Successful treatment of mycotic thoracic aortic aneurysm in collaboration with cardiovascular and general thoracic surgeons

We report a rare case of ruptured mycotic thoracic aortic aneurysm that required almost one month for correct diagnosis. A 71-year-old woman who had hemoptysis for several weeks was initially suspected to have lung cancer based on several examinations, including fluorine-18 fluorodeoxyglucose-positron emission tomography. However, contrast-enhanced computed tomography revealed a ruptured mycotic thoracic aortic aneurysm in the lower lobe of the left lung. She underwent emergency surgery carried out collaboratively by cardiovascular and general thoracic surgeons. En bloc resection of the aneurysm with the left lower lobe and in situ graft replacement of the descending aorta were performed successfully, although left lower lobectomy was difficult due to the insufficient segmentation of the upper and lower lobes and strong adherence of the aneurysm to the left lung. The clinical course was uneventful. The reason for survival for one month was thought to be that the rupture was covered by the lung. Because the resection of the lung is often difficult in cases in which the aneurysmal rupture shows extensive lung invasion, collaboration with cardiovascular and general thoracic surgeons is important

A randomized phase II study of S-1 monotherapy versus cisplatin with vinorelbine for completely resected stage II/IIIA non-small cell lung cancer: rationale and study protocol design for the LOGIK1702 study

Background: The current standard postoperative treatment for stage II-IIIA non-small cell lung cancer (NSCLC) is a regimen of platinum doublet adjuvant chemotherapy. These regimens, which are the same as for solid NSCLC tumors, often cause severe adverse reactions in the treated patients. Therefore, an effective treatment regimen with fewer side effects is needed.Methods/design: The purpose of this study is to evaluate the effectiveness and safety of S-1 monotherapy (80 mg/m2 orally administrated twice daily, at day 1–14, 16 cycles) and cisplatin with vinorelbine combination therapy (cisplatin 80 mg/m2 at day 1,vinorelbine 25 mg/m2 at day 1, 8, 4 cycles) in patients with II/IIIA stage non-small-cell lung cancer who underwent a total resection. In addition, we will also evaluate the level of treatment side effects by assessing quality of life (QOL), work productivity and activity performance. The primary endpoint is a 2-year relapse free survival (RFS) and the second primary endpoints are 2-year overall survival (OS), rate of treatment completion, safety, work productivity and activity, and quality of adjusted life years (QALY). At the same time, we aim to obtain precise information required to perform future phase 3 randomized controlled trials. The study is designed to estimate the primary endpoint with accuracy determined as the width of its 95% confidence interval to be less than 20%. Recruitment started in May 2017 and is ongoing.Discussion: This study has been conceived to establish a superior regimen for completely resected NSCLC based on efficacy, safety and QOL.Trial registration: Registry number: UMIN000027435. Registered May 22, 2017

Increased In Vitro Intercellular Barrier Function of Lung Epithelial Cells Using Adipose-Derived Mesenchymal Stem/Stromal Cells

With the emergence of coronavirus disease-2019, researchers have gained interest in the therapeutic efficacy of mesenchymal stem/stromal cells (MSCs) in acute respiratory distress syndrome; however, the mechanisms of the therapeutic effects of MSCs are unclear. We have previously reported that adipose-derived MSCs (AD-MSCs) strengthen the barrier function of the pulmonary vessels in scaffold-based bioengineered rat lungs. In this study, we evaluated whether AD-MSCs could enhance the intercellular barrier function of lung epithelial cells in vitro using a transwell coculture system. Transepithelial electrical resistance (TEER) measurements revealed that the peak TEER value was significantly higher in the AD-MSC coculture group than in the AD-MSC non-coculture group. Similarly, the permeability coefficient was significantly decreased in the AD-MSC coculture group compared to that in the AD-MSC non-coculture group. Immunostaining of insert membranes showed that zonula occuldens-1 expression was significantly high at cell junctions in the AD-MSC coculture group. Moreover, cell junction-related gene profiling showed that the expression of some claudin genes, including claudin-4, was upregulated in the AD-MSC coculture group. Taken together, these results showed that AD-MSCs enhanced the barrier function between lung epithelial cells, suggesting that both direct adhesion and indirect paracrine effects strengthened the barrier function of lung alveolar epithelium in vitro

Remaining Physiological Barriers in Porcine Kidney Xenotransplantation: Potential Pathways behind Proteinuria as well as Factors Related to Growth Discrepancies following Pig-to-Kidney Xenotransplantation

Considerable shortages in the supply of available organs continue to plague the field of solid organ transplantation. Despite changes in allocation, as well as the utilization of extended criteria and living donors, the number of patients waiting for organs continues to grow at an alarming pace. Xenotransplantation, cross-species solid organ transplantation, offers one potential solution to this dilemma. Previous extensive research dedicated to this field has allowed for resolution of xenograft failure due to acute rejection, leaving new areas of unresolved challenges as barriers to success in large animal models. Specific to kidney xenotransplantation, recent data seems to indicate that graft compromise can occur due to discrepancies in growth between breeds of donors and significant proteinuria leading to nephrotic syndrome in the recipient. Given these potential limitations, herein, we review potential pathways behind proteinuria, as well as potential causative factors related to growth discrepancies. Control of both of these has the potential to allow xenotransplantation to become clinically applicable in an effort to resolve this organ shortage crisis

Video-Assisted Thoracoscopic Pericardial Window in the Treatment of Pericardial Effusion: Report of Two Cases

A 54-year-old man had a history of subxiphoid pericardial window due to suspected tuberculous effusions. Seventeen years later, following chronic heart failure and implantation of a pacemaker, he again developed pericardial and pleural effusion, requiring repeated percutaneous pericardiocentesis, pleurocentesis and chest tube drainage. A 5×5-cm section of pericardium was successfully resected with video-assisted thoracic pericardial window. No recurrence of pericardial effusion has since been encountered during 36 months follow-up. An 85-year-old woman had a history of percutaneous pericardiocentesis and pleurocentesis due to chronic pericarditis. The effusion of unknown origin was refractory to medication and additional pericardiocentesis and percutaneous pericardial and chest tube drainage. A 4×4-cm section of pericardium was also successfully resected. No recurrence of pericardial effusion has been seen during 8 months follow-up. Video-assisted thoracoscopic pericardial window is an effective procedure for treating intractable pericardial effusion

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

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