Successful Resection of locally infiltrative Glomus Tumor without pulmonary resection

Introduction: Extracutaneous glomus tumors occurring in the bronchus is very rare. Complete resection is basic procedure for treatment of glomus tumor. We present a glomus tumor of the left main bronchus that was successfully treated with rigid bronchoscopy followed by sleeve resection of the left main bronchus. Presentation of case: A 56-year-old man underwent two term resections to glomus tumor that originated from the left main bronchus. Firstly, we performed palliative resection with rigid bronchoscopy to make the correct diagnosis and evaluate the extent of the tumor. We subsequently performed curative resection. No complications or recurrence has occurred since the operation took place one year ago. Discussion: Before curative resection, it is important to confirm the diagnosis and spread of the tumor. Therefore, palliative tumor resection by rigid bronchoscopy was useful to make the correct diagnosis, evaluate the extent of the tumor and open the bronchial lumen. After bronchoscopic treatment, curative pulmonary resection was performed and preservation of lung function was successful. Conclusion: Two term resections enabled us to make an accurate diagnosis and evaluation, thereby preserving respiratory function without pulmonary resection

Video-assisted thoracic surgery attenuates perioperative oxidative stress response in lung cancer patients: a preliminary study

Objectives: Reactive oxygen species (ROS) function as key metabolites that can impair biological processes. The aim of this preliminary study was to assess the perioperative oxidative changes in lung cancer surgery.Methods: We measured the levels of blood hydroperoxides, a type of ROS, as an index of oxidative injury to cellular components, as well as the plasma ferric-reducing ability as an index of total antioxidant potential in 32 lung cancer patients. Hydroperoxides were measured by the levels of diacron reactive oxygen metabolites (d-ROMs). The antioxidant potential was determined by the biological antioxidant potential (BAP), which represents the levels of endogenous antioxidant enzymes.Results: Lung cancer patients had slightly affected oxidative stress before surgery. The d-ROM and BAP levels after surgery and were significantly decreased than before surgery (p< 0.001) and the levels recovered preoperatively at third postoperative day. The d-ROM level in video-assisted surgery group (n=17) was significantly decreased than those in thoracotomy group (n=15) at third and seventh post-operative day (p < 0.001, and < 0.02).Conclusions: Lung cancer patients had already exposed oxidative stress before surgery and surgical intervention also generates large amounts of ROS. Video-assisted thoracic surgery can reduce the ROS compared to the standard thoractomy

Effects of photodynamic therapy using talaporfin sodium (Laserphyrin® ) on wound healing in an animal model

Background: Photodynamic therapy (PDT) is an effective laser treatment for locally advanced carcinoma and is promising as neoadjuvant chemotherapy before surgery. The aim of this study was to clarify the adverse effects of PDT using a photosensitizer, talaporfin sodium (Laserphyrin®), for wound healing.Methodology: For PDT, a laser light with a wavelength of 660 nm and a frequency of 10 Hz with a total energy fluency of60 J/cm2 was used. Macroscopic and histological findings of wound healing after PDT were examined in vivo (4-week-old male BALB/c mice).Results: In Model 1, in which skin was cut at 0, 3, 7 days after PDT (n=3, each), wounds were similarly healed 7 days after cutting in all groups, and regenerating epithelium and the number of fibroblasts on histological findings were not different. In Model 2, in which skin defects were created before or after PDT, the size of the defects was larger at day 7 in the groups with skin defects before or after PDT in comparison with groups with no PDT.However, macroscopic wound healing at day 14 was complete in all groups and there were no significant differences among the groups by this point. Histological findings of skin defects at day 14 showed no significant difference in terms of regenerating epithelium and number of fibroblasts in each group with or without PDT.Conclusions: PDT did not influence wound healing and can be safely applied before surgical therapy

Bioengineered lungs generated from human iPSCs‐derived epithelial cells on native extracellular matrix

