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Background The advantages of segmentectomy over lobectomy in sparing pulmonary function remain controversial. Lower lobe segmentectomy is divided into simple segmentectomy, such as segment 6; and complex segmentectomy that includes the basal segments. Here, we compared residual lung function after thoracoscopic segmentectomy versus lobectomy in the lower lobe using the three-dimensional computed tomography volumetric method. Methods Between January 2012 and October 2020, 67 patients who underwent thoracoscopic segmentectomy of the lower lobe were matched to 67 patients who underwent thoracoscopic lower lobectomy during the same period using propensity score matching analysis. The postoperative decrease in the rate of forced expiratory volume in 1 s was compared between methods. The regional forced expiratory volume in 1 s of the residual lobe rescued by segmentectomy was measured using volumetric and spirometric analyses and compared to lower lobectomy. The ratio of the actual to predicted postoperative forced expiratory volume in 1 s in the residual lobe was defined as the preservation rate. Results Of the 67 thoracoscopic segmentectomies, 43 were S6, seven were S8, three were S8 + 9, seven were S10, and seven were S9 + 10. The percentage of postoperative/preoperative forced expiratory volume in 1 s was significantly higher in the segmentectomy versus lobectomy group (90.7% vs. 85.7%, p = 0.001). The preservation rates after simple segmentectomy ( n = 43) and complex segmentectomy ( n = 24) did not differ significantly (82.2% vs. 80.2%, p = 0.709). Conclusions Thoracoscopic lower lobe segmentectomy versus lobectomy preserves postoperative lung function. Even complex segmentectomy exhibited outcomes relevant to simple segmentectomy by sparing the residual lobe.

OBJECTIVES Through 3-dimensional lung volumetric and morphological analyses, we aimed to evaluate the difference in postoperative functional changes between upper and lower thoracoscopic lobectomy. METHODS A total of 145 lung cancer patients who underwent thoracoscopic upper lobectomy (UL) were matched with 145 patients with lung cancer who underwent thoracoscopic lower lobectomy (LL) between April 2012 and December 2018, based on their sex, age, smoking history, operation side, and pulmonary function. Spirometry and computed tomography were performed before and 6 months after the operation. In addition, the postoperative pulmonary function, volume and morphological changes between the 2 groups were compared. RESULTS The rate of postoperative decreased and the ratio of actual to predicted postoperative forced expiratory volume in 1 s were significantly higher after LL than after UL (P CONCLUSIONS Pulmonary function after thoracoscopic LL was superior to that after UL because the upward displacement and the pulmonary reserves of the remaining lobe appeared more robust after LL.

OBJECTIVES Although segmentectomy is an acceptable alternative to lobectomy for peripheral small-sized non-small-cell lung cancer, the effectiveness of segmentectomy for inner lesions remains unknown. The aim of this study was to examine the feasibility of segmentectomy in comparison with lobectomy for inner lesions. METHODS We retrospectively analysed 570 patients with small (≤2 cm) cN0 non-small-cell lung cancer who underwent segmentectomy or lobectomy between January 2007 and March 2021. We focused on patients with lesions located in the inner two-thirds, which were determined using three-dimensional computed tomography (n = 227). After propensity score matching analysis based on sex, age, pulmonary function, serum carcinoembryonic antigen level, radiographic tumour findings and tumour location, we compared the surgical and oncological outcomes in patients who underwent segmentectomy (n = 66) and lobectomy (n = 66). RESULTS Postoperative mortality or morbidity did not differ significantly between the 2 groups. The 5-year recurrence-free and overall survival rates in the segmentectomy and lobectomy groups were 93.6% vs 84.1% and 95.8% vs 87.9%, respectively. The differences between 2 groups were not significant (P = 0.62 and P = 0.23, respectively). The 2 groups also showed no differences in loco-regional recurrence. Multivariable Cox regression analysis revealed that segmentectomy had a comparable impact on recurrence-free survival (hazard ratio, 0.61; 95% confidence interval, 0.17–2.03; P = 0.43). CONCLUSIONS Segmentectomy for inner-located small-sized non-small-cell lung tumours could be an acceptable treatment in comparison with lobectomy.

