Trapped Lung as a Sequela of Dramatic Tumor Shrinkage of Lung Cancer.

Herein, we report a case of 72-year-old man who had L858R EGFR-mutated lung adenocarcinoma. Chest computed tomography revealed a large lung mass that had completely replaced the right upper lobe. Although the mass dramatically shrank after initiating chemotherapy, non-malignant pleural effusion appeared. Because diffuse pleural thickening and shrinking of the thoracic cage gradually became apparent, the patient was diagnosed with trapped lung. Despite the stabilization of his lung cancer, he experienced severe dyspnea and significant weight loss, ultimately leading to a decreased performance status. Chest physicians should recognize that trapped lung can develop as a sequela of dramatic tumor shrinkage in lung cancer.

Treatment Strategies for Non-Small-Cell Lung Cancer with Comorbid Respiratory Disease; Interstitial Pneumonia, Chronic Obstructive Pulmonary Disease, and Tuberculosis.

Non-small cell lung cancer (NSCLC) patients are often complicated by other respiratory diseases, including interstitial pneumonia (IP), chronic obstructive pulmonary disease (COPD), and pulmonary tuberculosis (TB), and the management of which can be problematic. NSCLC patients with IP sometimes develop fatal acute exacerbation induced by pharmacotherapy, and the establishment of a safe treatment strategy is desirable. For advanced NSCLC with IP, carboplatin plus nanoparticle albumin-bound paclitaxel is a relatively safe and effective first-line treatment option. Although the safety of immune checkpoint inhibitors (ICIs) for these populations remains controversial, ICIs have the potential to provide long-term survival. The severity of COPD is an important prognostic factor in NSCLC patients. Although COPD complications do not necessarily limit treatment options, it is important to select drugs with fewer side effects on the heart and blood vessels as well as the lungs. Active TB is complicated by 2-5% of NSCLC cases during their disease course. Since pharmacotherapy, especially ICIs, reportedly induces the development of TB, the possibility of developing TB should always be kept in mind during NSCLC treatment. To date, there is no coherent review article on NSCLC with these pulmonary complications. This review article summarizes the current evidence and discusses future prospects for treatment strategies for NSCLC patients complicated with IP, severe COPD, and TB.

KRASG12C Inhibitor as a Treatment Option for Non-Small-Cell Lung Cancer with Comorbid Interstitial Pneumonia.

Non-small-cell lung cancer (NSCLC) with comorbid interstitial pneumonia (IP) is a population with limited treatment options and a poor prognosis. Patients with comorbid IP are at high risk of developing fatal drug-induced pneumonitis, and data on the safety and efficacy of molecularly targeted therapies are lacking. KRAS mutations have been frequently detected in patients with NSCLC with comorbid IP. However, the low detection rate of common driver gene mutations, such as epidermal growth factor receptor and anaplastic lymphoma kinase, in patients with comorbid IP frequently results in inadequate screening for driver mutations, and KRAS mutations may be overlooked. Recently, sotorasib and adagrasib were approved as treatment options for advanced NSCLC with KRASG12C mutations. Although patients with comorbid IP were not excluded from clinical trials of these KRASG12C inhibitors, the incidence of drug-induced pneumonitis was low. Therefore, KRASG12C inhibitors may be a safe and effective treatment option for NSCLC with comorbid IP. This review article discusses the promise and prospects of molecular-targeted therapies, especially KRASG12C inhibitors, for NSCLC with comorbid IP, along with our own clinical experience.

Drug-related pneumonitis caused by amikacin liposome inhalation suspension: One pathologically proven case and single-center experience.

Amikacin liposome inhalation suspension (ALIS) is known to cause drug-related pneumonitis, which has been described as "hypersensitivity pneumonitis (HP)". However, its clinical and pathological characteristics have never been reported. We retrospectively evaluated 18 patients treated with ALIS. Three (16.7%) patients developed HP-pattern pneumonitis on high-resolution computed tomography. Serum eosinophil counts were elevated up to above 1000/µL in these three patients, which decreased with ALIS discontinuation only. Of note, the specimen obtained by transbronchial lung cryobiopsy in one patient revealed a mild degree of lymphocyte and eosinophil infiltration. Rather, the findings of acute lung injury such as an edematous thickening of the alveolar walls, and an accumulation of foamy degenerative macrophages in the alveolar lumina was prominent. A pulmonary alveolar proteinosis reaction was also observed. HP-pattern pneumonitis due to ALIS may pathologically correspond to acute lung injury and a pulmonary alveolar proteinosis reaction despite increasing serum eosinophil counts.