The development of an alternative source for donor lungs would change the paradigm of lung transplantation. Recent studies have demonstrated the potential feasibility of using decellularized lungs as scaffolds for lung tissue regeneration and subsequent implantation. However, finding a reliable cell source and the ability to scale up for recellularization of the lung scaffold still remain significant challenges. To explore the possibility of regeneration of human lung tissue from stem cells in vitro, populations of lung progenitor cells were generated from human iPSCs. To explore the feasibility of producing engineered lungs from stem cells, we repopulated decellularized human lung and rat lungs with iPSC‐derived epithelial progenitor cells. The iPSCs‐derived epithelial progenitor cells lined the decellularized human lung and expressed most of the epithelial markers when were cultured in a lung bioreactor system. In decellularized rat lungs, these human‐derived cells attach and proliferate in a manner similar to what was observed in the decellularized human lung. Our results suggest that repopulation of lung matrix with iPSC‐derived lung epithelial cells may be a viable strategy for human lung regeneration and represents an important early step toward translation of this technology.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142929/1/term2589.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142929/2/term2589_am.pd

Recruitment of Young Medical Apprentices (RYOMA) Project: A Comprehensive Surgical Education Program at a Local Academic Institute in Japan

Objectives The number of young surgeons in Japan has significantly decreased in recent years, which may lead to future problems in the medical field. Therefore, comprehensive training programs for young surgeons are needed. Design Retrospective study Setting We developed a specific education program called the "Recruitment of Young Medical Apprentices" (RYOMA) project. Participants We performed this project between January 2008 and August 2013 on fourth- to sixth-year medical students and internship doctors. The RYOMA project included step-by-step surgical education programs on open and scopic procedures as dry, wet, and animal laboratory training. Our goal was to increase the number of young and specialist surgeons. Results Based on an interview questionnaire answered by 90 medical students, most young students were interested in surgical training and several chose to become surgeons in the future. The most positive opinions regarding the field of surgery were the impressive results achieved with surgery, whereas negative opinions included the difficulty of the surgical skill, physical concerns related to difficult work environments, and the severity of surgical procedures. The present program has begun to resolve negative opinions through adequate training or simulations. Of the 19 medical students and internship doctors who attended the RYOMA project in 2008, 17 trainees (90%) were satisfied with this special surgical program and 16 (88%) showed interest in becoming surgeons. The number of participants considering the field of surgery increased between 2008 and 2013. Of 23 participants, 19 (83%) had a positive opinion of the program after the training. Conclusions Gaining experience in surgical training from an early stage in medical school and step-by-step authorized education by teaching staff are important for recruiting students and increasing the number of young surgeons

Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery

Objectives: Chest tube insertion seems to be one important factor leading to intercostal nerve impairment. The purpose of this prospective study was to objectively evaluate intercostal nerve damage using current perception threshold testing in association with chest tube insertion. Methods: Sixteen patients were enrolled in this study. Intercostal nerve function was assessed with a series of 2000-Hz (Aβ fiber), 250-Hz (Aδ fiber), and 5-Hz (C fiber) stimuli using current perception threshold testing (Neurometer CPT/C R). Current perception threshold values at chest tube insertion were measured before surgery, during chest tube insertion and after removal of the chest tube. Intensities of ongoing pain were also assessed using a numeric rating scale (0-10). Results: Current perception thresholds at each frequency after surgery were significantly higher than before surgery. Numeric rating scale scores for pain were significantly reduced from 3.3 to 1.9 after removal of the chest tube (p = 0.004). The correlation between current perception threshold value at 2000 Hz and intensity of ongoing pain was marginally significant (p = 0.058). Conclusions: This is the first study to objectively evaluate intercostal nerve damage at chest tube insertion. The results confirmed that chest tube insertion has clearly deleterious effects on intercostal nerve function

Effects of photodynamic therapy using talaporfin sodium (Laserphyrin® ) on wound healing in an animal model

