Safety and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for patients aged 80 years and older.

BACKGROUND: The safety and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients aged 70 years and older has been established. However, few studies have evaluated the safety, usefulness, and significance of EBUS-TBNA in patients aged 80 years and older. METHODS: We retrospectively investigated patients aged 80 years and older who underwent EBUS-TBNA under local anesthesia. The study period was 10 years; from November 1, 2010 to October 31, 2020. The primary endpoint was the safety of EBUS-TBNA, which was measured as the incidence of complications associated with the procedure. The secondary endpoints were the overall diagnostic rate, malignant disease diagnosis rate, and malignant disease treatment rate. RESULTS: A total of 111 patients were enrolled in the study, and the median age was 82 years (range: 80-89 years). The incidence of complications (the primary endpoint) was 5% (5/111) and comprised oversedation in one case, chest pain in one case, hypoxemia in two cases, and arrhythmia in one case. Regarding the secondary endpoints, the diagnostic rate for all patients was 75% (83/111), and the diagnostic rate of malignant disease was 89% (75/84). Of the 75 patients with malignant disease diagnosed with EBUS-TBNA, 61 (81%) received tumor-specific therapy in accordance with their diagnoses. CONCLUSION: EBUS-TBNA can be considered safe and effective even in patients aged 80 years and older.

The Role of Rigid Bronchoscopic Intervention for Bronchial Carcinoid.

Bronchial carcinoid is a rare malignant tumor that is categorized as a typical carcinoid or atypical carcinoid. Many institutions use flexible bronchoscopy for diagnosis. However, due to the hemorrhagic nature of the tumor, the amount of specimen obtained is often small, making it difficult to obtain an accurate diagnosis. The use of rigid bronchoscopy may not only contribute to obtaining a diagnosis but also be beneficial in the treatment plan. The aim of this study was to evaluate the efficacy of rigid bronchoscopic interventions for the diagnosis and treatment of bronchial carcinoids. All patients with bronchial carcinoids who underwent rigid bronchoscopic intervention under general anesthesia at our institution between June 2006 and August 2018 were analyzed retrospectively. Eight patients [3 men and 5 women; median age, 71 years (range 45-82 years)] were eligible for the analysis. None of the cases had accurate subtyping preoperatively before intervention. In contrast, all cases were diagnosed as carcinoid with subtypes (5 patients had typical carcinoid and 3 had atypical carcinoid) following rigid bronchoscopic intervention. All respiratory symptoms improved immediately after the procedure. One instance of bleeding occurred, and was easily controlled by argon plasma coagulation and intraluminal administration of epinephrine under flexible and rigid bronchoscopy. Four patients (3 with typical carcinoid and 1 with atypical carcinoid) underwent radical surgery sequentially, and no recurrences were observed. We conclude that rigid bronchoscopic intervention is safe and effective for accurate diagnosis and improvement of respiratory symptoms in patients with bronchial carcinoids.

Habitat template approach for green roofs using a native rocky sea coast plant community in Japan.

The present study examined whether it is possible to simulate a local herbaceous coastal plant community on a roof, by studying the natural habitats of rocky sea coast plants and their propagation and performance on a green roof. After studying the natural habitat of coastal areas in Izu peninsula, a germination and cutting transplant study was carried out using herbaceous plants from the Jogasaki sea coast. Many plant species did not germinate at all and the use of cuttings was a better method than direct seeding. The green roof was installed in the spring of 2012 in Chiba city. Thirteen plant species from the Jogasaki sea coast, which were successfully propagated, were planted in three kinds of substrate (15 cm depth): pumice, roof tile and commercial green roof substrate. The water drainage was restricted and a reservoir with 5 cm depth of water underlaid the substrate to simulate a similar growing environment to the sea coast. Volcanic rocks were placed as mulch to create a landscape similar to that on the Jogasaki sea coast. Plant coverage on the green roof was measured every month from June 2012 to October 2014. All plants were harvested and their dry shoot weight was measured in December 2014. The type of substrate did not cause significant differences in plant survival and dry shoot weight. Sea coast plant species were divided into four categories: vigorous growth; seasonal change; disappearing after a few years; limited growth. Understanding the ecology of natural habitats was important to simulating a local landscape using native plant communities on the green roof.