Spontaneous regression of acute fibrinous organizing pneumonia induced by COVID-19 vaccination: A case report.

A 42-year-old woman visited our hospital with complaints of fever, muscle pain, and dyspnea one week after receiving the coronavirus disease 2019 (COVID-19) vaccine. Chest high-resolution computed tomography showed a patchy consolidation and ground-glass attenuation in the both lungs, consistent with acute interstitial pneumonia. Transbronchial lung cryobiopsy revealed organizing pneumonia with marked intra-alveolar fibrin, and pathologically diagnosed as acute fibrinous organizing pneumonia (AFOP). Other causative diseases such as dermatomyositis was clinically ruled out, and COVID-19 vaccine-induced AFOP was diagnosed. Physician should check the history of COVID-19 vaccination when encountering a case of AFOP with an unknown cause.

Disaster response among hospital nurses dispatched to evacuation centers after the Great East Japan Earthquake: a thematic analysis.

BACKGROUND: Disaster relief operations involve a variety of components of healthcare efforts. The post-disaster recovery is a key component of hospital preparedness. This study aimed to investigate the role of hospital nurses in the disaster area and their challenges during the relief efforts after the Great East Japan Earthquake in 2011. METHODS: Semi-structured interviews were conducted with ten nurses who worked in a general public hospital before the Great East Japan Earthquake and were dispatched to the evacuation centers after the disaster. A qualitative approach with the thematic analysis method was employed. Three research queries (RQs) were prepared before the interview. RESULTS: The study participants played administrative roles as city employees in addition to performing nursing services as healthcare providers in evacuation centers. The first RQ on their challenges in evacuation centers gave us four themes: criticism by the evacuees, conflicts between multiple roles, difficulties in performing the first experience, and anxiety in working. The second RQ asking about motivation to accomplish disaster relief efforts raised three themes of carrying out the nursing role, acceptance by evacuees, and strengths of human connections. Two themes of awareness of disaster medicine and professional growth were raised from the third RQ of gains from the experiences in the evacuation centers. CONCLUSIONS: The hospital nurses in the disaster area performed multiple roles in the relief efforts in the evacuation centers, which developed a psychological burden on them. A sense of competence supported the motivation to accomplish the disaster relief activities and professional growth as a specialist in disaster medicine. A study limitation is missing hospital nurses who resigned during the relief efforts. Further study is warranted to refine the disaster preparedness of hospital operations.

A Global Collaboration for Community-Based Disaster Preparation and Health Promotion: Fukushima to Zuunbayan in Mongolia.

Excessive radiation exposure has adverse effects on health. In Fukushima, psychological issues such as anxiety are still affecting people nine years after the Fukushima nuclear power plant accident in 2011. In light of the lessons learned from Fukushima communities, a joint Japanese and Mongolian research team introduced a community program to the Zuunbayan district in Mongolia, which is located near a uranium deposit, to promote good health by strengthening radiation emergency preparedness. The program, which commenced in 2017, aimed to increase community participation, education, information dissemination, and capacity of community preparedness. After two years a monitoring study showed that, out of 227 respondents, the proportions who thought that any level of radiation was dangerous decreased from 53.3% in 2017 to 33.9% in 2019. Moreover, half of the respondents knew that there were safe and unsafe radiation levels and that their community was safe. This global collaboration demonstrated that a lesson learned from a disaster can be applied to other countries and changed people's recognition and behavior toward good health and disaster/emergency preparedness.

Issues in Radiation Nursing Education in Japan Before and After the Fukushima Daiichi Nuclear Power Plant Accident.

BACKGROUND: The response of nurses in Japan to the Fukushima Daiichi Nuclear Power Plant accident was deemed inadequate. This study examined the issues in Japanese radiation nursing education. METHOD: Anonymous, self-administered postal questionnaires were sent to managers and teachers of 1053 basic nursing educational institutions in Japan. RESULTS: Among the 342 institutions that completed the questionnaire, 218 (63.7%) had incorporated Radiological Nursing Education into their curriculum while 124 (36.3%) had not. Based on the time of their incorporation, they were divided into the pre-accident incorporation group and the post-accident incorporation groups. For 89 of 111 institutions (85.6%) in the former group, the main reason for the incorporation was radiotherapy care. For 11 of 26 institutions (42.3%) in the latter group, the incorporation was their response to the nuclear disaster. CONCLUSION: Nursing education in Japan has been inadequate, and as such, nurses find it hard to respond to nuclear disasters. Examining the current nursing education system and building a new model based on the nuclear disaster experience are urgent issues.

