pulmonary sequestration, focusing on precautions for aberrant arterial vessels. Object and methods We performed pulmonary resections for five patients with interlobar pulmonary sequestration in a lower lobe (left, n = 4; right, n = 1) between April 2004 and May 2020. All aberrant vessels were derived from the lower thoracic artery. Two patients had a single aberrant artery and three had multiple. In four patients, these vessels were detected before surgery, and pulmonary sequestration was diagnosed in four. In one elderly patient, the aberrant vessel was overlooked, and lung cancer was suspected before surgery. Angiography or multidetector-row computed tomography was subsequently performed in four cases. The surgical plan was determined according to the location and size of the pulmonary lesion and three-dimensional images of aberrant vessels. Result In all patients, approaches were made thoracoscopically. Hemorrhage from an anomalous vessel was encountered in one case. Pulmonary resections included two lobectomies and three limited resections. Angioplasty for the root of anomalous branches was performed following pulmonary resections under converted minimal lateral thoracotomy in two cases. Conclusion Preoperative assessment of the anatomical variations in abnormal vessels is essential to achieve safe surgical procedures. According to the situation of the aberrant vessels, selecting surgical procedures with consideration of potential subsequent complications arising over a long period of time is important.

We reported a surgical case of methotrexate-associated lymphomatoid granuloma. A 69-year-old female had been treated with methotrexate for rheumatoid arthritis for 35 months. The patient underwent partial resection of the right upper pulmonary lobe for lung cancer when she was 67 years old. A nodule was detected in the left lung field on a chest radiograph performed during the postoperative follow-up period. Computed tomography revealed a 28-mm nodule in the lower left pulmonary lobe. A transbronchial biopsy examination did not lead to a diagnosis. The pulmonary nodule subsequently increased in size. We suspected a malignant tumor and performed lower left lobectomy. A pathological examination revealed lymphomatoid granuloma. Finally, the patient was diagnosed with methotrexate-associated lymphomatoid granuloma based on her history of oral methotrexate treatment.

Sternal bone fractures with bilateral multiple rib fractures cause serious instability of the anterior chest wall, and prolonged mechanical ventilation may be required. A 45-year-old man was injured in a motor vehicle collision. He suffered from a bilateral flail chest injury accompanied by a transverse sternal fracture. Minimally invasive surgical stabilisation of the anterior chest wall was performed using two bars as per the Nuss procedure. Two days after surgery, he was extubated from artificial respiration and was ultimately discharged without any complications.

Pathological stage is the most important prognostic factor in patients with lung cancer, and is defined according to the tumor node metastasis classification system. The present study aimed to investigate the clinicopathological significance of lymphatic invasion in 103 patients who underwent surgical resection of lung squamous cell carcinoma (SqCC). The patients were divided into two groups, according to the degree of lymphatic invasion: Those with no or mild lymphatic invasion (ly0-1) and those with moderate or severe lymphatic invasion (ly2-3). Ly2-3 was associated with tumor size (P=0.028), lymph node metastasis (P

The principal insecticidal compounds from the herbal medicines Saishin, the root of Asarum sieboldii Miquel, and Sekishōkon, the rhizome of Acorus gramineus Soland, were isolated by successive silica gel column chromatography and high performance liquid chromatography. The active components, which work against larvae of the cigarette beetle, Lasioderma serricorne (F.), were identified as methyleugenol (4-allyl-1,2-dimethoxybenzene) and β-asarone {1,2,4-trimethoxy-5-[(Z)-prop-1-enyl]benzene} by gas chromatography and gas chromatography/mass spectrometry analyses. These two compounds share some structural features, such as a benzene ring with o-dimethoxy groups and a propenyl group in the opposite position. Consequently, the insecticidal activities of 20 structurally related compounds were tested to evaluate their structure–activity relationship. We found myristicin (5-allyl-1-methoxy-2,3-methylenedioxybenzene) exhibited comparable insecticidal activity to methyleugenol and β-asarone, but the other tested compounds were less active. The lack of insecticidal activity of compounds with a hydrogen, hydroxy, or acetoxy substituent in place of one methoxy group indicates that o-dimethoxy groups are essential for insecticidal activity. The position and configuration of a double bond in the propenyl side chain affected the toxicity, but there was a lack of consistency in the structure–activity relationship for this.