OBJECTIVES Two methods are available to identify the intersegmental plane during segmentectomy: the inflation-deflation method, based on the ventilation area, and injection of indocyanine green, based on the pulmonary arterial distribution. However, whether the intersegmental plane created by these 2 methods matches remains unknown. Our goal was to identify the demarcation lines based on bronchial and arterial territories using 3-dimensional computed tomography-based volumetry. METHODS We collected data from patients who underwent thoracoscopic segmentectomy in our hospital between April 2012 and May 2021. Three-dimensional images were reconstructed from the preoperative contrast-enhanced computed tomography data using the SYNAPSE VINCENT software program. The volume of the affected area and the distance of the tumour from the intersegmental plane were calculated based on each affected artery and bronchus. Each calculated volume was compared to each affected segment using a paired t-test. RESULTS Of 195 patients, 114 underwent upper lobe segmentectomy, and 81 underwent lower lobe segmentectomy. In upper lobe segmentectomy, the affected arterial segmental volume was smaller than the bronchial volume (505.0 ml vs 539.4 ml, P CONCLUSIONS As per the results, the affected segmental volume delineated by the indocyanine green method would be underestimated in upper lobe segmentectomy.

OBJECTIVESWe investigated the influence of the preoperative haemoglobin A1c (HbA1c) value on the prognosis and pathology of patients with lung adenocarcinoma who underwent surgery.METHODSWe reviewed the medical records of 400 lung adenocarcinoma patients who underwent lobectomy with mediastinal lymph node dissection between 2009 and 2013 using a prospectively maintained database. We stratified 400 patients into 4 groups according to the preoperative HbA1c value as follows: HbA1c ≤ 5.9 (n = 296), 6.0 ≤ HbA1c ≤ 6.9 (n = 70), 7.0 ≤ HbA1c ≤ 7.9 (n = 21) and HbA1c ≥ 8.0 (n = 12). We compared the recurrence-free survival and overall survival (OS) among these 4 groups. Univariate and multivariate analyses were performed to identify the risk factors for recurrence.RESULTSThe median follow-up period was 61.2 months. On comparing the recurrence-free survival and OS rates among these 4 groups, we found that these rates among patients in the HbA1c ≥ 8.0 group were significantly poorer compared with the other 3 groups (5-year recurrence-free survival: HbA1c ≤ 5.9, 70.4%; 6.0 ≤ HbA1c ≤ 6.9, 69.7%; 7.0 ≤ HbA1c ≤ 7.9, 70.7%; ≥8.0 HbA1c, 18.8%; P = 0.002; and 5-year OS: HbA1c ≤ 5.9, 88.7%; 6.0 ≤ HbA1c ≤ 6.9, 80.6%; 7.0 ≤ HbA1c ≤ 7.9, 90.2%; ≥8.0 HbA1c, 66.7%; P = 0.046). Patients in the HbA1c ≥ 8.0 group had significantly more tumours with vascular invasion (P = 0.041) and experienced distant metastasis significantly more often (P = 0.028) than those with other values. A multivariate analysis revealed that preoperative HbA1c ≥ 8.0 [hazard ratio (HR) 2.33; P = 0.026] and lymph node metastasis (HR 3.94; P CONCLUSIONSOur results revealed that preoperative HbA1c ≥ 8.0 is associated to poor prognosis due to the occurrence of distant metastasis and we should carefully follow these patients after surgery.Clinical registration numberHyogo Cancer Center, G-57.

OBJECTIVES Despite significant advances in surgical techniques, including thoracoscopic approaches and perioperative care, the morbidity rate remains high after lung resection. This study focused on a low attenuation cluster analysis, which represented the size distribution of pulmonary emphysema and assessed its utility for predicting postoperative pulmonary complications after thoracoscopic lobectomy. METHODS From April 2013 to September 2018, lung cancer patients who received spirometry and computed tomography (CT) before surgery and underwent thoracoscopic lobectomy were included. The cumulative size distribution of the low attenuation area (LAA, defined as ≤−950 Hounsfield unit on CT) clusters followed a power-law characterized by an exponent D-value, a measure of the complexity of the alveolar structure. D-value and LAA% (LAA/total lung volume) were calculated using preoperative 3-dimensional CT software. The relationship between pulmonary complications and patient characteristics, including D-value and LAA%, was investigated. RESULTS Among 471 patients, there were 61 respiratory complication cases (12.9%). Receiver operation characteristic curve analysis revealed that the best predictive cut-off value of D-value and LAA% for pulmonary complications was 2.27 and 16.5, respectively, with an area under the curve of 0.72 and 0.58, respectively. D-value was significantly correlated with % forced expiratory volume in 1 s. Per univariate analysis, gender, smoking history, forced expiratory volume in 1 s/forced vital capacity, LAA% and D-value were risk factors for predicting postoperative pulmonary complications. In the multivariate analysis, D-value remained a significant predictive factor. CONCLUSION Preoperative assessment of emphysema cluster analysis may represent the vulnerability of the operated lung and could be the novel predictor for pulmonary complications after thoracoscopic lobectomy.

