Assessment of emphysematous change and pulmonary function after lobectomy for lung cancer - quantitative 3D-CT analysis

Background: Lung volume reduction surgery (LVRS) in patients with severe chronic pulmonary emphysema (CPE) results in postoperative improvement in pulmonary function. Lobectomy in patients with lung cancer also has the same effect.Methods: One hundred fourteen patients underwent lobectomy for lung cancer from 2006 to 2011. Computed tomography (CT) and pulmonary function test (PFT) were performed preoperatively and six months to one half year after surgery. All CT examinations were performed using a 64-row multidetector CT scanner during a breath-hold at deep inspiration. Total lung volume (TLV), each lobe volume, and low attenuation area (LAA) were extracted from CT data of each patient.Results: TLV after upper lobectomy was increased signifi cantly compared with lower lobectomy (111.0 ± 18.9% vs 103.9 ± 16.1%;p=0.05). There was no relationship between lung volume change and preoperative LAA%. In contrast, LAA% change demonstrated a negative relationship with preoperative LAA% (r=0.4590). In the group defi ned as preoperative LAA% more than 20%, postoperative LAA% decreased signifi cantly (34.9 ± 13.9% to 32.8 ± 18.4%; p<0.01) and FEV1% predicted improved (70. 3 ± 9.7% to 75.3 ± 12.7%;p=0.03).Conclusions: The resected lobe region is more important than the resected lobe volume (RLV) and segment number in TLV change after lobectomy. Preoperative LAA% is a negative factor of LAA% change. Therefore patients with severe emphysematous lung are less likely to increase their postoperative LAA%. Lobectomy for patients with high LAA% provides improved FEV1 % predicted.departmental bulletin pape

Bioinspired mineralization of calcium carbonate in peptide hydrogel acting as a multifunctional three-dimensional template

Biomineralization is the process by which biominerals, minerals composed of bioinorganic matter possessing a controlled structure and orientation and a biomacromolecular assembly with an ordered structure that acts as a 3D template, are formed. In this study, we investigated the fabrication of organic/inorganic hybrid gels by bioinspired mineralization in peptide hydrogels. An Ac-(VHVEVS)3-CONH2 peptide was used as a multifunctional template with a mineral source supply capability and structural controllability that facilitates the formation of hydrogels via self-assembly. Hydrogels with varying viscoelastic strengths were prepared from the designed peptide by controlling the concentration of calcium ions added as cross-linking agents. The peptide hydrogel supplied carbonate anions as the mineral source through the hydrolysis of urea and mineralized CaCO3 with controlled morphology on the peptide network. With increases in the concentration of calcium ions added, the morphology of the mineralized CaCO3 changed from a fibrous structure to a thin film. This implies that the nucleation and growth mechanisms of CaCO3 formed by bioinspired mineralization were affected not only by the morphology and supply rate of the mineral source by the peptide network acting as a multifunctional template, but also by the viscoelastic strength of the hydrogel that served as a 3D reaction field

Partial arch replacement of type A aortic dissection after thoracic endovascular aortic repair for type B dissection

Abstract Background Stent graft-induced new entry (SINE), defined as the stent graft-induced formation of a new entry point for blood to enter an area, is increasingly being observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection worldwide. We herein describe a case of Stanford type A aortic dissection due to proximal SINE after TEVAR for Stanford type B dissection. Case presentation This case involved a 58-year-old man with type A aortic dissection due to SINE. Six years previously, he had developed severe back pain and was diagnosed with type B aortic dissection after computed tomography examination. Because the primary entry was positioned at the descending aorta, we conducted TEVAR for exclusion of the entry with a GORE TAG conformable thoracic aortic graft. He was thereafter followed by our hospital. Six years later, he developed jaw pain and was examined at another hospital. He was transferred to our hospital because of the possibility of type A dissection. Computed tomography revealed type A aortic dissection with proximal site SINE. Emergency partial arch replacement was conducted, and he was discharged on postoperative day 27. Because the entry was at the lesser curve of the arch, we excluded the entry and conducted partial arch replacement. Conclusions In this case, proximal SINE occurred 6 years after TEVAR. Because SINE may occur even in the long term after TEVAR, careful follow-up is necessary

