Video-Assisted Thoracoscopic Surgery Using Extracorporeal Membrane Oxygenation for Intractable Pneumothorax

Intractable pneumothorax with poor lung function that has received multiple conservative treatments may occur. Case 1 was a 70-year-old woman with aspergilloma who was admitted for pneumothorax. Case 2 was a 68-year-old man with acute exacerbation of interstitial pneumonia who developed pneumothorax. In both cases, multiple conservative therapies were administered, but the leak continued; thus, operations using veno-venous extracorporeal membrane oxygenation (ECMO) were planned. By video-assisted thoracoscopic surgery (VATS), we obtained the optimal surgical field by lung collapse. We removed many blood clots that were used for pleurodesis, ligated the bulla in case 1, and covered the leak point with strengthening agents in case 2. For cases of intractable pneumothorax, lung collapse by ECMO is advantageous because we can check details and leak points even in blood clots or in poor condition of the lung, and we can maneuver the lung in poor condition with a clear surgical field

Synthesis of tertiary alkylphosphonate oligonucleotides through light-driven radical-polar crossover reactions

光エネルギーで新しい化学修飾核酸を合成 --核酸リン原子の第三級アルキル化に成功--. 京都大学プレスリリース. 2023-11-01.Chemical modification of nucleotides can improve the metabolic stability and target specificity of oligonucleotide therapeutics, and alkylphosphonates have been employed as charge-neutral replacements for naturally-occurring phosphodiester backbones in these compounds. However, at present, the alkyl moieties that can be attached to phosphorus atoms in these compounds are limited to methyl groups or primary/secondary alkyls, and such alkylphosphonate moieties can degrade during oligonucleotide synthesis. The present work demonstrates the tertiary alkylation of the phosphorus atoms of phosphites bearing two 2’-deoxynuclosides. This process utilizes a carbocation generated via a light-driven radical-polar crossover mechanism. This protocol provides tertiary alkylphosphonate structures that are difficult to synthesize using existing methods. The conversion of these species to oligonucleotides having charge-neutral alkylphosphonate linkages through a phosphoramidite-based approach was also confirmed in this study

Patient Satisfaction after Endoscopic Thoracic Sympathectomy for Palmar Hyperhidrosis

Endoscopic thoracic sympathectomy (ETS) for palmar hyperhidrosis was performed using a 3-mm small endoscope at our hospital, and we conducted a questionnaire for the purpose of studying the conditions and satisfaction after surgery. The subjects were comprised of 50 patients, of which 35 patients (75%) answered the survey. The average age of the respondents was 27 years old (range: 12?62 years old) including 13 males and 22 females and the average postoperative observation period was 33 months (1?114 months). The results showed the good effects of surgery in all of the patients for palmar sweating while patient satisfaction was 79.4 points, which concluded that ETS was sufficiently accepted as treatment for palmar hyperhidrosis. However, compensatory sweating (CS) developed in 97.1% of the patients, and 82.9% answered that they were disturbed because it was more than they had expected. This result makes us realize further the importance of preoperative informed consent for CS. The problem of palmar hyperhidrosis is very serious for patients, and hence it is important to give treatment with a thorough understanding of the effectiveness and problems of ETS for palmar hyperhidrosis according to the analytical results of this questionnaire

Prognostic Factors for Post Recurrence Survival in Resected Pathological Stage I Non-small Cell Lung Cancer

[Background]Recurrence of lung cancer after surgical resection is a major obstacle in the cure and long-term survival of patients and has become the most common cause of death. However, prognostic factors and efficacy of therapy after recurrence remain controversial. We evaluated the prognostic factors of post recurrence survival (PRS) in patients of resected stage I non-small cell lung cancer (NSCLC). [Methods]Of the 551 patients who underwent surgery　for stage I NSCLC between 2005 and 2013, we reviewed 89 (16.2%) patients who had recurrence. We examined PRS using the Kaplan?Meier method and multivariate　Cox regression analyses. [Results]The median follow-up period after recurrence was 21.0 months. The median recurrence free interval (RFI) was 16.8 months. The 1-year PRS and 3-year PRS were 65.6% and 44.7%, respectively. Multivariate analysis revealed that size of primary lesion > 25 mm (P = 0.048), RFI ? 17 months (P = 0.048) and no treatment for recurrence (P < 0.001) were independent poor-prognosis factors of PRS. We further examined PRS in 66 patients who underwent any post recurrence therapy. For the patients who underwent treatment after recurrence, bone metastasis (P = 0.025) and treatment without epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) (P = 0.049) were independent poor prognostic factors. [Conclusion]PRS may be associated with characteristics of a recurrent lesion, including the biology of the recurrent tumor, RFI, recurrent site, the treatment for recurrence, rather than characteristics of primary lesion. Although further validation is needed, this information is important for the design of clinical trials for post-recurrence therapy

Thoracoscopic Resection of an Anterior Mediastinal Bronchogenic Cyst

We report a very rare case of anterior mediastinal bronchogenic cyst, successfully resected by thoracoscopic surgery. A 78-year-old female was noted as having an abnormal shadow on her chest X-ray during a routine medical checkup. Chest CT revealed a cystic tumor in the anterior mediastinum. A thymic cyst was suspected after a detailed examination and thoracoscopic surgery was performed. A cystic tumor containing yellowish-white mucus measuring 46 × 33 × 19 mm in size was successfully removed. Calcification was also observed in the cyst wall. Pathologically, the tumor was characterized by a ciliated columnar epithelial lining, and was subsequently diagnosed as a bronchogenic cyst. Although they may be rare, bronchogenic cysts should also be considered in the evaluation of cystic tumors in the anterior mediastinum

Observation of Acoustically Induced Dressed States of Rare-Earth Ions

Acoustically induced dressed states of long-lived erbium ions in a crystal are demonstrated. These states are formed by rapid modulation of two-level systems via strain induced by surface acoustic waves whose frequencies exceed the optical linewidth of the ion ensemble. Multiple sidebands and the reduction of their intensities appearing near the surface are evidence of a strong interaction between the acoustic waves and the ions. This development allows for on-chip control of long-lived ions and paves the way to highly coherent hybrid quantum systems with telecom photons, acoustic phonons, and electrons

Inflammatory Pseudotumor of the Lung Identified by 18F-Fluorodeoxyglucose Positron Emission Tomography: A Patient Report

The patient was a 71-year-old man with an abnormal shadow on chest X-ray. Computed tomography (CT) of the chest showed a tumor of 38 mm in size in the upper lobe of the left lung S3. A CT-guided lung biopsy was performed, but no malignancy was observed. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed a high FDG uptake in the tumor: the maximum and mean values of the standard FDG uptake in the early phase were 7.3 and 5.3, respectively, and those in the latter phase, 8.3 and 5.9, respectively. The hilar and mediastinal lymph nodes also showed positive for high FDG uptakes. We strongly suspected lung cancer, and performed a left upper lobectomy by video-assisted thoracic surgery. The pathological diagnosis was an inflammatory pseudotumor of the lung: it is a rare disease but often requires differentiation from lung cancer. Literature has been few on FDG-PET about inflammatory pseudotumor of the lung. Differentiation of the disease from lung cancer was especially difficult in the present patient, because both lymph nodes and the tumor showed high FDG uptakes