OBJECTIVES Pleural invasion (pl) is strongly associated with the pleural lavage cytology (PLC) status. We analysed tumours with pl and evaluated the relationship between the PLC status and pl. METHODS We retrospectively reviewed 428 surgically treated patients who had been diagnosed with non-small-cell lung cancer with pl and had their PLC status examined between 2000 and 2016. We investigated the influence of a PLC-positive status on the prognosis and searched for the factors predictive of a PLC-positive status. RESULTS Seventy-eight (18%) patients were PLC positive. The recurrence-free survival of PLC-positive patients was significantly worse than that of PLC-negative patients in pl1 and pl2, but not in pl3 (5-year recurrence-free survival rate, PLC positive versus PLC negative: pl1, 22.0% vs 60.0%, P = 0.002; pl2, 30.4% vs 59.7%, P = 0.015; pl3, 50.0% vs 59.6%, P = 0.427). A multivariable analysis showed that the degree of pl (pl2–3 versus pl1) [odds ratio (OR) 5.34, P CONCLUSIONS If a tumour was suspected of being pl2–3 and had EGFR mutation positivity and CEA ≥5 ng/ml, the PLC-positive rate was extremely high. Clinical trial registration number Hyogo Cancer Center, G-138.

OBJECTIVES Segmentectomies such as S1 + 2, S1 + 2+3 and S4 + 5 segmentectomy are used to treat patients with non-small-cell lung cancer (NSCLC) in the left upper lobe. However, the preservable lung volume and changes after such segmentectomies remain unknown. We compared the residual pulmonary function after thoracoscopic segmentectomy or lobectomy in the left upper lobe and examined the efficacy of S1 + 2 segmentectomy regarding postoperative pulmonary function. METHODS Patients with left upper lobe NSCLC who underwent thoracoscopic segmentectomy or lobectomy were included. Spirometry and computed tomography were performed before and 6 months after resection, and the ipsilateral preserved lobe volume was calculated using 3-dimensional computer tomography. The percentage of postoperative/preoperative forced expiratory volume in 1 s and actual/predicted regional forced expiratory volume in 1 s (preservation rate) in the residual lobe were compared. RESULTS Eighty-eight patients underwent lobectomy and 70 patients underwent segmentectomy (23 S1 + 2, 35 S1 + 2+3 and 12 S4 + 5 segmentectomies). The percentage of postoperative/preoperative forced expiratory volume in 1 s was 97 in S1 + 2, 82 in S1 + 2+3, 86 in S4 + 5 segmentectomy and 73 in left upper lobectomy, indicating that segmentectomy could be a meaningful approach to preserve pulmonary function. The preservation rate was 83% in S1 + 2 and 62% in S1 + 2+3 segmentectomy and was significantly higher in S1 + 2 than in S1 + 2+3 segmentectomy (P CONCLUSIONS Postoperative pulmonary function and the preservable lung volume of the residual lobe after thoracoscopic S1 + 2 segmentectomy were well-preserved among other segmentectomies and lobectomy. Thoracoscopic S1 + 2 segmentectomy is a good alternative for preserving postoperative function.

Background Partner of Sld five 3 (Psf3) is a member of the heterotetrameric complex that consists of SLD5, Psf1, Psf2, and Psf3. We have shown in previous studies that high Psf3 expression was a poor prognostic marker for pulmonary adenocarcinoma. Here, we statistically evaluated the relationship between clinicopathologic factors and Psf3 expression in stage I pulmonary adenocarcinoma. Methods A total of 583 patients who had undergone complete resection of stage I pulmonary adenocarcinoma from January 2002 to December 2009 were included in the study. Tissue microarrays were performed, and the resected tumors were divided into groups according to Psf3 expression. Results Of 583 patients, high expression of Psf3 was observed in 211 (36.2%) and low expression of Psf3 observed in 372 (63.8%) patients. Among stage I patients, the five-year survival rate was 76.7% in the Psf3 high expression group and 90.9% in the Psf3 low expression group (P < 0.0001). On multivariate analysis, Psf3 was found to be the independent prognostic factor. Among stage I patients in the Psf3 high expression group, a significantly greater five-year survival rate was observed in patients who received postoperative chemotherapy with tegafur-uracil than in those who underwent surgery alone (P < 0.0001). In contrast, among stage I patients in the Psf3 low expression group, no difference was found in the five-year survival, regardless of the presence or absence of tegafur-uracil (P = 0.873). Conclusion The Psf3 expression was an independent prognostic factor and could be a biomarker of adjuvant tegafur-uracil for stage I pulmonary adenocarcinoma. Key points Significant findings of the study: The Psf3 expression could be a biomarker of adjuvant tegafur-uracil administration for stage I pulmonary adenocarcinoma. What this study adds: Appropriate patients of adjuvant chemotherapy for stage I pulmonary adenocarcinoma using Psf3 expression could be selected.

