Efficacy of Supraglottic Airway for Preventing Lung Injury Associated with Coughing at Extubation after Pulmonary Lobectomy.

BACKGROUND: The use of double-lumen endobronchial tubes (DLTs) is necessary for differential lung ventilation during pulmonary lobectomy. However, when used with conventional extubation procedures, coughing is more likely and is associated with an increased risk for parenchymal air leak along the staple line and possible subsequent lung injury. We examined the prevalence of coughing-associated air leaks at extubation and the efficacy of using supraglottic airways (SGAs) to prevent air leaks with post-lobectomy extubation. METHODS: This study included 150 patients with pulmonary emphysema diagnosed using preoperative computed tomography, who underwent pulmonary lobectomy between April 2010 and March 2015. The patients were chronologically enrolled in two groups: the DLT group (60 patients) from April 2010 to August 2012, and the SGA group (90 patients) from September 2012 to March 2015. (Note: the DLT group only included cases without air leak present just prior to extubation). Data were collected on specific patient characteristics and operative and postoperative factors. RESULTS: Coughing at extubation occurred in 15 (25.0 %) of 60 DLT patients, and parenchymal air leaks developed in 10 (66.7 %) of these 15. Comparison of groups revealed the SGA group was significantly lower for the following: patients with coughing at extubation (P < 0.001), coughing-associated air leaks at extubation (P < 0.001), air leaks >7 days (P = 0.006), reoperation due to air leaks (P = 0.013), and duration of chest tube drainage (P < 0.001). CONCLUSIONS: The SGA is effective for preventing air leaks associated with coughing during conventional DLT extubation in post-lobectomy patients.

Opposing role of NMDA receptor GluN2B and GluN2D in somatosensory development and maturation.

Development of correct topographical connections between peripheral receptors and central somatosensory stations requires activity-dependent synapse refinement, in which the NMDA type of glutamate receptors plays a key role. Here we compared functional roles of GluN2B (GluRε2 or NR2B) and GluN2D (GluRε4 or NR2D), two major regulatory subunits of neonatal NMDA receptors, in development of whisker-related patterning at trigeminal relay stations. Compared with control littermates, both the appearance of whisker-related patterning and the termination of the critical period, as assessed by unilateral infraorbital nerve transection, were delayed by nearly a day in the somatosensory cortex of GluN2B(+/-) mice but advanced by nearly a day in GluN2D(-/-) mice. Similar temporal shifts were found at subcortical relay stations in the thalamus and brainstem of GluN2B(+/-) and GluN2D(-/-) mice. In comparison, the magnitude of lesion-induced critical period plasticity in the somatosensory cortex, as assessed following row-C whisker removal, was normal in both mutants. Thus, GluN2B and GluN2D play counteractive roles in temporal development and maturation of somatosensory maps without affecting the magnitude of critical period plasticity. To understand the opposing action, we then examined neuronal and synaptic expressions of the two subunits along the trigeminal pathway. At each trigeminal station, GluN2B was predominant at asymmetrical synapses of non-GABAergic neurons, whereas GluN2D was selective to asymmetrical synapses of GABAergic neurons. Together, our findings suggest that GluN2B expressed at glutamatergic synapses on glutamatergic projection neurons facilitates refinement of ascending pathway synapses directly, whereas GluN2D expressed at glutamatergic synapses on GABAergic interneurons delays it indirectly.

Port-site recurrence after complete resection of stage I thymoma by video-assisted thoracoscopic surgery: report of a case.

A 62-year-old female with myasthenia gravis and a mediastinal tumor underwent extended thymothymectomy by video-assisted thoracoscopic surgery (VATS). The tumor was diagnosed as a stage I type B2 thymoma. Eight years after the initial surgery, an abnormal shadow was detected on the annual follow-up chest radiograph, and computed tomography showed a homogeneous 35 × 15 mm hemispherical mass under a port-site scar in the right anterior chest wall. The mass was between the second and third ribs and was found to be adherent to the lung during surgery, and was excised via lung and chest wall resection. The pathological examination confirmed that it was a type B2 thymoma invading the third rib, and the tumor was considered to be a port-site recurrence. Care should be taken during VATS to avoid contact between the tumor surface and the port tracts to prevent tumor cell implantation.