A 63-year-old man was pointed out with a mediastinal tumor on chest computed tomography (CT). On positron emission tomography-CT, fluorodeoxyglucose accumulation with a maximum standardized uptake value of 12.70 was seen in this tumor. Scar-like nodule was found in the apex of the right lung, but no abnormal accumulation was observed in this nodule. The level of carcinoembryonic antigen was abnormally elevated. We performed mediastinal tumorectomy under thoracoscopic surgery. Since arterial oxygen saturation fell during intraoperative one-lung ventilation, we finished the surgery without resection of right apex nodule. Histologically, mediastinal tumor was diagnosed as metastatic adenocarcinoma in lymph node. Because immunohistochemical staining suggested lung adenocarcinoma as the primary site, the right apex nodule was resected. Pathological diagnosis of this nodule was scar fibrosis. No other malignant lesions were detected, and therefore we finally diagnosed this tumor as mediastinal lymph node carcinoma of unknown primary site. The patient was given adjuvant chemotherapy, and at present, 37 months after surgery, the patient remains free of the disease.

A 54-year-old woman with adenocarcinoma of the lung and lymph node metastasis experienced nystagmus and cerebellar ataxia 2 weeks after initiating nivolumab therapy. An evaluation for several autoimmune-related antibodies and paraneoplastic syndrome yielded negative results. We eventually diagnosed the patient with nivolumab-induced acute cerebellar ataxia, after excluding other potential conditions. Her ataxic gait and nystagmus resolved shortly after intravenous steroid pulse therapy followed by the administration of decreasing doses of oral steroids. Nivolumab, an immune checkpoint inhibitor, is known to induce various neurological adverse events. However, this is the first report of acute cerebellar ataxia associated with nivolumab treatment.

We report a 16-year-old male with histiocytic sarcoma (HS) originating in the lung. Partial resection of the lung was performed for a 3-cm mass with a clear boundary detected in the right inferior pulmonary lobe on a health checkup. Histologically, the tumor infiltrated into the surrounding tissue, and was comprised of spindle cells, mainly, and foam cells accompanied by mild nuclear atypia. The tumor cells were immunohistochemically positive for CD68 and CD163, indicating histiocytic lineage and the MIB-1-positive rate was low. Spindle cell morphology of HS is quite rare and only 3 cases of pulmonary HS have previously been reported.

Podoplanin is a 38 kDa transmembrane protein that is involved in cell migration and cancer cell invasion. Some studies have reported that podoplanin expression was correlated with poor prognosis in lung squamous cell carcinoma (SqCC). However, there have been no clinicopathological studies of podoplanin membrane expression and localization in lung SqCC. In this study, we focused on the intensity and localization of podoplanin membrane expression, and its clinicopathological significance for lung SqCC. Strong membrane expression of podoplanin was significantly associated with lymph node metastasis, lymphatic invasion, and histological differentiation. Cases with strong podoplanin expression at cell membrane showed better prognosis of lung SqCC (HR, 3.301). Peripheral localization of podoplanin was associated with tumor size, lymphatic invasion, and histological differentiation. Cases with peripheral podoplanin expression showed favorable prognosis of lung SqCC (HR, 2.830). Both strong membrane expression and peripheral expression of podoplanin were independent predictors of mortality of lung SqCC (HR, 2.869; HR, 2.443, respectively). The cases with strong or peripheral podoplanin expression showed better overall survival (P = 0.001, both). Podoplanin intensity is significantly associated with podoplanin localization (P < 0.001), and its correlation coefficient was 0.678. We concluded that podoplanin membrane expression, not only its localization, is a useful prognostic indicator of lung SqCC patients.

Pulmonary hamartoma (PH) is usually a solid mass of less than 4 cm in size that contains cartilage omponents. A 44-year-old Japanese woman received surgical resection of a well-demarcated cystic tumor in the right lung. Resected tissue contained a 13 × 10 × 8 cm-sized solid mass with a prominent unilocular cyst (8 × 6.5 × 5 cm). The tumor was composed of a dominant smooth muscle cell (SMC) component with entrapped glandular respiratory epithelium. There was little cartilaginous or fatty tissue. Immunohistochemically, SMC was positive for smooth muscle actin (SMA) and desmin, as well as CD34. We report a unique case of giant pulmonary hamartoma with a dominant CD34 (+) SMC component.

