Diagnosis, knowledge, perception, and productivity impact of headache education and clinical evaluation program in the workplace at an information technology company of more than 70,000 employees.

BACKGROUND: Migraine is a highly prevalent, disabling, misunderstood, underdiagnosed, and undertreated neurological disease. It is a leading cause of productivity loss in the workplace. METHODS: This is the first large-scale company-wide headache education and evaluation program in the workplace. RESULTS: 73,432 (90.5%) Fujitsu employees participated. The prevalence of migraine was 16.7%, tension-type headache 40.7%, and cluster headache 0.5%. After completing the training, 82.9% of participants without headache said they would change their attitude towards colleagues with headache disorders and 72.5% of total participants said their understanding of headache changed. The proportion of employees who thought that headache had a significant impact on people's lives increased from 46.8% to 70.6%; 2971 (4.1%) of all participants were interested in a virtual consultation with a headache specialist as part of the program, more than half of whom had not previously consulted for headache. Approximately 14.7 days per year of full productivity per employee with headache were gained resulting in an annual productivity saving per employee of US$4531. CONCLUSION: This unique headache workplace program was associated with a high level of participation, an improvement in the understanding of migraine and attitude towards colleagues with migraine, reduction in disability and increased employee productivity, and decreased costs of lost productivity due to migraine. Workplace programs for migraine should be considered for all industry sectors.

[Introduction of Support for Thoracoscopic Surgery by Clinical Engineers:Task Shift as Scopist by Clinical Engineers].

On October 1, 2021, the Clinical Engineer Law was revised and expanded the task of clinical engineers (CEs). After that, they can hold and operate a endoscope in endoscopic surgery. On June 9, 2022, our hospital asked CEs to directly participate in thoracoscopic pleural biopsy as scopist( scope operator) for the first time, and since then, a total of 54 thoracoscopic surgery cases were performed by CEs as scopist over the course of one year. In the CE-supported lung surgery of lobectomy and segmentectomy cases, there was a trend toward an increase in operating time of about 15 minutes, although there was no significant difference in operating time compared with conventional surgery. Other than that, however, there were no particular problems, and we expect that further CE education will provide a favorable surgical environment.

Outcome of thoracoscopic anatomical sublobar resection under 3-dimensional computed tomography simulation.

BACKGROUND: Previous studies have reported the feasibility and efficacy of thoracoscopic anatomical sublobar resection under three-dimensional computed tomography (3DCT) simulation; however, its long-term outcomes have not been clearly established in primary lung cancer. This study aimed to evaluate the long-term outcomes of this technique. METHODS: We retrospectively reviewed data from 112 consecutive patients with selected clinical stage IA non-small cell lung cancer (NSCLC) who underwent thoracoscopic anatomical sublobar resection from 2004 to 2014. This procedure was planned using preoperative 3DCT simulation to ensure sufficient surgical margins and enabled tailor-made surgery for each patient. Patients who had predominantly ground glass opacity lung cancers underwent anatomical sublobar resection as a curative-intent resection. Other patients who were high-risk candidates for lobectomy underwent anatomical sublobar resection as a compromised limited resection. RESULTS: Of the 112 cases, 82 had a curative-intent resection, while 30 had a compromised limited resection. Recurrence occurred in only 2 cases (1.8%), both of which were in the compromised limited group. A second primary lung cancer was observed in 5 cases (4.5%). Of the 5 patients, 4 underwent surgery for a second cancer and had no recurrence. The 5-year overall survival, lung cancer-specific overall survival, and recurrence-free survival rates were 92.5%, 100%, and 98.2%, respectively, for all cases; 97.6%, 100%, and 100%, respectively, in the curative-intent group; and 75.8%, 100% and 92.6%, respectively, in the compromised limited group. CONCLUSIONS: Thoracoscopic anatomical sublobar resection under 3DCT simulation may be an acceptable alternative treatment in selected patients with NSCLC. TRIAL AND CLINICAL REGISTRY: Clinical registration number: IRB No. 2020-98 (Dated: 2020.6.30).

Evaluation of effects of perioperative oral care intervention on hospitalization stay and postoperative infection in patients undergoing lung cancer intervention.