[Surgical treatment of oral cancer pulmonary metastases].

We examined the efficacy of surgical resection of oral cancer pulmonary metastases. Between April 2001 and October 2010, 12 patients with pulmonary metastases underwent thoracic operations. There were 8 men and 4 women with a median age of 66.5 years (range, 27~76). All tumors were squamous cell carcinomas and the most common primary site was tongue (7 patients). Overall survival rate after metastasectomy was 50% at 3 years. Overall survival rate at 2 years by lobectomy was greater than by partial resection. For patients with oral cancer pulmonary metastasis, surgical resection is the effective treatment option.

Cytochemical and cytological properties of perineuronal oligodendrocytes in the mouse cortex.

Neuronal cell bodies are associated with glial cells collectively referred to as perineuronal satellite cells. One such satellite cell is the perineuronal oligodendrocyte, which is unmyelinating oligodendrocytes attaching to large neurons in various neural regions. However, little is known about their cellular characteristics and function. In this study, we identified perineuronal oligodendrocytes as 2',3'-cyclic nucleotide 3'-phosphodiesterase-positive cells attaching to neuronal perikarya immunostained for microtubule-associated protein 2, and examined their cytochemical and cytological properties in the mouse cerebral cortex. 2',3'-Cyclic nucleotide 3'-phosphodiesterase-positive perineuronal oligodendrocytes were immunonegative to representative glial markers for astrocytes (brain-type lipid binding protein and glial fibrillary acidic protein), microglia (Iba-1) and NG2(+) glia. However, almost all perineuronal oligodendrocytes expressed glia-specific or glia-enriched metabolic enzymes, i.e. the creatine synthetic enzyme S-adenosylmethionine:guanidinoacetate N-methyltransferase and L-serine biosynthetic enzyme 3-phosphoglycerate dehydrogenase. As to molecules participating in the glutamate-glutamine cycle, none of the perineuronal oligodendrocytes expressed the plasmalemmal glutamate transporters GLAST and GLT-1, although nearly half of the perineuronal oligodendrocytes were immunopositive for glutamine synthetase. Cytologically, perineuronal oligodendrocytes were mainly distributed in deep cortical layers (layers IV-VI), and attached directly and tightly to neuronal cell bodies, making a long concave impression to the contacting neurons. Interestingly, they attached more to glutamatergic principal neurons than to GABAergic interneurons, and this became evident at postnatal day 14, when the cerebral cortex develops and maturates. These cytochemical and cytological properties suggest that perineuronal oligodendrocytes are so differentiated as to fulfill metabolic support to the associating principal cortical neurons, rather than to regulate their synaptic transmission.

Successful Excision of Epithelioid Hemangioendothelioma of the Superior Vena Cava.

Epithelioid hemangioendothelioma is a rare, low-grade vascular tumor. Mediastinal localization is rare for epithelioid hemangioendothelioma. We report a case of a radically resected mediastinal EHE originating from the superior vena cava. A 79-year-old woman was referred to our hospital for colon cancer surgery. Computed tomography showed a 50-mm middle mediastinal tumor in direct contact with the left and right brachiocephalic veins, aortic arch, and right brachiocephalic artery. Right lateral thoracotomy was performed, and the tumor was resected en bloc with the right brachiocephalic vein and vagal nerve. Recurrence was not observed at 7 years after the operation, even without adjuvant therapy.

Glutamate transporters regulate lesion-induced plasticity in the developing somatosensory cortex.