Background: Large-cell neuroendocrine carcinoma (LCNEC) and small cell lung cancer (SCLC) are categorized as high-grade neuroendocrine carcinoma (HGNEC). We analyzed the efficacy of perioperative chemotherapy for HGNEC and the prognostic factors. Methods: We retrospectively reviewed the medical records of patients who underwent tumor resection and were diagnosed with HGNEC between January 2001 and December 2014. The overall survival (OS) was estimated by the Kaplan-Meier method. Propensity score matching was performed to compare the OS between the treatment groups. Multivariate analyses using a Cox proportional hazards model were performed to search for prognostic factors for HGNEC. Results: We analyzed 146 HGNEC patients (LCNEC n=92, SCLC n=54) without synchronous multiple cancers, who underwent complete resection. Seventy patients (LCNEC n=31, SCLC n=32) received perioperative chemotherapy and all of them received a platinum-based anticancer drug. Perioperative chemotherapy significantly improved the 5-year OS rates of HGNEC patients (all stages: 74.5% vs. 34.7%, P

Rhabdomyosarcoma is a well-known neoplasm in children that frequently occurs in the extremities, the head and neck region, and the genitourinary tract. To the best of our knowledge, pulmonary primary rhabdomyosarcoma in adults is exceedingly rare, and few resected cases have been reported. We report a case of pulmonary primary rhabdomyosarcoma that was surgically resected then treated with adjuvant chemotherapy (vincristine, actinomycin-D and cyclophosphamide). At 9 months after surgery, the patient is free from disease. Although the prognosis of rhabdomyosarcoma is unfavorable, surgical resection and adjuvant therapy could be a potential treatment strategy for pulmonary primary rhabdomyosarcoma.

A pneumatocele is a cystic change of the lung that is caused by a check valve in the bronchiole due to infection, trauma and positive-pressure ventilation. We herein report a case of pneumatocele triggered by using of continuous positive airway pressure (CPAP) for sleep apnea syndrome (SAS) after pulmonary resection. A 69-year-old man underwent right upper lobectomy for lung cancer and developed interstitial pneumonia (IP) 10th postoperative day (POD). He was treated with steroid pulse therapy (solmedrol 500 mg × 3 days), and thereafter with oral steroid therapy (predonin 30mg/day). Well responded to the steroid therapy, IP was improved. However, he noticed bloody sputum 29th POD, and chest computed tomography showed a giant cystic lesion on the dorsal right lower lobe. We resected the cyst and the pathological findings revealed that the cystic lesion was pneumatocele, and CPAP was strongly suspected of triggering this disease.

A 69-year-old man with hypertension was referred for an abnormal shadow detected on chest computed tomography(CT) at a medical checkup. Enhanced CT showed a highly enhanced posterior mediastinal tumor of 34×27 mm. Magnetic resonance imaging (MRI) revealed a low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Thus, a neurogenic tumor was suspected and the surgery was performed. The tumor was carefully dissected as it was hyper-vascular and hemorrhagic. Immediately after tumor resection, the patient's blood pressure rapidly decreased, and phenylephrine hydrochloride was needed to maintain the blood pressure. The pathological diagnosis was paraganglioma.

Background This study compares long-term prognosis of intentional extended segmentectomy and lobectomy of clinical T1aN0M0 non-small cell lung cancer (NSCLC). Risk factors of local-regional recurrence are identified and segmentectomy outcomes are examined per segment. Methods 164 intentional extended segmentectomies were compared with 73 lobectomies subcategorized by consolidation to maximum tumor diameter ratio (C/T) measured by computed tomographies. Preoperative characteristics were propensity score matched to evaluate local-regional recurrence-free survival using the log-rank test. Preoperative factors and surgical procedure were analyzed with the Cox proportional hazards regression model to identify independent predictor of local-regional recurrence. Local-regional recurrence per segment were assessed by Kaplan-Meier estimates between both groups. Results No recurrences were observed for 46 C/T ≤0.5 segmentectomies. In 59 C/T >0.5 propensity score-matched pairs, 5-year local-regional recurrence-free survival rates of segmentectomies were 76.3%, versus 91.5% for lobectomies ( p = 0.082). Multivariate analysis confirmed segmentectomies to be the only independent risk factor for local-regional recurrence-free probability ( p = 0.020). Subset analysis reveals superior segmentectomies have significantly less local-regional recurrence ( p = 0.029) than other segments and comparable prognosis to lower lobectomies. Left upper lobe segmentectomies also showed comparable prognosis to lobectomies. Segmentectomies in the right upper lobe and of basal segments showed significantly higher local recurrence ( p = 0.001) than other segments. Basal segmentectomies showed significantly poor prognosis versus lower lobectomies ( p = 0.005). Conclusions For radiographically invasive right upper lobe or basal segment clinical T1a NSCLC, strict inclusion criteria is necessary for intentional segmentectomy. For superior and left upper lobe segments, however, segmentectomies may be preferred with prognosis comparable to lobectomies.