Gamma dose rate distribution in the Unegt subbasin, a uranium deposit area in Dornogobi Province, southeastern Mongolia.

Unegt subbasin in Dornogobi Province, southeastern Mongolia, contains the Dulaan Uul uranium deposit, for which development for commercial mining has been conducted as of 2015. Zuunbayan is a commune located close to the Dulaan Uul uranium deposit, and residents of Zuunbayan and their livestock can easily approach the uranium deposit area, including an aboveground dump site, which was created as a result of the mining development. The present study measured and analyzed the gamma dose rate (absorbed dose rate in air) distribution in Unegt subbasin using data collected from a car-borne measurement survey. The gamma dose rate increased from the northern (45-65 nGy/h) to the central (50-69 nGy/h, including Zuunbayan) and the southern (54-195 nGy/h, including Dulaan Uul) parts of the study area. The gamma dose rates (up to 195 nGy/h) around the dump site in Dulaan Uul were significantly higher than the background level (< 80 nGy/h) at several points. Additional in-situ measurements showed that the gamma dose rates reached up to 450 nGy/h at these locations, which was primarily attributed to the gamma radiation emitted by 238U series elements. Spatial distribution of gamma dose rates around the dump site revealed that the gamma radiation did not originate from the dump, but from the ground, at the measurement points. Analysis of collected soil samples showed that 238U and 226Ra were concentrated in deeper soil. These results indicate that the gamma dose rates higher than the background level were not associated with the aboveground mine dump; rather, they were very probably caused by presence of uranium deposits close to the ground surface.

Characteristics of awareness and behavior of medical staff for prevention of falling accidents among inpatients.

The purpose of this study is to clarify the characteristics of awareness and behavior for falling accident prevention according to medical profession. We used a questionnaire called "Self-Evaluation of Awareness and Behavior for Falling Accident Prevention," which was originally designed for nurses. In October and November 2016, the questionnaire was administered to 1,670 medical staff (nurses, doctors, lab technicians, nursing assistants, radiological technicians, pharmacists, physical therapists, nutritionists, and occupational therapists, among others) at a hospital in Japan, using a 5-step scale and a not applicable (N/A) option. Valid responses were obtained from 923 (55.3%) participants, and all seven factors extracted by factor analysis had Cronbach's α coefficients of greater than 0.9. Using cluster analysis based on principal component analysis, four categories were identified. According to the results of the N/A χ2 (chi-square) test question item and occupation, nurses answered N/A the least, followed by doctors, physical therapists, and occupational therapists. Nursing assistants' awareness and behavior were both low, suggesting the necessity of education on preventing falling accidents. By applying the "Self-Evaluation of Awareness and Behavior for Falling Accident Prevention" to all medical staff, we succeeded in clarifying their characteristics of awareness and behavior for falling accident prevention.

ELEVATION OF GAMMA DOSE RATE BY CONSTRUCTION OF THE ASIAN HIGHWAY 3 (AH3) BETWEEN ULAANBAATAR AND SAINSHAND, MONGOLIA.

The present study aimed at examining changes of gamma radiation level associated with road construction in Mongolia. A car-borne survey of gamma dose rate was made for a paved, ~450-km long part of the Asian Highway 3 between Ulaanbaatar and Sainshand. The gamma dose rates ranged from 48 to 173 nGy/h. Elevation of the gamma dose rates was observed only on a 86-km long segment of the survey route which was newly constructed from 2011 to 2013. The gamma dose rates over the newer paved segment were twice as high as those over the bare dirt surface alongside it. Outdoor measurements of gamma-ray pulse height distributions also indicated an abundance of natural radionuclides, especially 232Th-series elements in road materials. These findings suggest that the gamma dose rates were elevated by introduction of road materials containing large amounts of natural radionuclides.

Lexical analysis suggests differences between subgroups in anxieties over radiation exposure in Fukushima.