Glutamate transporters are involved in neural differentiation, neuronal survival, and synaptic transmission. In the present study, we examined glutamate transporter 1 (GLT1) expression in the neonatal somatosensory cortex of C57BL/6 mice, and pursued its role in somatosensory development by comparing barrel development between GLT1 knock-out and control mice. During the first few neonatal days, a critical period for barrels, GLT1 expression is strikingly upregulated in cortical astrocytes, whereas it was downregulated in neuronal elements to below the detection threshold. GLT1 knock-out neonates developed normally in terms of body growth, cortical histoarchitecture, barrel formation, and critical period termination. However, when row C whiskers were lesioned during the critical period, reduction of lesioned row C barrels and reciprocal expansion of intact row B/D barrels were both milder in GLT1 knock-out mice than in control littermates. Accordingly, the map plasticity index, calculated as (B + D)/2C, was significantly lowered in GLT1 knock-out mice. We also found that extracellular glutamate levels in the neonatal somatosensory cortex were significantly elevated in GLT1 knock-out mice. Diminished lesion-induced plasticity was further found in mutant mice lacking glutamate-aspartate transporter (GLAST), an astrocyte-specific glutamate transporter throughout development. Therefore, glutamate transporters regulate critical period plasticity by enhancing expansion of active barrels and shrinkage of inactive barrels. Because cortical contents of glutamate receptors and GLAST were unaltered in GLT1 knock-out mice, this action appears to be mediated, at least partly, by keeping the ambient glutamate level low. Considering an essential role of glutamate receptors in the formation of whisker-related thalamocortical synapse patterning, glutamate transporters thus facilitate their activity-dependent remodeling.

Successful Excision of Endobronchial Cellular Schwannoma With Right Lower Sleeve Lobectomy.

Cellular schwannoma is a rare variant of schwannoma, showing high cellularity and a low mitotic index. A 64-year-old man was admitted to our hospital with a 2-month history of productive cough. Chest computed tomography showed an endobronchial tumor with complete atelectasis of the right lower lobe. Bronchoscopy showed an endobronchial tumor occluding the intermediate bronchus that was diagnosed as a cellular schwannoma on biopsy and was successfully excised with a right lower sleeve lobectomy to preserve the middle lobe. The postoperative course was uneventful, and the patient remains well with no sign of recurrence at the 7-year follow-up.

Pathological evaluation of the visceral pleura in the radical pleurectomy/decortication for malignant pleural mesothelioma patients.

BACKGROUND: Radical pleurectomy/decortication (P/D) is applied as a surgical treatment of resectable malignant pleural mesothelioma (MPM). Although P/D removed visceral pleura, dissection plain was not histologically explored previously. We examined a pathological evaluation of surgically removed visceral pleura in P/D. METHODS: Twenty-five patients with MPM who underwent P/D at the Tokyo Medical and Dental University Hospital between April 2010 and April 2018 were studied. The 25 cases included 20 with epithelioid tumors, 4 with a biphasic tumor and 1 with desmoplastic tumors. Nine, 1, 11 and 4 patients had mesotheliomas of stages I, II, III and IV, respectively. We analyzed the site of the visceral pleural lesions using the HE & Elastica van Gieson (EVG) staining. The tumor involvement of the pleura and the surgical dissection plane were defined using the depth criteria, D0-3. We added survival analyses according to the depth criteria. RESULTS: Ninety-nine lesions in total 45 lobes: 20 upper right, 14 middle, 20 lower, 22 upper left, and 23 lower were examined. Based on the depth D 0-3 criteria, there were 21 type D0, 18 type D1, 22 type D2 and 38 type D3 lesions. The growth of tumor cells in the pleura was partially diffuse or nodular in all cases. While 38 lesions which invaded the lung parenchyma were excised, another 61 lesions that reached within the pleura were dissected from lung parenchyma. Type D2&3 showed poor survivals than type D0&1. CONCLUSIONS: The lung parenchyma was always the dissection plane in P/D, regardless of tumor involvement in the visceral pleura. The depth criteria would help us in classifying pleural invasion histologically and possibly predicting the prognosis.

High expression of P-cadherin is significantly associated with poor prognosis in patients with non-small-cell lung cancer.

OBJECTIVES: Placental (P)-cadherin expression is associated with malignant phenotype of cancer cell. The loss of E-cadherin has been thought to play a key role in tumor progression in several cancers. In this study, we aimed to clarify the role of P-cadherin expression in non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: NSCLC patients (n = 172) were enrolled in this study; among them, 107 harbored adenocarcinomas, and 65 had squamous cell carcinomas. We examined P-cadherin and E-cadherin expression by immunohistochemical analysis and assessed the associations between each cadherin expression and both cadherin expression patterns with clinicopathological factors and prognosis. To investigate the pathway to acquire tumor progression associated with P-cadherin and E-cadherin, we examined p120 catenin localization by immunohistochemical analysis. RESULTS: High P-cadherin expression was significantly associated with lymphatic metastasis, pathological stage, and Ki-67 proliferation index (P < .05, respectively). Low E-cadherin expression was significantly associated with maximum standardized uptake value, lymphatic metastasis, and pathological stage (P < .05, respectively). The cytoplasmic p120 catenin localization was associated with the low E-cadherin and high P-cadherin expression group (P < .001). High P-cadherin expression was associated with shorter disease-free survival (P = .044) and shorter overall survival (OS; P = .044). The low E-cadherin and high P-cadherin expression group was associated with shorter OS (P = .024). CONCLUSIONS: High P-cadherin expression was associated with tumor progression and poor patient survival in NSCLC. In these patients, the low E-cadherin expression might be associated with tumor progression involving cytoplasmic p120 catenin.