Total thoracoscopic lung segmentectomy of anterior basal segment of the right lower lobe (RS8) for NSCLC stage IA (case report)

Abstract A 69-year-old woman with a pulmonary nodule in anterior basal segment of the right lower lobe (RS8) was referred to our department. The diameter of the tumor was 12 mm, and it had increased over a few months. First, video-assisted thoracoscopic lung surgery (VATS) biopsy of the pulmonary nodule was carried out. Frozen section examination of this nodule confirmed the diagnosis of bronchioloalveolar carcinoma (BAC). Segmentectomy of RS8 with lower mediastinal node dissection (ND2a-1) was performed. The intersegmental plane was identified using the intersegmental veins as landmarks and the demarcation between the resected (inflated) and preserved (collapsed) lungs. Electrocautery at 70 watts was used to divide the intersegmental plane. A vessel sealing system was used to seal and cut the pulmonary arteries. Postoperative histopathological examination revealed that the tumor was T1aN0M0 BAC, and the minimal distance between the surgical margin and the tumor edge was 15 mm. The patient was discharged from hospital on postoperative day 5 without any complications.</p

Morphological changes in functional tricuspid regurgitation on contrast-enhanced computed tomography correlates to tricuspid regurgitation grade

PURPOSE: To examine the relationship between each severity of functional tricuspid regurgitation (FTR) and morphological evaluation on contrast-enhanced computed tomography (CT). METHODS: Forty-five patients underwent contrast-enhanced CT. Tricuspid annulus area (TAA), tricuspid annulus circumference (TAC), right ventricular volume (RVV), and the distances between the tips and bases of the papillary muscles were measured on contrast-enhanced CT in diastole and systole. The patients were classified organized into 4 groups by TR grade measured by transthoracic echocardiography (none+trivial: 26, mild: 6, moderate: 6, severe: 7), and the data were compared among the groups. RESULTS: In parameters measured on contrast-enhanced CT images, TAA, TAC, and the distances between the tips of the anterior and posterior papillary muscles in both diastole and systole and RVV in diastole were significantly different among the groups (p0.40). The septal papillary muscle could not be identified in about 1/3 (35.6%) of cases. CONCLUSIONS: TAA, TAC, RVV, and the distance between the tips of the anterior and posterior papillary muscles measured on contrast-enhanced CT images had relatively positive correlations with TR grade

Adverse plasma branched-chain amino acid profile mirrors fatty muscle degeneration in diabetic heart failure patients

Aims Elevated plasma branched-chain amino acids (BCAAs) are tightly linked to incident diabetes and its complications, while lower BCAAs are associated with adverse outcomes in the elderly and heart failure (HF) patients. The interplay between body compositions and plasma BCAAs, especially under the influence of co-morbid diabetes in HF patients, is not well understood. Here, we examined the impact of diabetes on the prognostic value of plasma BCAA and its association with body compositions in HF patients. Methods and results We retrospectively examined 301 HF patients (70 ± 15 years old; 59% male), among which 36% had diabetes. Blood samples for plasma BCAA measurements were collected in a fasting state after stabilization of HF and analysed using ultraperformance liquid chromatography. A dual-energy X-ray absorptiometry scan assessed regional body compositions, and muscle wasting was defined as appendicular skeletal muscle mass index (ASMI) < 7.00 and <5.40 kg/m2 for males and females, respectively, according to the criteria of the Asian Working Group for Sarcopenia. Although analyses of covariance revealed that plasma BCAAs were significantly higher in diabetic patients, low valine (<222.1 nmol/mL) similarly predicted adverse events defined by HF hospitalization, lethal arrhythmia, or all-cause death in both diabetic and non-diabetic patients independently of age, sex, and NT-proBNP (adjusted hazard ratio [HR] 3.1, 95% confidence interval [CI] of 1.1–8.6 and adjusted HR 2.67, 95% CI 1.1–6.5, respectively; P for interaction 0.88). In multivariate linear regression analyses comprising age, sex, and regional body compositions as explanatory variables, plasma BCAAs were positively correlated with visceral adipose tissue area in non-diabetic patients (standardized β coefficients [β] = 0.44, P < 0.001). In contrast, in diabetic patients, plasma BCAAs were correlated positively with ASMI (β = 0.49, P = 0.001) and negatively with appendicular fat mass index (AFMI; β = −0.42, P = 0.004). Co-morbid diabetes was independently associated with muscle wasting (adjusted odds ratio 2.1, 95% CI 1.1–4.0) and significantly higher plasma 3-methylhistidine level, a marker of myofibrillar degradation. In diabetic patients, ASMI uniquely showed a J-shaped relationship with AFMI, and in a subgroup of HF patients with muscle wasting, diabetic patients showed 12% higher AFMI than non-diabetic patients despite comparable ASMI reductions. Conclusions Despite higher plasma BCAA levels in HF patients with diabetes, the prognostic value of low valine remained consistent regardless of diabetes status. However, low BCAAs were distinctly associated with fatty muscle degeneration in the extremities in diabetic patients, suggesting the importance of targeted interventions to prevent such tissue remodelling in this population.journal articl