PURPOSE: This retrospective study investigated the effect of perioperative oral care intervention on postoperative outcomes in patients undergoing lung cancer resection, in terms of the length of postoperative hospital stay and the incidence of postoperative respiratory infections. METHODS: In total, 585 patients underwent lung resection for lung cancer, 397 received perioperative oral care intervention, whereas the remaining 188 did not. This study retrospectively investigated the demographic and clinical characteristics (including postoperative complications and postoperative hospital stay) of each group. To determine whether perioperative oral care intervention was independently associated with either postoperative hospital stay or postoperative respiratory infections, multivariate analysis, multiple regression analysis, and multivariate logistic regression analysis were conducted. RESULTS: Parameters significantly associated with a prolonged postoperative hospital stay in lung cancer surgery patients were older age, postoperative complications, increased intraoperative bleeding, more invasive operative approach (e.g., open surgery), and lack of perioperative oral care intervention (standard partial regression coefficient (ß) = 0.083, p = 0.027). Furthermore, older age and longer operative time were significant independent risk factors for the occurrence of postoperative respiratory infections. Lack of perioperative oral care intervention was a potential risk factor for the occurrence of postoperative respiratory infections, although not statistically significant (odds ratio = 2.448, 95% confidence interval = 0.966-6.204, p = 0.059). CONCLUSION: These results highlight the importance of perioperative oral care intervention prior to lung cancer surgery, in order to shorten postoperative hospital stay and reduce the risk of postoperative respiratory infections.

[The Novel Procedure for Thoracoscopic Anatomical Segmentectomy].

Since 2004, over 300 patients have undergone thoracoscopic segmentectomy without mini-thoracotomy. Thoracoscopic segmentectomy is one of the most complicated surgeries. To perform the complex segmentectomies, pre-operative simulation and 3-dimensional multi-detector computed tomography( 3DCT) are both essential for safely performing operations and for securing adequate surgical margins. Comprehension of the intersegmental and intrasegmental veins to visualize the segmental border facilitates an easier parenchymal dissection. We describe our method and knack for creating an inflation-deflation line for lung segmentectomy that could especially be useful in thoracoscopic procedures for seg-mentectomy. The 5-year over overall survival, cancer specific survival and recurrence free survival rates were 91.8%( curative intent 98.1% versus compromised 74.6%), 100% and 98.1%( curative intent 100% versus compromised 93.3%). According to these technical aspects, our method of thoracoscopic segmentectomy is acceptable for selective patient.

[Curative Left Pulmonary Resection Combined with Total En Bloc Spondylectomy for Lung Cancer Invading the Second and Third Thoracic Vertebral Bodies].

Introduction of spinal surgery into the operation of lung cancer has made extensive surgical treatment feasible with acceptable long-term survival. We report our experience on total en bloc total spondylectomy for lung cancer invading the spine. A 60-year-old man was diagnosed with lung adenocarcinoma of the apicodorsal segment of the left lobe with invasion of the 2nd and 3rd thoracic vertebral bodies. After induction chemoradiotherapy, we performed en bloc resection through a posterolateral thoracotomy in the right decubitus position and a posterior median approach in the prone position. The thoracic manipulation was done earlier, making it useful for the dissection of the prevertebral plane from the posterior mediastinum at the upper thoracic level in addition to confirmation of non-N2 disease. Vertebral stabilization was achieved with rod fixation and placement of a titanium mesh cage between the remaining vertebral bodies.

[Complete Resection of Non-seminomatous Germ Cell Tumor with Plastron Approach].

A 17-year-old man was admitted to our hospital for the abnormal chest shadow. Chest computed tomography(CT) demonstrated mediastinal tumor, measuring 13 cm in diameter with high serum level of alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG). The lesions were diagnosed as mixed germ cell tumors including a non-seminomatous malignant component by CT guided needle biopsy. After 5 courses of chemotherapy, the serum AFP and hCG were decreased almost normal level but the tumor size was not changed. Because it seemed to be difficult to get sufficient operating field with standard median sternotomy and patient wanted to treat funnel chest, we selected tumor resection with plastron approach. The tumor was completely resected with a good operation field by this procedure.

[Chest Wall Reconstruction Using Titanium Plates Sandwiched Between Sheets after Resection of Chest Wall Chondrosarcoma].