Epithelial-mesenchymal transition (EMT) is an important step leading to invasion and migration of various cancer cells, and are characterized by decreased E-cadherin as an epithelial marker, and increased vimentin as a mesenchymal marker. The present study focused on the clinicopathological significance of E-cadherin and vimentin expression in lung squamous cell carcinoma (SqCC). Immunohistochemically, E-cadherin expression patterns were classified into two types: preserved or reduced; and vimentin expression patterns were also divided into two types: positive or negative. The univariate analyses showed six factors associated with increased mortality: tumor size (P = 0.031), lymph node metastasis (P0.001), lymphatic invasion (P0.001), histological differentiation (P = 0.036), E-cadherin reduced expression (P0.001), and vimentin positive expression (P = 0.004). Multivariate analysis demonstrated that E-cadherin reduced expression (P0.001), vimentin positive expression (P = 0.028), lymph node metastasis (P0.001), and age (P = 0.020) were independent predictors of patient mortality. There may be some correlation between E-cadherin and vimentin expression (P = 0.017), but the correlation coefficient was 0.235. The complete EMT and the incomplete EMT type were associated with a poor prognosis (p0.001 and p=0.036, respectively). The overall survival rate after curative resection was significantly lower in patients with the complete EMT type (reduced E-cadherin / positive vimentin). In conclusion, both E-cadherin and vimentin are independent predictors of mortality, and the EMT phenotype is a significant indicator of poor prognosis in lung SqCC.

Ischemia-reperfusion injury resulting in post-transplant lung dysfunction involves a complicated network of cytokines that has yet to be fully investigated. We analyzed temporal changes in cytokine levels in epithelial lining fluid (ELF) from the distal airways of a canine lung transplantation model.Ischemic time was set to 18 hours to enhance lung injury in a left single-lung transplantation model. ELF was collected via bronchoscopic microsampling, a minimally-invasive technique allowing repeated sampling, hourly up to 5 hours after reperfusion started. We compared levels of pro-inflammatory cytokines in ELF with those at baseline (time zero), and with a sham-operated control group.Concentrations of tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) significantly increased immediately after the start of lung reperfusion in the transplant group relative to the sham group (P0.005 and P0.05, respectively); both were sustained through the 5 hours. Interferon gamma (IFN-γ levels were significantly reduced 3 h after reperfusion started (P0.05).We found time- and cytokine-dependent changes in TNF-α, IL-6, and IFN-γ in ELF from the lung transplantation model. These specific changes in the cytokine profile may relate to the mechanism underlying post-transplant lung dysfunction.

Steroid hormones regulate life stage transitions, allowing animals to appropriately follow a developmental timeline. During insect development, the steroid hormone ecdysone is synthesized and released in a regulated manner by the prothoracic gland (PG) and then hydroxylated to the active molting hormone, 20-hydroxyecdysone (20E), in peripheral tissues. We manipulated ecdysteroid titers, through temporally controlled over-expression of the ecdysteroid-inactivating enzyme, CYP18A1, in the PG using the GeneSwitch-GAL4 system in the fruit fly Drosophila melanogaster. We monitored expression of a 20E-inducible glue protein gene, Salivary gland secretion 3 (Sgs3), using a Sgs3:GFP fusion transgene. In wild type larvae, Sgs3-GFP expression is activated at the midpoint of the third larval instar stage in response to the rising endogenous level of 20E. By first knocking down endogenous 20E levels during larval development and then feeding 20E to these larvae at various stages, we found that Sgs3-GFP expression could be triggered at an inappropriate developmental stage after a certain time lag. This stage-precocious activation of Sgs3 required expression of the Broad-complex, similar to normal Sgs3 developmental regulation, and a small level of nutritional input. We suggest that these studies provide evidence for a tissue-autonomic regulatory system for a metamorphic event independent from the primary 20E driven developmental progression.

A 14-year-old girl presented with progressively worsening intermittent orthopnea. Imaging studies showed cardiomegaly, extensive pericardial effusion, and a mediastinal tumor. By pericardial drainage, approximately 8,000-mL fluid was collected over 10 days. Left thoracoscopic pericardial fenestration and mediastinal tumor biopsy were performed, revealing lymphangiomatosis. Chylous pleural effusion developed post-surgery. Although control was attempted, her condition worsened. Eight months later, she died of sudden cardiopulmonary arrest. Autopsy revealed systemic spread of the primary lesion from the hyperplastic lymph ducts to the parietal pleura and mediastinum confirming systemic lymphangiomatosis.