Paragonimus westermani infection mimicking recurrent lung cancer: A case report

AbstractHerein, we report a case of Paragonimus westermani infection, which required differentiation from recurrent lung cancer. A 66-year old Japanese man with a history of lung cancer who had undergone a lobectomy was referred to our clinic for treatment of cough, sputum, dyspnea, and a right pulmonary nodule. He had previously eaten seafood he visited China. P. westermani infection was confirmed by the presence of antibody against P. westermani antigen in the patient's serum and eggs in his sputum. Eventually, molecular identification by PCR-restriction fragment length polymorphism analysis and sequencing confirmed that the patient was infected with triploid forms of P. westermani

Human Molecular Chaperone Hsp60 and Its Apical Domain Suppress Amyloid Fibril Formation of α-Synuclein

Heat shock proteins play roles in assisting other proteins to fold correctly and in preventing the aggregation and accumulation of proteins in misfolded conformations. However, the process of aging significantly degrades this ability to maintain protein homeostasis. Consequently, proteins with incorrect conformations are prone to aggregate and accumulate in cells, and this aberrant aggregation of misfolded proteins may trigger various neurodegenerative diseases, such as Parkinson’s disease. Here, we investigated the possibilities of suppressing α-synuclein aggregation by using a mutant form of human chaperonin Hsp60, and a derivative of the isolated apical domain of Hsp60 (Hsp60 AD(Cys)). In vitro measurements were used to detect the effects of chaperonin on amyloid fibril formation, and interactions between Hsp60 proteins and α-synuclein were probed by quartz crystal microbalance analysis. The ability of Hsp60 AD(Cys) to suppress α-synuclein intracellular aggregation and cytotoxicity was also demonstrated. We show that Hsp60 mutant and Hsp60 AD(Cys) both effectively suppress α-synuclein amyloid fibril formation, and also demonstrate for the first time the ability of Hsp60 AD(Cys) to function as a mini-chaperone inside cells. These results highlight the possibility of using Hsp60 AD as a method of prevention and treatment of neurodegenerative diseases

Two Case Reports of Successful Withdrawal of Mycofenolate Mofetil After Living Donor Lobar Lung Transplantation

Background: Lung transplantation cases have immunosuppression maintained using a calcineurin inhibitor, anti-metabolites, and steroid. Case Report: We report 2 clinical cases in which anti-metabolites (mycophenolate mofetil) were successfully withdrawn after living donor lobar lung transplantation by monitoring immune function using the ImmuKnow® assay. In the first case, a 43-year-old woman underwent living donor lobar lung transplantation for pulmonary alveolar proteinosis. Two healthy relatives donated a lower lobe each. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroid. Six months posttransplantation, she developed invasive pulmonary aspergillosis. During anti-fungal treatment, we withdrew mycophenolate mofetil and tacrolimus trough levels were kept around 8 ng/mL. Despite the resulting low-level immunosuppression, the ImmuKnow assay showed immune function to be in the moderate range with tacrolimus and steroid alone, encouraging us to maintain this strategy to avoid recurrence of invasive pulmonary aspergillosis. In the second case, a 24-year-old man underwent living donor lobar lung transplantation for cystic fibrosis. Two healthy relatives donated a lower lobe each. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroid. Five months posttransplantation, he developed persistent Pseudomonas aeruginosa pneumonia derived from the paranasal sinuses. Under ImmuKnow assay monitoring, mycophenolate mofetil was withdrawn, but immune function was maintained within the moderate range using tacrolimus and steroid alone. Discussion: Respiratory function in both cases was maintained; no findings of bronchiolitis obliterans syndrome were noted during this period. To the best of our knowledge, no reports have described successful anti-metabolite withdrawal in lung transplantation with ImmuKnow monitoring. Immune evaluation by ImmuKnow could offer a useful method to monitor and control immune status, particularly among recipients susceptible to infection, revealing that moderate immune function could be maintained using tacrolimus and steroid in living donor lobar lung transplantation

Epidermal growth factor signals regulate dihydropyrimidine dehydrogenase expression in EGFR-mutated non-small-cell lung cancer

Schematic diagrams of the signal cascade of EGF-induced DPD expression of EGFR-mutated type cells. TF, transcription factor; Mit A, mithramycin A. (JPG 130 kb

Development of a finger like multi-joint articulated surgical retractor for use in endoscopic surgery