Although many experts have attempted communication about radiation risk, fears about radiation exposure stemming from the Fukushima Daiichi Nuclear Power Plant accident remain deeply rooted. The characteristics of the anxiety vary with social background, which makes it difficult to alleviate with one approach. Our ultimate goal is therefore to create risk-communication materials tailored to various groups with differing social backgrounds. Towards that end, the purpose of the present study was to clarify potential factors associated with radiation-related anxieties within these groups. After obtaining informed consent, we conducted focus group interviews (FGIs) with Fukushima residents from various social groups, including evacuees, emergency responders, government personnel, medical staff, and decontamination workers. We obtained narrative comments specifically related to the following two themes: (i) lessons learned (at work or home) in light of one's position in society, and (ii) health issues. After transcribing the comments, we examined potential factors associated with radiation-related anxieties using both quantitative and qualitative study methods simultaneously, using the KH Coder software and the Steps for Coding and Theorization (SCAT) method respectively. FGIs were undertaken with 141 persons. Categories, words and storylines extracted in this study might indicate potential anxieties that are unique to each group, but our analysis also suggested that some anxieties were common to all groups. We expect to continue the analyses and, ultimately, to establish group-tailored risk-communication materials for achieving our final goal of adapting and better managing risk-communication efforts to help people deal more effectively with the scientific, technological and societal changes that came about after the disaster.

Epidemiological survey of thyroid volume and iodine intake in schoolchildren, postpartum women and neonates living in Ulaan Baatar.

OBJECTIVE: Although endemic goiter had been recognized in most parts of the country, there are few available data on iodine-deficiency disorders (IDDs) in Mongolia. This study aimed to characterize the current status of iodine deficiency in Ulaan Baatar, Mongolia's capital city. DESIGN: Cross-sectional, observational study designed and performed according to the surveillance methods for IDD prevalence recommended by WHO/UNICEF/ICCIDD. SUBJECTS: A total of 505 schoolchildren aged 9-14 years (237 girls and 268 boys) and 138 mothers and their neonatal infants were selected to clinical and biochemical examination of the thyroid in 1996 and 1999. MEASUREMENTS: The anthropometric measurements, thyroid volume determined by ultrasound, blood TSH and FT4 concentrations, urinary iodine concentration and iodine content of salt consumed in households. RESULTS: Median thyroid volumes based on age were generally higher than those in iodine-sufficient areas and comparative to those reported in mild iodine-deficiency areas. Application of the updated WHO/ICCIDD reference values in iodine-replete European schoolchildren to the Mongolian children aged 10-12 years resulted in a goiter prevalence of 43.3%. The median value of urinary iodine concentration was 152.5 micro g/l (1.20 micro mol/l) and 40.3% of children excreted iodine below 100 micro g/l. Iodized salt (> 40 ppm) was consumed in 63.1% of households and in the children using noniodized salt their urinary iodine concentration was lower than those using ionized salt. In postpartum women, median thyroid volume and urinary iodine concentration were 11.3 ml and 107 micro g/l (0.84 micro mol/l), respectively, and 46% of women excreted less than 100 micro g/l (0.79 micro mol/l) of iodine. Of their neonates, 17.8% had elevated blood TSH levels (> 5 mU/l). In a 1999 survey, the goiter prevalence and ratio of low iodine excretion in schoolchildren decreased to 29.8% and 31.3%, respectively, while median urinary iodine concentration remain unchanged (160 micro g/l; 1.26 micro mol/l). CONCLUSION: The present study clearly indicates the presence of mild iodine deficiency in Mongolia. Enlarged thyroid gland and normal iodine excretion observed in schoolchildren living in Ulaan Baatar may result from the residual effects of iodine deficiency previously and presumably still exist in the city. Slight reduction in the rate of children with enlarged thyroid and low urinary iodine excretion after the onset of national iodinization programme suggests incomplete normalization of thyroid volume in children and that the correction of iodine deficiency is now in progress in Ulaan Baatar. Further nationwide surveys together with monitoring the progress of the national programme eliminating IDD are required in suburban areas surrounding the city and also in rural areas.

Difference in goiter rates between regular and occasional users of iodized salt in Mongolia.

In Mongolia many households use iodized salt only occasionally. We investigated whether the occasional use of iodized salt had an impact on the reduction of goiter size. We examined 685 children (8-11 years old) in five groups of households that (1) used iodized salt regularly, (2) used more than 10 kg of iodized salt annually, (3) used 6 to 10 kg annually, (4) used less than 6 kg annually, (5) and regularly used noniodized salt. The prevalence of goiter as determined by ultrasound in these five groups was 31.1%, 30.3%, 40.6%, 52.1%, 56.6%, respectively. There was no difference between goiter rates among the first three groups, but these groups had significantly lower rates than the last two groups. We concluded that annual use of more than 6 kg of iodized salt, preferably more than 10 kg, by a household had a beneficial effect on the rate of goiter. In addition, the possibility was suggested that households that consumed only iodized salt consumed less salt than other households.