Extensive chest wall resection carries the risk of difficult reconstruction and surgical complications. We report our experience on chest wall reconstruction using titanium plates for a wide thoracic defect after tumor resection. A 74-year-old man was diagnosed with chondrosarcoma of the 6th rib on the right. He needed extensive chest wall resection because of skip lesions on 4th rib noted on operative inspection, leaving a defect measuring 33 × 20 cm. Reconstruction using 5 transverse titanium plates sandwiched between an expanded polytetrafluoroethylene patch and a polypropylene mesh sheet stabilized the chest wall. This reconstruction allowed successful separation from ventilatory support after operation. The postoperative course was uneventful, and he was discharged on postoperative day 20. The advantages of this form of reconstruction over conventional prostheses are rigidity, and stability and usability.

[Natural history of Kawasaki disease vasculitis].

Kawasaki disease is an acute vasculits syndrome of unknown etiology, which mainly affects small and medium arteries particularly coronary arteries in infants and young children. The cardiovascular problems include coronary artery lesions that develop the aneurysm formation, thrombotic occlusion, progression to coronary artery disease, and pre- mature atherosclerosis. However, the long-term consequences of these cardiovascular problems are still uncertain. In this article the long-term spectrums of Kawasaki disease vasculitis are described by our long-term follow-up study of 2,450 patients from clinical and pathological aspects. We like to emphasize that the long-term cardiovascular prob- lems are important issues not only in children but also in adulthood.

A prospective 10-year follow-up study after sublobar resection for ground-glass opacity-dominant lung cancer.

This single-arm multi-institutional prospective study aimed to evaluate the 10-year outcomes of sublobar resection for small-sized ground-glass opacity-dominant lung cancer. Among 73 patients prospectively enrolled from 13 institutions between November 2006 and April 2012, 53 ground-glass opacity-dominant lung cancer patients underwent sublobar resection with wedge resection as the first choice. The inclusion criteria were maximum tumor size of 8-20 mm; ≥ 80% ground-glass opacity ratio on high-resolution computed tomography; lower 18F-fluorodeoxyglucose accumulation than the mediastinum; intraoperative pathological diagnosis of adenocarcinoma in situ; and no cancer cells on intraoperative cut margins. The primary endpoint was a 10-year disease-specific survival. The 53 eligible patients had a mean tumor size of 14 ± 3.4 mm and a mean ground-glass opacity ratio of 95.9 ± 7.2%. Wedge resection and segmentectomy were performed in 39 and 14 patients, respectively. The final pathological diagnoses were adenocarcinoma in situ in 47 patients (88.7%) and adenocarcinoma with mixed subtype in 6 patients (11.3%). The 10-year disease-specific survival and overall survival were 100% and 96.2%, respectively, during a median follow-up period of 120 months (range, 37-162 months). Ground-glass opacity-dominant small lung cancer is cured by sublobar resection when patients are strictly selected by the inclusion criteria of this study.

[Long survival case of resected lung cancer after chemotherapy with gefitinib].

In another hospital, a 71-year-old man had been pointed out to have an abnormal shadow in the left lung field on chest radiograph at a medical checkup. Computed tomography( CT) scan revealed a mass both in the S1+2 and in the S10 of the left lung. The mass in the S1+2 was diagnosed as squamous cell carcinoma by bronchoscopy. CT scan revealed a swelling lymph node at the opposite side. He was diagnosed as having lung cancer (cT2N3M1:stage IV) and was given chemotherapy. The S1+2-mass showed a partial response and the S10-nodule was stable disease. He was then changed to gefitinib administration due to severe side effect of the chemotherapy. The side of S10-nodule once reduced, however, it grew up again after 16 months treatment with gefitinib. He was then referred to our hospital for surgery, and bisegmentectomy with mediastinal dissection was performed. He had no complications after the operation, and is well without recurrence for 8 years after the operation.

[Thoracoscopic surgery for traumatic mediastinal hematoma].

We report a rare case of traumatic mediastinal hematoma treated by thoracoscopic surgery. A 78-year-old man accidentally fell down from the roof, and he was urgently transferred to our hospital. Soon after the arrival, he showed breathlessness followed by cardiopulmonary arrest, necessitating tracheal intubation and resuscitation. Computed tomography (CT) showed a large cervical hematoma extending to the tracheal bifurcation level of mediastinum, causing tracheal obstruction. Five days later, the large mediastinal hematoma was removed by thoracoscopic surgery. The patient recovered without any complications after our treatments.

Long-term prognosis of patients with Kawasaki disease complicated by giant coronary aneurysms: a single-institution experience.