An indium oxide-based precursor solution has been developed by spin coating method. In order to apply this material to mass production, material, process, and equipment optimizations for slot die coating have been implemented. Slot die coating is a cost-effective and scalable process and already applied to photoresist materials in the display industry. The indium oxide-based precursor solution has been coated on bare glasses and thin-film transistor substrates by a mass production-type slot die coater. Mobility of over 10 cm2/Vs is achieved for the first time for a large area at an annealing temperature of 350 °C. The homogeneity of the film will be presented.

An indium oxide based precursor solution has been developed by spin-coating method. In order to apply this material to a mass production, material, process and equipment optimizations for slot die coating have been implemented. Slot die coating is a cost-effective, scalable process and already applied to photoresist materials in the display industry. The indium oxide based precursor solution has been coated on bare glasses and TFT substrates by a mass production type slot die coater. Mobility of over 10cm2/Vs is achieved for the first time for large area at annealing temperatures of 350°C. The homogeneity of the film will be presented.

Background Segmentectomy has shown a beneficial effect on preserving lung function after resection. However, the preservable lung volume and changes after thoracoscopic segmentectomy remain unknown. We compared the residual lung function after thoracoscopic segmentectomy and lobectomy, using a novel three-dimensional computed tomography-based volumetric method. Methods Seventy-four patients who received thoracoscopic segmentectomy were matched to the 74 patients who received thoracoscopic lobectomy. Spirometry and computed tomography were performed before and 6 months after resection, and the ipsilateral residual preserved and nonoperated lobe volume and the contralateral lung volume were calculated using three-dimensional computed tomography. The percentage of actual/predicted regional forced expiratory volume in 1 second (the preservation rate) in each lobe (measured by volumetry and spirometry) was compared with the extent of resection and procedural difficulty (typical or atypical segmentectomy). Results The postoperative lung function was significantly more well preserved in segmentectomy than in lobectomy. After segmentectomy and lobectomy, the regional forced expiratory volume in 1 second of the ipsilateral unaffected lobe was increased in comparison with the preoperative value, whereas that of the residual lobe rescued by segmentectomy was decreased. The preservation rates of the residual and unaffected lobes were inversely and positively correlated, respectively, with the extent of the resected segment. The preservation rates of the residual lobe after typical or atypical segmentectomy were not significantly different. Conclusions Although the decrease in the actual lung function of the residual lobe was greater than predicted and increased with increasing extent of resection, segmentectomy preserved the whole lung function better than lobectomy.

We aimed to analyze the risk factors of postoperative cerebral infarction (CI) and thrombus formation in the left upper pulmonary vein (PV) stump after lobectomy. We retrospectively investigated 1670 patients who underwent lobectomy or more intervention, and analyzed the risk factors of postoperative CI. Furthermore, postoperative contrast-enhanced computed tomography (CE-CT) were reviewed in patients who underwent left upper lobectomy (LUL), and risk factors of the thrombus formation in the left upper PV stump were evaluated. Chi-square test or unpaired t test was used to compare the factors. Cerebral infarction was observed in 10 (0.60%) patients, being more significant in patients with left side lesions (90%) who underwent LUL (50%). Eighty percent of the CI cases occurred by day 4 postoperative. CI was found in 1.47% after LUL. Among 339 patients who underwent LUL, CE-CT was performed in 137 (40%) postoperatively. Among them, left upper PV stump thrombus was found in 16 (11.7%), which was statistically significant in higher age and p stage II or more disease (= 0.003, 0.040). In contrast, preoperative histories including anticoagulant administration, atrial fibrillation, diabetes mellitus, several surgical procedures or intraoperative factors were not associated statistically with thrombus formation. Postoperative CI occurred in the very early-phase after lobectomy, and the incidence was significantly higher in patients undergoing LUL. Because left upper PV stump thrombus was frequently found retrospectively, a prospective observation study would be required to investigate the real incidence of PV stump thrombus after lobectomy.

