Postoperative Delirium in Lung Cancer Anatomical Resection-Analysis of Risk Factors and Prognosis.

BACKGROUND: The incidence of postoperative delirium after anatomical lung resection ranges from 5 to 16%. This study aimed to analyze the risk factors and prognosis of postoperative delirium in anatomical lung resection for lung cancer. METHODS: This study included 1351 patients undergoing anatomical lung resection between April 2010 and October 2020. We analyzed the perioperative risk factors of postoperative delirium. We also compared postoperative complications and survival between the delirium and non-delirium groups. RESULTS: Postoperative delirium was identified in 44 (3.3%) of 1351 patients who underwent anatomical lung resection for lung cancer. Age, peripheral vascular disease, depression, and current smoking status were independent risk factors for postoperative delirium in the multivariate analysis. The percentage of postoperative delirium was 0.6% in never smokers and 6.0% in current smokers. The delirium and non-delirium groups showed significant differences in overall survival (p = 0.0144) and non-disease-specific survival (p = 0.0080). After propensity score matching, the two groups did not significantly differ in overall survival (p = 0.9136), non-disease-specific survival (p = 0.8146), or disease-specific survival (p = 0.6804). CONCLUSIONS: Age, peripheral vascular disease, depression, and current smoking status were considered independent risk factors for postoperative delirium in anatomical lung resection for lung cancer. Smoking cessation for at least four weeks before surgery is recommended for reducing incidence of post-operative delirium.

Homeobox transcription factor engrailed homeobox 1 is a possible diagnostic marker for adenoid cystic carcinoma and polymorphous adenocarcinoma.

Diagnostic utility of a homeobox transcription factor, engrailed homeobox 1 (En1) in the histopathology of salivary gland neoplasms was studied. The expression of En1 was immunohistochemically examined in 51 cases of adenoid cystic carcinoma (AdCC) and 143 cases of other salivary gland neoplasms. In all 51 AdCCs, En1 was expressed in 30-100% of tumor cells. In eight of nine polymorphous adenocarcinomas (PACs), En1 was expressed in 40-100% of tumor cells. Less than 5% of tumor cells expressed En1 in three of 12 epithelial-myoepithelial carcinomas, one of 17 basal cell adenomas (BCAs), and one of 34 pleomorphic adenomas (PAs). Among 55 other carcinoma cases, 1-30% of tumor cells expressed En1 in three salivary duct carcinomas (SDCs) ex PA. None of the myoepitheliomas and Warthin tumors expressed En1. When the cut-off value of the percentage of En1-expressing cells was set to 25%, all 51 AdCCs, eight of nine PACs and one SDC ex PA were En1-positive and the others were En1-negative. En1 is expressed consistently in AdCCs, frequently in PACs, but rarely in other salivary gland neoplasms. En1 is a possible diagnostic marker for AdCC and PAC in the histopathology of salivary gland neoplasms.

Postoperative Atrial Fibrillation in Lung Cancer Lobectomy-Analysis of Risk Factors and Prognosis.

BACKGROUND: The incidence of postoperative atrial fibrillation (POAF) after pulmonary lobectomy ranges from 6.4 to 12.6%. This study aimed to analyze the postoperative risk factors and prognosis for POAF in lobectomy for lung cancer. METHODS: Data were collected from patients undergoing pulmonary lobectomy from April 2010 to March 2019. We analyzed risk factors for POAF among perioperative factors and compared postoperative complications or overall survival between POAF and non-POAF groups. We classified POAF as either the temporary or non-temporary type and compared perioperative factors, postoperative complications, and overall survival. RESULTS: POAF was identified in 49 (5.2%) of the 947 lobectomies. The POAF group included more males, patients with poor performance status (PS), history of paroxysmal atrial fibrillation (AF), chronic obstructive pulmonary disease (COPD), and intraoperative blood transfusions. Poor PS, COPD, previous paroxysmal AF, and intraoperative blood transfusion were independent risk factors for POAF in multivariate analysis. The POAF group had a poorer prognosis than the non-POAF group (p = 0.0045). POAF was divided into 29 temporary and 20 non-temporary types. The onset date of non-temporary-type POAF was significantly later than that of the transient type (P < 0.01), and diabetes mellitus was significantly higher in non-temporary-type POAF. Non-temporary-type POAF had a significantly poorer prognosis in terms of overall survival (p = 0.005). CONCLUSIONS: Poor PS, COPD, history of PAF, and intraoperative blood transfusion were independent risk factors for POAF. Non-temporary-type POAF occurred significantly later than transient type and caused poorer prognosis after lobectomy for lung cancer.