Background: Photodynamic therapy (PDT) is an effective laser treatment for locally advanced carcinoma and is promising as neoadjuvant chemotherapy before surgery. The aim of this study was to clarify the adverse effects of PDT using a photosensitizer, talaporfin sodium (Laserphyrin®), for wound healing. Methodology: For PDT, a laser light with a wavelength of 660 nm and a frequency of 10 Hz with a total energy fluency of 60 J/cm2 was used. Macroscopic and histological findings of wound healing after PDT were examined in vivo (4-week-old male BALB/c mice). Results: In Model 1, in which skin was cut at 0, 3, 7 days after PDT (n=3, each), wounds were similarly healed 7 days after cutting in all groups, and regenerating epithelium and the number of fibroblasts on histological findings were not different. In Model 2, in which skin defects were created before or after PDT, the size of the defects was larger at day 7 in the groups with skin defects before or after PDT in comparison with groups with no PDT. However, macroscopic wound healing at day 14 was complete in all groups and there were no significant differences among the groups by this point. Histological findings of skin defects at day 14 showed no significant difference in terms of regenerating epithelium and number of fibroblasts in each group with or without PDT. Conclusions: PDT did not influence wound healing and can be safely applied before surgical therapy

Is pain catastrophizing scale useful for predicting post-thoracotomy pain after lung cancer surgery?

Background: The aim of this study was to evaluate preoperative pain catastrophizing scale (PCS) for predicting post-thoracotomy pain in patients with non-small-cell lung cancer. Methods: We previously conducted a randomized open control trial that was published under the title “Is early postoperative administration of pregabalin beneficial for patients with lung cancer?” This is a report of analysis of that trial’s secondary endpoint using PCS. PCS were obtained before surgery, on 1 and 7 days and at 1 and 3 months after surgery. Results: The study cohort comprised 67 patients. Postoperative pain scored on a numeric rating scale (NRS) was significantly less 3 months after surgery (p25) PCS score group of 35 according to the median preoperative PCS score. None of the assessed patient characteristics, including age, sex, body mass index, type of surgical procedure and lymph node dissection, operation time, bleeding, duration of chest tube insertion, and consumption of analgesia differed significant between these groups. The NRS scores on postoperative day 1 (p=0.33), day 7 (p=0.50), 1 month (p=0.31) and 3 months (p=0.18) did not differ significantly between the groups. Multiple logistic regression analyses was performed to predict the postoperative significant pain intensity (NRS≧3) at any postoperative period found that preoperative PCS was not the significant factor. Conclusions: PCS scores did not predict acute or chronic postoperative thoracotomy pain

Down-Regulation of Nogo-B Expression as a Newly Identified Feature of Intrahepatic Cholangiocarcinoma

Nogo-B, located in the endoplasmic reticulum, is an isoform belonging to the reticulon protein family, which is expressed specifically in cholangiocytes and non-parenchymal cells in the liver. Nogo-B expression is down-regulated with the progression of liver fibrosis, but its distinct function in liver malignancies has not been fully clarified. We have hypothesized that Nogo-B expression may be altered in intrahepatic cholangiocarcinoma (ICC), a relatively rare type of primary liver cancer with highly malignant behavior. The present study aimed to investigate the relationship between Nogo-B expression, assessed by immunohistochemical staining, and clinicopathological factors and prognosis in 34 ICC patients. Positive expression was observed in 19 (56%) of 34 ICC specimens: 6 patients (18%) with positivity levels of 1+ (positive cells in 10-50% of cancer cells) and 13 patients (38%) with 2+ (positive cells over 50%). Importantly, the remaining 15 patients (44%) were categorized as negative expression (Nogo-B-positive cells, less than 10%). Conversely, the mass-forming type of ICC tended to express Nogo-B with the degree of 2+ positivity, compared to the periductal infiltration type (p = 0.064), and the mass-forming type showed a better 5-year survival rate (66% vs. 5%) after hepatectomy (p < 0.05). However, the degree of positivity was not associated with tumor relapse rate, disease-free and overall survival, although each of the periductal infiltration type, intrahepatic metastasis, larger tumor size, and lower microvessel counts was associated with lower survival rates. We propose that Nogo-B expression is down-regulated in ICC, the implication of which, however, remains to be investigated