Surgical treatment for therapy-related pectoral hematoma: report of a case and review of published reports

A 96-year-old man with a rapidly growing right chest wall mass was referred to our department for further treatment. Enhanced chest computed tomography showed a huge pectoral hematoma (12×6 cm) in the right thorax. He was on oral antiplatelet medication, but no abnormalities in clotting ability were detected. Because the hematoma was enlarging and painful, it was evacuated surgically and hemostasis achieved around the pectoral branches of the thoraco-acromial artery. His postoperative course was uneventful with no evidence of subcutaneous fluid retention. Surgical hemostasis and hematoma evacuation of this pectoral hematoma might be effective as one treatment method

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

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

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

A novel ex vivo lung cancer model based on bioengineered rat lungs

Introduction: Two-dimensional cell cultures have contributed substantially to lung cancer research, but 3D cultures are gaining attention as a new, more efficient, and effective research model. A model reproducing the 3D characteristics and tumor microenvironment of the lungs in vivo, including the co-existence of healthy alveolar cells with lung cancer cells, is ideal. Here, we describe the creation of a successful ex vivo lung cancer model based on bioengineered lungs formed by decellularization and recellularization.Methods: Human cancer cells were directly implanted into a bioengineered rat lung, which was created with a decellularized rat lung scaffold reseeded with epithelial cells, endothelial cells and adipose-derived stem cells. Four human lung cancer cell lines (A549, PC-9, H1299, and PC-6) were applied to demonstrate forming cancer nodules on recellularized lungs and histopathological assessment were made among these models. MUC-1 expression analysis, RNA-seq analysis and drug response test were performed to demonstrate the superiority of this cancer model.Results: The morphology and MUC-1 expression of the model were like those of lung cancer in vivo. RNA sequencing revealed an elevated expression of genes related to epithelial-mesenchymal transition, hypoxia, and TNF-α signaling via NF-κB; but suppression of cell cycle-related genes including E2F. Drug response assays showed that gefitinib suppressed PC-9 cell proliferation equally well in the 3D lung cancer model as in 2D culture dishes, albeit over a smaller volume of cells, suggesting that fluctuations in gefitinib resistance genes such as JUN may affect drug sensitivity.Conclusions: A novel ex vivo lung cancer model was closely reproduced the 3D structure and microenvironment of the actual lungs, highlighting its possible use as a platform for lung cancer research and pathophysiological studies

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