Salvage endovascular embolization of the left pulmonary artery for recurrent pseudoaneurysm

Background: Pulmonary pseudoaneurysm (PPA) is a potentially lethal complication of lung resection with a high risk of recurrence after endovascular coiling. Case presentation: We report a case in which recurrent hemoptysis due to PPA after left lower lobe sleeve resection was treated by endovascular embolization of the left main pulmonary artery as a salvage treatment. The first hemoptysis was managed by endovascular coil embolization with extracorporeal membrane oxygenation, but refractory hemorrhage occurred 3 months later due to penetration of the endovascular coil into the bronchial anastomosis site. Because left completion pneumonectomy was considered too high risk, the left main pulmonary artery was palliatively embolized using an Amplatzer vascular plug (St. Jude Medical, MN, USA) to totally disrupt the left pulmonary arterial flow. Conclusions: Total embolization of the left main pulmonary artery for repeated PPA rupture may be useful as a palliative treatment in patients unable to tolerate pneumonectomy

Intraoperative margin assessment by wireless signals in thoracoscopic anterior (S3) segmentectomy using a radiofrequency identification marker

Despite the use of near-infrared thoracoscopy with intravenous indocyanine green, intraoperative assessment of the surgical margin for the resection of non-palpable tumors located near the intersegmental plane requires highly advanced surgical skill for the prevention of local recurrence. Because the demarcation line is limited to the pleural surface, to overcome uncertainty in tumor palpation for deeply located small-sized lesions, other supplemental localization techniques have been proposed. Here, we present a novel surgical technique using radiofrequency identification markers for intraoperative assessment of the lateral surgical margin in segmentectomy

Feasibility study of a novel wireless localization technique using radiofrequency identification markers for small and deeply located lung lesions

Objectives: To evaluate the safety and efficacy of a novel wireless localization technique that uses radiofrequency identification markers for small and deep lung lesions. Methods: Preliminary use of the device was retrospectively evaluated in 2 Japanese centers. Under general anesthesia, a marker was placed as close as possible to the tumor via computed tomography-guided bronchoscopy in a hybrid operation theater. Surgeons located the marker without lung palpation using a detection probe the tone of which changed to indicate the marker-probe distance. Efficacy was defined as functional marker placement (bronchoscopy time and marker position) and deep margin distance. Results: Twelve markers were placed for 11 lesions (mean size, 6.8 ± 2.7 mm) located at a mean depth from the pleura of 11.4 ± 8.4 mm (range = 0-26.0 mm). Of 12 markers, 7 markers (58.3%) were placed within 10 mm from the lesion in 25.5 ± 14.4 minutes. For the 11 wedge resections, markers were placed at a mean distance of 6.7 mm (range, 0-13.0 mm) from the lesion and a mean distance of 14.4 mm (range, 3.0-42.0 mm) from the pleura. All markers were recovered without complications, and all tumors were resected with negative margins. For 5 lesions >10 mm deep to the pleura (mean depth, 18.9 ± 5.5 mm; range, 11.0-26.0 mm), the median depth of the surgical margin was 11.6 ± 2.1 mm (range, 9.0-14.0 mm). Conclusions: Radiofrequency identification marking was safe and precisely localized small lung lesions, including their depth

Strategy for lung parenchyma-sparing bronchial resection: a case series report

Lung parenchyma-sparing bronchial resection is uncommon, and the operative procedure depends on the cause and location of the stenosis. We present 6 cases and discuss the different surgical strategies for sleeve resection of the central airway without lung resection. Bronchoplasty for the main bronchus and truncus intermedius was performed with a posterolateral approach. We resected the right main bronchus including the right lateral wall of the lower trachea and half of the carina obliquely and performed an anastomosis. The tumour in the left lobar bronchus was exposed and removed by transient division of the accompanying pulmonary artery. Although post-transplant stenosis and malacia can pose a challenge, bronchoplasty can be used as a definitive treatment in experienced centres

The effectiveness of Modified Early Warning Score (MEWS) using individual-specific range in predicting pneumonia hospitalization among nursing home residents in Japan: Comparison with National Early Waring Score (NEWS)