Background The aim of this study was to evaluate the efficacy of buttressed stapling using a stapler with an attached polyglycolic acid sheet in reducing the rate of air leak associated with pulmonary lobectomy. Materials and Methods A prospective, randomized, phase III study was conducted to confirm the superiority of a buttressed stapler in a test treatment group to a conventional nonbuttressed stapler in a current international standard of care group among patients undergoing pulmonary lobectomy. The primary end point was the frequency of intraoperative air leaks. Results Although no fatal postoperative bleeding occurred in the present study, this trial closed early with 100 patients because the manufacturer recalled the buttressed stapler based on reports of 13 serious injuries and 3 fatalities following pulmonary resection in routine clinical practice. A total of 76 patients treated with a stapler (35 in the non-B group and 41 in the B group) were included as subjects in the analysis. No statistical differences were observed between the groups in the frequency of intraoperative air leaks (22 [63%] vs. 26 [63%]) or the postoperative duration of air leaks (mean: 3.5 vs. 2.9 days). The frequency of air leak from stapler holes was significantly lower in the B group than in the non-B group (2% [1/41] vs. 20% [7/35]; p = 0.016). Conclusions The efficacy of buttressed stapling in reducing the rate of air leak in patients undergoing pulmonary lobectomy could not be clearly demonstrated. However, air leak from stapler holes can be prevented with buttressed stapling.

OBJECTIVES: Phase III trials regarding the feasibility of segmentectomy for lung cancer ≤2 cm in size are now underway in Japan and the USA. However, despite their small size, lung cancers that show a pure-solid appearance on thin-section computed tomograpy (CT) are considered to be invasive with a high frequency of nodal involvement. METHODS: Between 2008 and 2011, 556 clinical Stage IA lung cancer patients underwent pulmonary resection. For all patients, the findings obtained by preoperative thin-section CT were reviewed and the maximum standardized uptake value (SUVmax) on positron emission tomography was recorded. Several clinicopathological features were investigated to identify predictors of nodal metastasis using multivariate analyses. RESULTS: One hundred and eighty-four clinical Stage IA lung cancer patients showed a pure-solid appearance on thin-section CT. Among them, air bronchogram was found radiologically in 58 (32%) patients. Nodal involvement was observed in 10 (17%) patients with air bronchogram, compared with 43 (34%) without air bronchogram, in clinical Stage IA pure-solid lung cancer. A multivariate analysis revealed that air bronchogram, clinical T1a and SUVmax were significant predictors of postoperative nodal involvement (P< 0.01

Background The aim of this study was to clarify the outcomes of lung resection for lung cancer in patients with cardiac disease, especially coronary artery disease, in a large-scale multi-institutional cohort. Methods We retrospectively analyzed the data on 1,254 patients who underwent major lung resection for lung cancer and had been diagnosed with coronary stenosis, atrial fibrillation, or both, in 58 institutions in Japan between January 2009 and December 2011. The primary outcome was 90-day postoperative mortality or in-hospital death. Results Among the 1,254 patients, 902 (71.9%) and 452 patients (36.0%) were preoperatively diagnosed with coronary stenosis and atrial fibrillation, respectively, and 951 patients (75.8%) received antiplatelet therapy. Among the patients with coronary stents (n = 532; 42.4%), 204 (16.3%) received drug-eluting stents. The 90-mortality or in-hospital death rate was 2.6% (n = 32), including stent thrombosis (n = 1), thromboembolic events without stent thrombosis (n = 2), and bleeding events (n = 2). In the multivariate analyses, blood transfusion, history of cerebrovascular disease, amount of bleeding, and history of congestive heart failure were associated with a higher independent risk of 90-day mortality or in-hospital death (odds ratio, 9.400, 3.574, 2.827, and 2.945, respectively). Preoperative discontinuation of antiplatelet therapy was not associated with an independent risk of 90-day mortality or in-hospital death on univariate analysis. Conclusions Major lung resection for lung cancer in patients with coronary artery disease is feasible. Our study suggests that discontinuation of antiplatelet therapy may not increase postoperative complications in patients with coronary artery disease.