Usefulness of the Global Leadership Initiative on malnutrition (GLIM) criteria in preoperative nutritional assessment of patients with primary lung cancer.

BACKGROUND AND AIMS: The Global Leadership Initiative on Malnutrition (GLIM) developed a new method for evaluating malnutrition; however, no consensus has been reached regarding the use of these criteria. Therefore, this study aimed to investigate the association between nutritional status assessed using the GLIM criteria and outcomes of lung cancer after surgery. METHODS: Patients with non-small cell lung cancer who underwent lung resection and bioelectrical impedance analysis to estimate muscle mass before surgery were included. Their background, pathological stage, recurrence, and prognosis were investigated. Patients were divided into two groups according to the GLIM criteria: normal nutrition and malnutrition groups. RESULTS: The normal and malnutrition groups comprised 110 and 88 patients, respectively. Malnutrition was significantly associated with poor overall survival after surgery (P = 0.025) but not with disease-free survival. Multivariate analysis showed that malnutrition (hazard ratio [HR]:2.374, P = 0.020), advanced pathological stage of lung cancer (HR: 1.919, P = 0.002), and the presence of postoperative complications (HR: 2.035, P = 0.047) were significantly associated with poor overall survival. CONCLUSION: Malnutrition assessed using the GLIM criteria was associated with the prognosis of patients with postoperative non-small cell lung cancer. Preoperative assessment using the GLIM criteria would allow for effective nutritional and rehabilitative interventions to improve prognosis.

Extended pleurectomy/decortication and hyperthermic intraoperative intrapleural cisplatin perfusion for malignant pleural mesothelioma.

Objective: To evaluate the efficacy of multimodality treatment including extended pleurectomy/decortication (P/D) and hyperthermic intraoperative chemotherapy (HIOC) with cisplatin for malignant pleural mesothelioma (MPM), we investigated the pharmacokinetics of platinum, adverse events after HIOC, and survival outcome. Methods: Fifty-three patients with pathologically diagnosed MPM (cT1-3N0-1M0, excluding sarcomatoid) underwent an extended P/D and HIOC (cisplatin 80 mg/m2 in saline 2 L, 42°C, 60 minutes) since 2011. The protocol includes postoperative 4 cycles of cisplatin and pemetrexed. Platinum concentrations in the perfusate (before and after) and the serum (1, 2, 4, 8, 24, 48, 72 hours after perfusion) were measured in 10 patients. Mortality and morbidity, especially adverse events of renal function, were investigated, and survival and affecting factors were examined. Results: All patients obtained macroscopic complete resection and pathologic staging revealed as follows: T1/2/3/4: 12/8/23/10, N0/1: 36/17, stage 1A/1B-3A/3B: 12/31/10, respectively. Platinum concentrations in the perfusate indicated that 28% of the dose remained in the pleural cavity, and the maximum concentration in the serum was 0.91 µg/mL. Six patients (11%) showed elevated max-creatinine (>2 mg/dL) postoperatively. Two patients (4%) received renal-replacement therapy, and one was weaned before discharge. There was no 30-day mortality and one in-hospital death (1.9%). Forty-six patients (87%) received multiple cycles of perioperative systemic chemotherapy. Median overall survival (OS) and disease-free survival (DFS) were 52.4 months and 18.7 months. Patents with stage 1A demonstrated a 5-year OS of 67.3% and a median DFS of 67.1 months, and patients with stage 1B-3A demonstrated a 5-year OS of 50.1% and a median DFS of 20.4 months. Univariate analysis showed histological subtype, p-T, p-stage, and multimodality treatment as significant factors affecting OS. Multivariate analysis revealed histology, p-stage, and multimodality as independent. Conclusions: Extended P/D and HIOC with cisplatin for MPM is acceptable with limited acute kidney injury. This multimodality protocol provides promising favorable survival for stage 1A-3A disease.

Extubation by supraglottic airway after lobectomy prevents cough-associated air leaks and prolonged coughing or sore throat.