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.

Segmental and complementary expression of L-serine biosynthetic enzyme 3-phosphoglycerate dehydrogenase and neutral amino acid transporter ASCT1 in the mouse kidney.

3-Phosphoglycerate dehydrogenase (Phgdh) is the initial step enzyme in the phosphorylated pathway of L-serine biosynthesis. We have previously revealed in the brain that Phgdh is preferentially expressed in glial cells, but not in neurons, and that glia-borne L-serine exerts strong neurotrophic actions to neuronal survive, differentiation, and development. To investigate whether such an L-serine-meditated intercellular relationship is constructed in peripheral organs and tissues, we examined the kidney, which is one of the organs with the highest expression of Phgdh mRNA in the body. We found that Phgdh was distributed highly in the renal papilla and inner layer of the outer zone and moderately in the cortex, whereas it was almost negative in the outer layer of the outer zone. This heterogeneous distribution was due to selective expression in distinct tubular segments, i.e., the Bowman's capsule, proximal tubule, and thin limbs of the Henle's loop. Interestingly, neutral amino acid transporter ASCT1, which preferentially transports alanine, serine, cysteine, and threonine, was selectively expressed in Phgdh-negative tubular segments, i.e., the distal tubule and collecting duct. Therefore, either Phgdh or ASCT1 is provided to each segment of renal tubules, suggesting that metabolic interplay mediated by L-serine biosynthesis and supply may exist in the kidney too.

Successful excision of a massive bleeding schwannoma by thoracoscopic surgery.

Massive intrathoracic bleeding caused by rupture of a benign schwannoma is extremely rare. A 73-year-old man was admitted to our emergency department because of chest pain and dyspnea. Computed tomography revealed massive pleural effusion and a posterior mediastinal tumor. Chest tube thoracostomy was performed, and the initial blood drainage was 1700 mL. Magnetic resonance imaging revealed that the tumor at the 8th costal level measured 46 × 60 mm. The tumor, located beside the 8th vertebra, had ruptured and caused the bleeding. It was successfully excised by thoracoscopic surgery and diagnosed as a benign schwannoma.

Expression of hypoxia-inducible factor-1α affects tumor proliferation and antiapoptosis in surgically resected lung cancer.

Hypoxia-inducible factor (HIF)-1 is a transcription factor that allows cells to adapt to hypoxic situations. HIF-1 is known to control tissue proliferation, antiapoptosis, angiogenesis and glucose metabolism. Furthermore, HIF-1 is involved in the growth of numerous cancer types. The present study aimed to examine the expression of HIF-1α immunohistochemically in resected lung cancers. The present study included 216 consecutive patients with lung cancer who underwent resection between April 2013 and January 2015. The patients' clinicopathological data were summarized, including imaging findings, tumor pathological characteristics, and the patient's age, sex and smoking status. The intratumoral expression of HIF-1α, survivin, c-Myc and the Ki-67 proliferation index were evaluated immunohistochemically. The patients were divided into two groups, according to the expression of HIF-1α (low vs. high) and the clinicopathological characteristics of these groups were compared. It was revealed that HIF-1α expression was significantly associated with ground glass opacity ratio, maximum standardized uptake value index, histological type (squamous cell carcinoma), differentiation and lymphatic invasion. Regarding the immunohistochemical findings, HIF-1α expression was significantly correlated with the expression levels of c-Myc (P<0.01) and survivin (P<0.01). Furthermore, the Ki-67 proliferation index was significantly higher in high-HIF-1α tumors compared with in low-HIF-1α tumors (P=0.01). The multivariate analysis identified squamous cell carcinoma, high SUVmax and lymphatic invasion as significant and independent factors for high HIF-1α expression. In conclusion, HIF-1 was highly expressed in certain subgroups of lung cancer with specific histopathology and images. HIF-1α expression was associated with tumor proliferation and antiapoptosis in lung cancer.