OBJECTIVES: Ground glass opacity (GGO) on thin-section computed tomography (CT) has been reported to be a favourable prognostic marker in lung cancer, and the size or area of GGO is commonly used for preoperative evaluation. However, it can sometimes be difficult to evaluate the status of GGO. METHODS: A retrospective study was conducted on 572 consecutive patients with resected lung cancer of clinical stage IA between 2004 and 2011. All patients underwent preoperative CT and their radiological findings were reviewed. The areas of consolidation and GGO were evaluated for all lung cancers. Lung cancers were divided into three categories on the basis of the status of GGO: GGO, part solid and pure solid. Lung cancers in which it was difficult to measure GGO were selected and their clinicopathological features were investigated. RESULTS: Seventy-one (12.4%) patients had lung cancer in whom it was difficult to measure GGO. In all these cases, consolidation and GGO were not easily measured because of their scattered distribution. In this cohort, nodal metastases were not observed at all. The frequency of other pathological factors, such as lymphatic and/or vascular invasion, was significantly lower (P< 0.0001). CONCLUSIONS: This new category of lung cancer with scattered consolidation on thin-section CT scan tended to be pathologically less invasive. When lung cancer has GGO and is difficult to measure because of a scattered distribution, its prognosis could be favourable regardless of the area of GGO. This new category could be useful for the preoperative evaluation of lung cancer.

背景．癌性胸膜炎による胸水貯留は胸腔ドレナージ施行後も肺が十分に再膨張しないことがあり，そのコントロールに難渋することがある．今回，我々は癌性胸膜炎による膨張不全肺に対して，ウロキナーゼの胸腔内注入を行い良好な肺の再膨張を得られた症例を経験したので報告する．症例．56歳女性．左乳癌術後経過観察中に左胸水の出現を認めた．その後胸水の著明な増加と労作時の呼吸困難が出現したため，当院乳腺科入院となった．胸腔ドレナージの後に胸膜癒着術が施行されたが，肺の膨張は不十分で胸腔内に多房性の胸水貯留が認められた．フィブリン溶解を目的としてウロキナーゼが胸腔内に投与された．その結果，形成されていた多房性の胸水は消失し良好な肺の再膨張が得られた．その後，再度胸膜癒着術が施行された．患者は約7ヶ月後に癌死となったが，その間胸水の再貯留を認めることなく安定した呼吸状態を保ち，自宅での生活が可能であった．結論．癌性胸膜炎に対するウロキナーゼの胸腔内注入は，trapped lungに対する治療法として有用であった．

The gut-brain hormone ghrelin is known to stimulate growth hormone release from the pituitary gland, and to regulate appetite and energy metabolism. Ghrelin-containing neurons have been shown to form neuronal network with several types of appetite-regulating neurons in the hypothalamus. Although ghrelin-containing cell bodies have been reported to localize in the hypothalamic arcuate nucleus, the published results present large discrepancies regarding the localization of ghrelin-positive cell bodies in the brain. In order to address this issue, we have generated a transgenic mouse model by microinjecting a DNA construct in which the transcription regulatory regions of ghrelin drive the enhanced green fluorescent protein (EGFP) gene. These transgenic mice expressed EGFP and ghrelin mRNA in the stomach and hypothalamus. Double immunostaining revealed that GFP-like immunoreactivity was co-localized with ghrelin-like immunoreactivity in the stomach of these animals, while EGFP fluorescence was clearly demonstrated in the hypothalamic arcuate nucleus by confocal laser microscopy. The ghrelin-EGFP transgenic mouse model described in this study therefore provides a powerful tool with which to analyze ghrelin neuronal circuits in the brain and should contribute to our understanding of the functional significance of ghrelin in the central nervous system.

To investigate anesthesia management in patients undergoing right lung surgery after a previous left upper lobectomy (LUL) that may require special precautions since angulation of the left bronchus can hamper correct placement of a left-sided double-lumen tube (DLT), and one-lung ventilation (OLV) depending solely on the left lower lobe may lead to inadequate oxygenation.A retrospective data analysis.Single university hospital.Patients underwent right lung surgery after previous LUL.None.Anesthesia management was investigated in 18 patients who underwent right lung surgery following LUL. All intubation procedures were performed under bronchoscopic guidance to prevent airway trauma. OLV could be achieved with a left-sided DLT in 12 patients, while tubes other than this were required in 6 patients, including a right-sided DLT (n = 3) and a bronchial blocker (n = 3). The presence or absence of remarkable bronchial angulation, characterized by a combination of a wide (140°) angle between the trachea and left main bronchus and a narrow (100°) angle between the left main and lower bronchi critically affected tube selections. The minimum SpO2 during OLV was 90.9±4.1%. In 2 patients, intermittent bilateral ventilation was required to treat desaturation. In all the patients, the scheduled surgery could be completed.Extent of left bronchial angulations had a critical impact on whether or not a left-sided DLT could be used in patients undergoing right lung surgery after LUL.