The hypnotic bromovalerylurea ameliorates 6-hydroxydopamine-induced dopaminergic neuron loss while suppressing expression of interferon regulatory factors by microglia.

The low molecular weight organic compound bromovalerylurea (BU) has long been used as a hypnotic/sedative. In the present study, we found that BU suppressed mRNA expression of proinflammatory factors and nitric oxide release in lipopolysaccharide (LPS)-treated rat primary microglial cell cultures. BU prevented neuronal degeneration in LPS-treated neuron-microglia cocultures. The anti-inflammatory effects of BU were as strong as those of a synthetic glucocorticoid, dexamethasone. A rat hemi-Parkinsonian model was prepared by injecting 6-hydroxydopamine into the right striatum. BU was orally administered to these rats for 7 days, which ameliorated the degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNpc) and alleviated motor deficits. BU suppressed the expression of mRNAs for interferon regulatory factors (IRFs) 1, 7 and 8 in the right (lesioned) ventral midbrain as well as those for proinflammatory mediators. BU increased mRNA expression of various neuroprotective factors, including platelet-derived growth factor and hepatocyte growth factor, but it did not increase expression of alternative activation (M2) markers. In microglial culture, BU suppressed the LPS-induced increase in expression of IRFs 1 and 8, and it reduced LPS-induced phosphorylation of JAK1 and STATs 1 and 3. Knockdown of IRFs 1 and 8 suppressed LPS-induced NO release by microglial cells. These results suggest that suppression of microglial IRF expression by BU prevents neuronal cell death in the injured brain region, where microglial activation occurs. Because many Parkinsonian patients suffer from sleep disorders, BU administration before sleep may effectively ameliorate neurological symptoms and alleviate sleep dysfunction.

Anti-inflammatory effects of noradrenaline on LPS-treated microglial cells: Suppression of NFκB nuclear translocation and subsequent STAT1 phosphorylation.

Noradrenaline (NA) has marked anti-inflammatory effects on activated microglial cells. The present study was conducted to elucidate the mechanisms underlying the NA effects using rat primary cultured microglial cells. NA, an α1 agonist, phenylephrine (Phe) and a ß2 agonist, terbutaline (Ter) suppressed lipopolysaccharide (LPS)-induced nitric oxide (NO) release by microglia and prevented neuronal degeneration in LPS-treated neuron-microglia coculture. The agents suppressed expression of mRNA encoding proinflammatory mediators. Both an α1-selective blocker terazocine and a ß2-selective blocker butoxamine overcame the suppressive effects of NA. cAMP-dependent kinase (PKA) inhibitors did not abolish the suppressive NA effects. LPS decreased IκB leading to NFκB translocation into nuclei, then induced phosphorylation of signal transducer and activator of transcription 1 (STAT1) and expression of interferon regulatory factor 1 (IRF1). NA inhibited LPS-induced these changes. When NFκB expression was knocked down with siRNA, LPS-induced STAT1 phosphorylation and IRF1 expression was abolished. NA did not suppress IL-6 induced STAT1 phosphorylation and IRF1 expression. These results suggest that one of the critical mechanisms underlying the anti-inflammatory effects of NA is the inhibition of NFκB translocation. Although inhibitory effects of NA on STAT1 phosphorylation and IRF1 expression may contribute to the overall suppressive effects of NA, these may be the downstream events of inhibitory effects on NFκB. Since NA, Phe and Ter exerted almost the same effects and PKA inhibitors did not show significant antagonistic effects, the suppression by NA might not be dependent on specific adrenergic receptors and cAMP-dependent signaling pathway.