Phrenic nerve paralysis from recurrence of stage I thymoma with myasthenia gravis 10 years after complete resection.

A 34-year-old woman underwent thymo-thymectomy for myasthenia gravis (MG) and was diagnosed with type B3 Masaoka stage I thymoma. Phrenic nerve paralysis developed 8 years after surgery, and a left-sided mediastinal mass was seen on a chest radiograph 10 years after surgery. Chest computed tomography revealed a tumor measuring 57 × 21 × 28 mm beside the aortic arch. Surgical resection of the tumor with partial resection of phrenic and recurrent nerve, the left upper lobe, and the pericardium was performed through a left thoracotomy. Histological examination confirmed recurrent thymoma invading the resected surrounding organs. The patient received radiation therapy postoperatively and was alive with stable symptoms of MG at the 2-year follow-up. Symptomatic relapse of thymoma is very rare and an occult recurrent thymoma should be considered in patients with unilateral phrenic nerve paralysis even after complete resection of thymoma. Detailed examination with careful follow-up should be considered.

Interim results of pleurectomy/decortication and intraoperative intrapleural hyperthermic cisplatin perfusion for patients with malignant pleural mesothelioma intolerable to extrapleural pneumonectomy.

OBJECTIVE: Surgical procedure for malignant pleural mesothelioma (MPM) remains controversial. We reviewed our protocol including pleurectomy/decortication (P/D) for patients with malignant pleural mesothelioma who were intolerable to extrapleural pneumonectomy (EPP). PATIENTS AND METHODS: From June 2010 to April 2014, 14 patients with MPM were intended to treat with multimodality therapy including surgery. Four patients who were intolerable to EPP received a protocol consisting of P/D and intraoperative intrapleural hyperthermic cisplatin perfusion, followed by systemic chemotherapy. Ten patients received trimodality treatment of EPP, systemic chemotherapy, and intensity modulated radiation therapy for hemithorax. Surgical outcomes of acute operative results and interim survivals were examined and compared between the groups. RESULTS: All patients obtained macroscopic complete resection and received multimodality treatment in P/D and EPP groups. Operation time was longer in P/D group; however, there were no differences in ICU stays or hospitalizations. Four patients in P/D group and seven patients in EPP group experienced postoperative complications; however, there was no operative morality. EPP group suffered from cardiac complications and P/D group had prolonged airleak. Full walk recovery was obtained earlier in P/D group. One patient in P/D group had a local recurrence 11 months after surgery, while the other three patients survived 23-41 months with no evidence of diseases. CONCLUSIONS: P/D and intraoperative intrapleural cisplatin perfusion achieved a favorable macroscopic resection in patients with MPM who were intolerable to EPP. Postoperative complications were manageable and survival could be promising. Further study warrants with a larger number of patients.

Changes in occlusal contact area and average bite pressure during treatment of anterior crossbite in primary dentition.

The purpose of this study was to examine changes in functional parameters of patients with anterior crossbite in primary dentition during orthodontic treatment. Occlusal contact area (OCA), average bite pressure (ABP) and integrated occlusal load (IOL) were measured. Data obtained before the start of treatment (period A), data obtained when crossbite had improved (period B) and data obtained when the appliance had been removed (period C) were compared. OCA showed the lowest value in period B, and then gradually increased. ABP increased until period B and then declined or became constant. OCA and IOL showed significant differences in periods A and B and periods B and C (p < 0.05). The results suggest that about 6 months is required for stability of the occlusion and acquisition of function in the new occlusion after improvement of crossbite.

Four cases of contralateral pneumothorax after pneumonectomy.

Contralateral pneumothorax after pneumonectomy (CPAP) is a rare but potentially fatal condition. Therefore, when treating CPAP prevention of recurrence is very important. Despite a number of case reports about CPAP, its management is still controversial. We describe 4 cases of CPAP that were treated successfully by bullectomy and coverage with absorbable polyglactin mesh.