Evaluating Cellularity Estimation Methods: Comparing AI Counting with Pathologists’ Visual Estimates

The development of next-generation sequencing (NGS) has enabled the discovery of cancer-specific driver gene alternations, making precision medicine possible. However, accurate genetic testing requires a sufficient amount of tumor cells in the specimen. The evaluation of tumor content ratio (TCR) from hematoxylin and eosin (H&E)-stained images has been found to vary between pathologists, making it an important challenge to obtain an accurate TCR. In this study, three pathologists exhaustively labeled all cells in 41 regions from 41 lung cancer cases as either tumor, non-tumor or indistinguishable, thus establishing a “gold standard” TCR. We then compared the accuracy of the TCR estimated by 13 pathologists based on visual assessment and the TCR calculated by an AI model that we have developed. It is a compact and fast model that follows a fully convolutional neural network architecture and produces cell detection maps which can be efficiently post-processed to obtain tumor and non-tumor cell counts from which TCR is calculated. Its raw cell detection accuracy is 92% while its classification accuracy is 84%. The results show that the error between the gold standard TCR and the AI calculation was significantly smaller than that between the gold standard TCR and the pathologist’s visual assessment (p0.05). Additionally, the robustness of AI models across institutions is a key issue and we demonstrate that the variation in AI was smaller than that in the average of pathologists when evaluated by institution. These findings suggest that the accuracy of tumor cellularity assessments in clinical workflows is significantly improved by the introduction of robust AI models, leading to more efficient genetic testing and ultimately to better patient outcomes

Cohort study to evaluate prognostic factors in idiopathic pulmonary fibrosis patients introduced to oxygen therapy

Abstract While high-level evidence is lacking, numerous retrospective studies have depicted the value of supplemental oxygen in idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases, and its use should be encouraged where necessary. The clinical course and survival of patients with IPF who have been introduced to oxygen therapy is still not fully understood. The objective of this study was to clarify overall survival, factors associated with prognosis, and causes of death in IPF patients after the start of oxygen therapy. This is a prospective cohort multicenter study, enrolling patients with IPF who started oxygen therapy at 19 hospitals with expertise in interstitial lung disease. Baseline clinical data at the start of oxygen therapy and 3-year follow-up data including death and cause of death were assessed. Factors associated with prognosis were analyzed using univariable and multivariable analyses. One hundred forty-seven eligible patients, of whom 86 (59%) were prescribed ambulatory oxygen therapy and 61 (41%) were prescribed long-term oxygen therapy, were recruited. Of them, 111 died (76%) during a median follow-up of 479 days. The median survival from the start of oxygen therapy was 537 ± 74 days. In the univariable analysis, low body mass index (BMI), low forced vital capacity (FVC), low diffusion capacity (DLCO), resting hypoxemia, short 6 min-walk distance, and high COPD assessment test (CAT) score were significantly associated with poor prognosis. Multivariable analysis revealed low BMI, low FVC, low DLCO, low minimum SpO2 on 6MWT, and high CAT score were independent factors for poor prognosis. The overall survival of IPF patients after starting oxygen therapy is about 1.5 years. In addition to pulmonary function tests, 6MWT and patient reported outcomes can be used to predict prognosis more accurately. Clinical Trial Registration: UMIN000009322