OBJECTIVES: Double-lumen endobronchial tubes (DLTs) are essential for differential lung ventilation during pulmonary lobectomy, but they are more rigid, longer, larger in diameter and irritable. Coughing at extubation sometimes causes airway and lung injury, which causes severe air leaks, prolonged cough and sore throat. We examined the prevalence of cough-associated air leaks at extubation and postoperative cough or sore throat after lobectomy and evaluated the efficacy of supraglottic airway (SGA) in preventing these complications. METHODS: Patient characteristics and operative and postoperative factors data were collected from patients who underwent pulmonary lobectomy between January 2013 and March 2022. After propensity score matching, these data were compared between the SGA and DLT groups. RESULTS: A total of 1069 patients with lung cancer (SGA, 641; DLTs, 428) were enrolled and coughing at extubation occurred in 100 (23.4%) patients in the DLT group, 65 (65.0%) showed increased cough-associated air leaks at extubation and 20 (30.8%) showed prolonged air leaks. Coughing at extubation occurred in 6 (0.9%) in the SGA group. In 193 patients from each group after propensity score matching, coughing at extubation and the associated air leak increase were significantly lower in the SGA group. Visual analogue scale of postoperative cough and sore throat on postoperative days 2, 7 and 30 were significantly lower in the SGA group. CONCLUSIONS: SGA is effective and safe for preventing cough-associated air leaks and prolonged postoperative cough or sore throat at extubation following pulmonary lobectomy.

Endobronchial Granular Tumor Excision With Bronchial Resection Inclusive of Second Carinoplasty.

Bronchial granular cell tumor is a rare tumor. A 39-year-old nonsmoking woman was admitted to our hospital with back pain. Chest computed tomography scan and bronchoscopy revealed a 10-mm endobronchial tumor arising from the membrane near the second carina. The tumor was excised inclusive of the right second carina that contained the extraluminally invaded endobronchial mass and was diagnosed as a granular cell tumor. The postoperative course was uneventful, and the patient was well without signs of recurrence for 3 years of follow-up.

Novel high-efficient butanol production from butyrate by non-growing Clostridium saccharoperbutylacetonicum N1-4 (ATCC 13564) with methyl viologen.

Non-growing Clostridium saccharoperbutylacetonicum N1-4 hardly produced butanol from only butyrate. As adding glucose to the medium, butyrate utilization and butanol production were stimulated. Addition of 0.1 mM methyl viologen as electron carrier resulted in the highest yield of butanol of 0.671 mol/mol to butyrate and glucose.

Co-existence of pemphigus vulgaris and Hashimoto's thyroiditis.

We report a case of pemphigus vulgaris (PV) associated with Hashimoto's thyroiditis. Direct immunofluorescent studies revealed intercellular deposits of IgG and C3. Both anti-desmoglein (Dsg) 1 and Dsg 3 antibodies were positive in the patient's serum by enzyme-linked immunosorbent assays. HLA genotyping was performed from the patient's peripheral blood leukocytes by polymerase chain reaction. HLA-A*02011, -A*2402101, -DQA1*0104, -DQB1*05031 and -DRB1*1405 alleles, which confer strong susceptibility to Japanese patients with PV, were found. HLA-DQA1*0303 which is strongly associated with Hashimoto's thyroiditis in the Japanese population was also determined.

Trichilemmal horn on burn scar tissue.

We describe the case of a 53-year-old Japanese woman with a trichilemmal horn on burn scar tissue on her left arm. When examined using light microscopy, the lesion showed U-shaped epidermal proliferations which keratinized in a fashion either identical or similar to trichilemmal keratinization. Immunohistochemical results established a relationship between the trichilemmal horn and the outer root sheath of the hair follicle. Trichilemmal keratinization was observed using electron microscopy. Apparently, the tumor had developed on a skin scar where hair follicles were not clinically present. We concluded that the tumor had originated from some hair follicle cells remaining in the epidermis after the burn.

Development of high-speed and highly efficient butanol production systems from butyric acid with high density of living cells of Clostridium saccharoperbutylacetonicum.

Living cells are alive and have the butanol-producing ability but not much proliferation under nitrogen source-limited condition. We investigated various butanol production systems with high density of living cells of Clostridium saccharoperbutylacetonicum N1-4 supplemented with methyl viologen (MV) as an electron carrier and nutrient dosing for activity regeneration. In continuous butanol production with high density of living cells, butanol yield was drastically increased from 0.365 C-mol/C-mol with growing cells to 0.528 C-mol/C-mol at a dilution rate of 0.85 h⁻¹, being increased with the butanol to total solvent ratio. This yield was increased to 0.591 C-mol/C-mol by adding 0.01 mM MV. MV addition increased not only butanol yield but also butanol concentration and productivity as compared to those without MV addition. However, living cells lost their activity with incubation time, which lowered the operational stability of the system. Therefore, to maintain constant stability, activity regeneration was carried out with high density of living cells and MV. This system produced butanol at high concentration (9.40 g l⁻¹) and productivity (7.99 g l⁻¹ h⁻¹) for approximately 100 h with maintenance of considerably high yield of butanol (0.686 C-mol/C-mol). Thus, we established a high-speed and highly efficient butanol production system.