BACKGROUND: Some patients with Kawasaki disease develop giant coronary aneurysms and coronary stenosis, leading to ischemic heart disease. The aim of this study was to determine the long-term prognosis of patients with Kawasaki disease with giant aneurysms. METHODS AND RESULTS: From our institutional database, 76 patients (57 men and 19 women) who developed giant aneurysms after January 1, 1972, were identified. Information on patient demographics, catheter and surgical interventions, and most recent status was collected from medical charts and patients' contacts. From these data, we calculated the survival rate and cumulative coronary intervention rate. The average age at onset was 2.9±2.9 years, and the median observational period was 19 years. During this period, 7 patients died and 1 patient underwent a heart transplantation, resulting in 95%, 88%, and 88% survival rates at 10, 20, and 30 years after the onset of KD, respectively. On the other hand, catheter and surgical coronary interventions (median, 1 intervention; range, 1 to 7 interventions) were performed to alleviate coronary ischemia in 46 patients (61%) at 1 month to 21 years (mode at 1 month) after onset, resulting in 28%, 43%, and 59% cumulative coronary intervention rates at 5, 15, and 25 years after onset, respectively. CONCLUSIONS: The long-term survival of patients with Kawasaki disease complicated by giant coronary aneurysms is moderately good with multiple catheter and surgical interventions. Further research should focus on the prevention of coronary vascular remodeling and on the indications for and effectiveness of percutaneous and surgical coronary interventions.

Inhibitory effects of polysaccharides on the cariogenic activities of Streptococcus mutans.

Many carbohydrates are involved in the biofilm formation and activities of glucosyltransferases (Gtfs) of Streptococcus mutans, and the effects of various disaccharides and polysaccharides were investigated in this study, including the hot water-extracted glucan fraction of the Lentinula edodes fruiting body (HWG). HWG was found to inhibit the initial adhesion of S. mutans to saliva-coated hydroxyapatite (sHA), and also laminarin to inhibit glucan synthesis by Gtfs. However, sucrose-dependent biofilm formation by S. mutans was not inhibited by these materials. Interestingly, dextran was found to have an inhibitory effect on the sucrose-dependent biofilm formation. The data suggest that the presence of such an edible glucan as dextran in daily foods would act to some degree on S. mutans for suppressing the cariogenic activity.

[Procedure for lung resection in patients with small-sized lung cancer and mid-term results].

Sublobar resection and the optimum approach for small-sized lung cancer remain controversial. We defined the criteria for the selection of cT1aN0M0 patients for thoracoscopic lung surgery and the criteria for other patients for open lung surgery in 2004. Limited resection for small-sized lung cancer was performed when the diameter of the solid lesion was less than 20% the diameter of lesions of groundglass opacity( GGO). The 5-year overall survival and 5-year disease-free survival( 5Y-DFS) was 89.9% and 91.7%, respectively. The 5Y-DFS according to the pathological stage was as follows:stage IA, 96.5%;IB, 100%;IIA, 50%;IIIA, 66.7%;and stage IV, 100%. According to computed tomography (CT) findings, the 5Y-DFS was as follows:pure GGO lesion, 100%;mixed GGO lesion, 100%;and solid lesion, 84.6%. Lymph node metastases and recurrence were noticed only in patients with a solid lesion. Thus, patients with GGO lesions are considered good candidates for thoracoscopic sublobar resection. In addition, thoracoscopic segmentectomy was performed in cT1bN0M0 patients with GGO lesions, and good prognostic results were obtained;therefore, these patients are also considered good candidates for the procedure.

[Left ventricular outflow tract pseudoaneurysm complicated with prosthetic valve endocarditis after aortic valve replacement].

A rare case of left ventricular outflow tract (LVOT) pseudoaneurysm complicated with prosthetic valve endocarditis was reported herein. A 78-year-old male previously underwent aortic valve replacement (AVR) with a bioprosthesis. Four years after the initial operation, he presented with prolonged high fever and bloody sputum. Multi-detector row computed tomography (MDCT) clearly showed LVOT pseudoaneurysm originating from a subvalvular fibrous region. The patient underwent re-AVR and repair of pseudoaneurysm. The postoperative course was uneventful, and the patient recovered good condition.

Roles and outcomes of thoracoscopic anatomic lung subsegmentectomy for lung cancer.