The authors have developed an articulated medical instrument which assists with the movement of and maintenance of the position of such as a lung during surgery to assist providing improved viewability and providing the necessary space required to work efficiently and effectively. Conventionally holding such as, a lung in a given position is achieved by arranging gauze in an appropriate configuration with the aid of a simple shaft like surgical instrument, however for various reasons the gauze requires constant replacement and rearrangement resulting in significant surgical inefficiency. By using an articulated mechanism that mimics the functionality of fingers, we have developed a surgical device that inherently provides greater mechanical stability and does not require the use of gauze, thus enabling more efficient surgery. The prototyping process was assisted with the use of 3D-CAD to simulate static and dynamic conditions and a 3D-printer to confirm the concept and then a working prototype was created. In order to validate the dynamic functionality of this surgical instrument, it was tested on a porcine lung which closely approximates human lungs by a clinical doctor of thoracic surgery. The result was that the developed prototype articulated mechanism was able to stably move and hold the lung in position during surgery thus confirming the dynamic efficacy of the mechanism

Effect of Platelet-Activating Factor Antagonist (TCV-309) on Survival in the Canine Double Lung Transplantation Model

Fourteen adult mongel dogs were subjected to sequential double lung transplantation. The animals were assigned randomly to three experimental groups. Four dogs served as the control group (no treatment). Four other dogs were flushed with 4°C University of Wisconsin (UW) solution (UW flush group). The remaining six dogs were treated with platelet-activating factor antagonist (TCV-309) (PAF- antagonist group). None of the animals in the control group or the UW flush group survived more than 6 hours after transplantation. In contrast, all of the dogs in the PAF- antagonist group were extubated. The mean survival in this group was 5.2 days. PAF-antagonist (TCV-309) preserved lung function and improved survival in the canine sequential double lung transplantation model

Research and development of a laparoscopic surgical device for ligating endless organs based on a flexible structure

While laparoscopic surgery has become increasingly widely used, many laparoscopic procedures are time-consuming and difficult to accomplish compared to open surgery. One such procedure is the ligation of endless organs. In this paper, the development and prototyping of a laparoscopic instrument that could significantly increase the efficiency of laparoscopic ligation is outlined. The mechanism is based on a snake-like flexible structure which is actuated by control wires. A simple simulation was carried out by both experienced surgical staff as well as non-surgical persons to confirm the effectiveness of the proposed mechanism

Surgical resection of a pulmonary artery pseudoaneurysm after middle lobectomy: Report of a case

A case of surgical resection of a pulmonary artery pseudoaneurysm after middle lobectomy is reported. A 76-year-old man with lung cancer, interstitial pulmonary fibrosis, and pneumoconiosis was referred for surgical resection. Right middle lobectomy with lymph node dissection was successfully performed. Postoperatively, the patient did well until a sudden high fever developed on postoperative day eight. Antibiotic therapy was started for suspected acute pneumonia, but the low-grade fever did not improve. Contrast-enhanced computed tomography showed a bronchopleural fistula that caused a pulmonary artery pseudoaneurysm. Right lower lobectomy via posterolateral thoracotomy was performed to resect the pseudoaneurysm. The pulmonary artery stump was sutured by monofilament unabsorbable stiches. The bronchus stump was sutured interruptedly with a pedicle of intercostal muscles. The patient’s postoperative course following repeat thoracotomy was complicated, including exacerbation of interstitial pneumonia and tracheostomy. He is still in hospital, and weaning off the mechanical ventilator is being attempted

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

The Efficacy of Polydioxanone Monofilament Absorbable Suture for Tracheal Anastomosis

To evaluate the efficacy of polydioxanon absorbable suture for tracheal anastomoses, we performed an experimental study using dose. Eight adult mongrel dogs underwent sleeve resection of the mediastinal trachea. A length of ten to twelve cartilage rings was resected. An end-to-end anastomosis was performed using either interrupted or continuous running 4-0 polydioxanone (PDS) suture. There was no detectable difference bronchoscopically, microangiografically, or histologically, in tracheal anastomotic healing between interrupted suture and continuous running suture. The inflammatory tissue response was mild and disappeared 3 weeks after surgery. The breaking strength, however, was greater in dogs in which interrupted sutures were used than in those with a continuous running sutures. We conclude that PDS is a useful suture material for tracheal anastomoses and that interrupted sutures are stronger and possibly safer than a continuous running suture for end-to-end anastomosis following sleeve resection of the trachea