Galanin-like peptide (GALP), commonly known as an appetite-regulating peptide, has been shown to increase plasma luteinizing hormone (LH) through luteinizing hormone-releasing hormone (LHRH). This led us to investigate, using both light and electron microscopy, whether GALP-containing neurons in the rat brain make direct inputs to LHRH-containing neurons. As LHRH-containing neurons are very difficult to demonstrate immunohistochemically with LHRH antiserum without colchicine treatment, we used a transgenic rat in which LHRH tagged with enhanced green fluorescence protein facilitated the precise detection of LHRH-producing neuronal cell bodies and processes. This is the first study to report on synaptic inputs to LHRH-containing neurons at the ultrastructural level using this transgenic model. We also used immunohistochemistry to investigate the neuronal interaction between GALP- and LHRH-containing neurons. The experiments revealed that GALP-containing nerve terminals lie in close apposition with LHRH-containing cell bodies and processes in the medial preoptic area and the bed nucleus of the stria terminalis. At the ultrastructural level, the GALP-positive nerve terminals were found to make axo-somatic and axo-dendritic synaptic contacts with the EGFP-positive neurons in these areas. These results strongly suggest that GALP-containing neurons provide direct input to LHRH-containing neurons and that GALP plays a crucial role in the regulation of LH secretion via LHRH.

We study the Kondo effect in a vertical quantum dot holding only one- or two-electrons. We observe clear Kondo features in the temperature and bias voltage dependence of the conductance when there is only one electron in the dot (spin S =1/2). The estimated Kondo temperature is much higher than in previous reports due to large dot-lead tunnel coupling on the order of 800 μeV . We also observe a Kondo enhancement of the conductance when the two-electron ground state makes a transition from a spin singlet ( S =0) to a triplet ( S =1) at a magnetic field of 3.2 T . The bias voltage dependence of the differential conductance at this transition field shows weak features that may be related to the Zeeman splitting of the triplet state.

Pituitary adenylate cyclase-activating polypeptide (PACAP) is a pleiotropic neuropeptide that belongs to the secretin/glucagon/vasoactive intestinal peptide (VIP) family. PACAP prevents ischemic delayed neuronal cell death (apoptosis) in the hippocampus. PACAP inhibits the activity of the mitogen-activated protein kinase (MAPK) family, especially JNK/SAPK and p38, thereby protecting against apoptotic cell death. After the ischemia-reperfusion, both pyramidal cells and astrocytes increased their expression of the PACAP receptor (PAC1-R). Reactive astrocytes increased their expression of PAC1-R, released interleukin-6 (IL-6) that is a proinflammatory cytokine with both differentiation and growth-promoting effects for a variety of target cell types, and thereby protected neurons from apoptosis. These results suggest that PACAP itself and PACAP-stimulated secretion of IL-6 synergistically inhibit apoptotic cell death in the hippocampus. The PAC1-R is expressed in the neuroepithelial cells from early developmental stages and in various brain regions during development. We have recently found that PACAP, at physiological concentrations, induces differentiation of mouse neural stem cells into astrocytes. Neural stem cells were prepared from the telencephalon of mouse embryos and cultured with basic fibroblast growth factor. The PAC1-R immunoreactivity was demonstrated in the neural stem cells. When neural stem cells were exposed to PACAP, about half of these cells showed glial fibrillary acidic protein (GFAP) immunoreactivity. This phenomenon was significantly antagonized by a PAC1-R antagonist (PACAP6-38), indicating that PACAP induces differentiation of neural stem cell into astrocytes. Other our physiological studies have demonstrated that PACAP acts on PAC1-R in mouse neural stem cells and its signal is transmitted to the PAC1-R-coupled G protein Gq but not to Gs. These findings strongly suggest that PACAP plays very important roles in neuroprotection in adult brain as well as astrocyte differentiation during development.

A new autoreduction system of hemin was established in the case of synthetic hemins with hydroquinone and isocyanide. The reduction of hemin needed both of hydroquinone and isocyanide. Kinetic studies suggested that a six-coordinated and low-spin iron porphyrin complex was an intermediate of the reduction.

A technique to evaluate the X-ray intensity distribution on the wafer in an X-ray lithography system equipped with a conventional X-ray source with a Pd target was devised. A practical formula for the Pd L X-ray production efficiency, including parameters such as the incident electron beam energy, its incident angle, and the X-ray take-off angle was derived to develop a method of simulating the X-ray intensity distribution on the wafer. This simulation includes realistic factors such as the target shape, the profile and direction of the electron beam, and the X-ray absorption by the window and mask membrane. A good agreement between the calculated and the measured X-ray intensity distributions obtained in the application of this technique to a cone shaped target verified the usefulness of the technique in the design of Pd X-ray sources.