OBJECTIVES: We performed sublobar resections, including thoracoscopic segmentectomy and subsegmentectomy for small lung cancers, and analysed the results of indications and outcomes of thoracoscopic subsegmentectomy. METHODS: Between March 2005 and May 2020, 357 consecutive patients underwent thoracoscopic anatomic sublobar resections for lung cancer, including 68 patients undergoing subsegmentectomy. These patients were compared with 289 patients who underwent segmentectomy during the same period. RESULTS: Subsegmentectomies included mono-/bi-/tri-subsegmentectomies for 34/23/11 of 68 patients, respectively. The median tumour size was 13.5 mm, significantly smaller than tumours in patients who underwent a segmentectomy (P < 0.001). Tumours obtained by mono-subsegmentectomy (11.0 mm) were significantly smaller than bi-/tri-subsegmentectomy (P = 0.028). The proportion of ground-glass opacity-dominant tumours obtained by subsegmentectomy (85.3%) was higher than that obtained by segmentectomy. The proportion of intentional cases satisfying the criteria for sublobar resection was higher than that of segmentectomy cases. Although tumour locations in 40 patients were not identified during surgery, tumours were correctly resected in 39 patients without tumour markers. The median operative time and blood loss were 167 min and 13 ml, significantly shorter and less, respectively, in subsegmentectomy than in segmentectomy patients (P = 0.005, P = 0.006). Duration of drainage and hospitalization were 1 and 5 days, respectively, for subsegmentectomy patients; complications occurred in 6 (8.8%). Outcomes were similar to those of the segmentectomy patients. Although 4 subsegmentectomy patients died of other diseases, none showed cancer recurrence during a mean follow-up of 50 months. CONCLUSIONS: Thoracoscopic subsegmentectomy can be used for patients with ground-glass opacity-dominant lung cancers <1.5 cm if adequate margins can be secured.

[Cytomegalovirus associated myelitis in a non-immunocompromised adult due to initial cytomegalovirus infection].

The patient was a 30-year-old man who developed muscle weakness in both lower extremities, sensory deficits below the fourth thoracic spinal cord level, and bladder rectal dysfunction owing to cytomegalovirus (CMV) associated myelitis. His blood tests showed mononucleosis, hepatic dysfunction, and the presence of serum CMV-IgM antibodies, and T2-weighted imaging on MRI displayed a continuous high signal on the ventral side of the spinal cord. Although his medical history and laboratory tests did not indicate that he was immunocompromised, we speculated he had CMV-associated myelitis. As the first infection with CMV in a non-immunocompromised adult can result in mononucleosis, we considered that this patient developed myelitis after mononucleosis caused by CMV infection for the first time. CMV-associated myelitis in non-immunocompromised individuals is rare. In general, CMV infections are common in immunosuppressed individuals. However, in Japan, adults with CMV antibodies have recently been decreasing, and hence CMV infections in non-immunocompromised adults are expected to increase in the future.

Identification and enzymic analysis of a novel protein associated with production of hydrogen sulfide and L-serine from L-cysteine in Fusobacterium nucleatum subsp. nucleatum ATCC 25586.

A third enzyme that produces hydrogen sulfide from L-cysteine was identified in Fusobacterium nucleatum subsp. nucleatum. The fn1055 gene was cloned from a cosmid library constructed with genomic DNA of F. nucleatum ATCC 25586. Despite the database annotation that the product of fn1055 is a cysteine synthase, reverse-phase HPLC revealed that no L-cysteine was produced in vitro by the purified Fn1055 protein; however, the enzyme did produce L-serine. In addition, a cysteine auxotroph, Escherichia coli NK3, transformed with a plasmid containing the fn1055 gene did not grow without cysteine, which further suggests that Fn1055 does not function as a cysteine synthase. The Michaelis-Menten kinetics (K(m) =0.09 ± 0.001 mM and k(cat) =5.43 ± 0.64 s(-1)) of the purified enzyme showed that the capacity of Fn1055 to produce hydrogen sulfide was between that of two other enzymes, Fn0625 and Fn1220. Incubation of Fn1055 with L-cysteine resulted in the production of hydrogen sulfide, but not of pyruvate, ammonia or lanthionine, which are all byproducts produced in addition to hydrogen sulfide when Fn0625 or Fn1220 is incubated with L-cysteine. Instead, Fn1055 produced L-serine in its reaction with L-cysteine. Fn1055 produces hydrogen sulfide from l-cysteine by a mechanism that is different from that of Fn0625 or Fn1220.