Aim: The purpose of this study was to compare the usefulness between the National Early Warning Score (NEWS), which uses the absolute value range, and the Modified Early Warning Score (MEWS), which considers individual-specific ranges (evaluated by mean and standard deviation [SD], relative measures), in predicting pneumonia hospitalization among nursing home residents.Methods: The current study was a retrospective, observational study. The subjects were 235 nursing home residents (75 men and 160 women; pneumonia group, n=62; non-pneumonia group, n=173). The mean and SD of each vital sign (systolic blood pressure, heart rate, body temperature, and oxygen saturation) of each subject recorded over 28 days was calculated. In the pneumonia group, the points at the date of hospitalization were aggregated to derive the NEWS and MEWS. In the non-pneumonia group, the point at the 35th day from the start of the nursing home stay was aggregated to derive the NEWS and MEWS.Results: The area under the curve (AUC) for predicting pneumonia hospitalization was 0.80 (95% confidence interval [CI], 0.72- 0.88) for NEWS and 0.92 (95%CI, 0.87-0.97) for MEWS using individual-specific ranges. The AUC of MEWS using individualspecific ranges was significantly greater than that of NEWS (p<0.0001). When 3 was used as a cutoff value in MEWS, the Youden Index was the best value (0.75). Sensitivity, pecificity, positive predictive value, and negative predictive value were 0.77, 0.97, 0.91, and 0.92, respectively.Conclusion: Our MEWS system using individual-specific ranges showed good performance in predicting hospitalization for pneumonia among nursing home residents

Virasoro constraint for Nekrasov instanton partition function

We show that Nekrasov instanton partition function for SU(N) gauge theories satisfies recursion relations in the form of U(1)+Virasoro constraints when {\beta} = 1. The constraints give a direct support for AGT conjecture for general quiver gauge theories.Comment: 23 pages, 7 figures. v2: typos correcte

Symmetry and Integrability of Non-Singlet Sectors in Matrix Quantum Mechanics

We study the non-singlet sectors of matrix quantum mechanics (MQM) through an operator algebra which generates the spectrum. The algebra is a nonlinear extension of the W_\infty algebra where the nonlinearity comes from the angular part of the matrix which can not be neglected in the non-singlet sector. The algebra contains an infinite set of commuting generators which can be regarded as the conserved currents of MQM. We derive the spectrum and the eigenfunctions of these conserved quantities by a group theoretical method. An interesting feature of the spectrum of these charges in the non-singlet sectors is that they are identical to those of the singlet sector except for the multiplicities. We also derive the explicit form of these commuting charges in terms of the eigenvalues of the matrix and show that the interaction terms which are typical in Calogero-Sutherland system appear. Finally we discuss the bosonization and rewrite the commuting charges in terms of a free boson together with a finite number of extra degrees of freedom for the non-singlet sectors.Comment: 34 pages, 4 figure

Walking and Sports Participation and Mortality From Coronary Heart Disease and Stroke

ObjectivesWe aimed to examine the impact of exercise on mortality from cardiovascular disease (CVD) in Asian populations.BackgroundFew data have been available in Asian countries, where job-related physical activity is higher than that in Western countries.MethodsBetween 1988 and 1990, 31,023 men and 42,242 women in Japan, ages 40 to 79 years with no history of stroke, coronary heart disease (CHD), or cancer, completed a self-administered questionnaire. Systematic mortality surveillance was performed through 1999, and 1,946 cardiovascular deaths were identified. We chose the second lowest categories of walking and sports participation as the reference to reduce a potential effect of ill health.ResultsMen and women who reported having physical activity in the highest category (i.e., walking ≥1 h/day or doing sports ≥5 h/week) had a 20% to 60% lower age-adjusted risk of mortality from CVD, compared with those in the second lowest physical activity category (i.e., walking 0.5 h/day, or sports participation for 1 to 2 h/week). Adjustment for known risk factors, exclusion of individuals who died within two years of baseline inquiry, or gender-specific analysis did not substantially alter these associations. The multivariate-adjusted hazard ratios (95% confidence interval) for the highest versus the second lowest categories of walking or sports participation were 0.71 (0.54 to 0.94) and 0.80 (0.48 to 1.31), respectively, for ischemic stroke (IS); 0.84 (0.64 to 1.09) and 0.51 (0.32 to 0.82), respectively, for CHD; and 0.84 (0.75 to 0.95) and 0.73 (0.60 to 0.90), respectively, for CVD.ConclusionsPhysical activity through walking and sports participation might reduce the risk of mortality from IS and CHD

Excited States of Calogero-Sutherland Model and Singular Vectors of the WNW_N Algebra

Using the collective field method, we find a relation between the Jack symmetric polynomials, which describe the excited states of the Calogero-Sutherland model, and the singular vectors of the $W_N$ algebra. Based on this relation, we obtain their integral representations. We also give a direct algebraic method which leads to the same result, and integral representations of the skew-Jack polynomials.Comment: LaTeX, 29 pages, 2 figures, New sections for skew-Jack polynomial and example of singular vectors adde