Prognostic significance of LAT1 expression in pleural mesothelioma.

Background: The L-type amino acid transporter (LAT1) exhibits significantly increased expression within tumor cells across various neoplasms. However, the clinical significance of LAT1 expression in patients with pleural mesothelioma (PM) remains unclear. Methods: Eighty patients diagnosed with PM between June 2007 and August 2022, were eligible for this study. LAT1, alanine-serine-cysteine transporter 2 (ASCT2), Ki-67, and VEGFR2 were evaluated by immunohistochemistry. Inflammatory and nutritional indices were also correlated with different variables, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI), and Glasgow prognostic score (GPS). Results: LAT1 was highly expressed in 57.5 % of patients with PM. Among the 80 patients included in this study, 65 (81.3 %) received chemotherapy, either alone or followed by surgical resection, while 15 (18.7 %) opted for best supportive care. The level of LAT1 significantly correlated with cell proliferation and ASCT2. Factors such as performance status, histology, LAT1 expression, PNI, ALI, and GPS were significant prognostic indicators for progression-free survival (PFS), while Ki-67, LAT1, NLR, SII, PNI, ALI, and GPS were identified as significant predictors for overall survival (OS). LAT1 expression emerged as an independent prognostic factor for predicting PFS and OS in all patients, as well as in the subgroup of 65 patients receiving chemotherapy. Notably, high LAT1 expression proved to be a significant predictor of outcome, particularly in the subgroup with high PLR and SII. Conclusion: LAT1 was a significant predictor of outcomes in patients with PM and was more predictive of worse outcomes in patients with high inflammatory and low nutritional status.

[Emergent Off-pump Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Report of a Case].

Dextrocardia associated with situs inversus totalis is a rare congenital anomaly. We herein report a patient with this condition and ischemic coronay artery disease who underwent emergency surgical myocardial revascularization. A 76-year-old man was admitted to our hospital with a diagnosis of unstable angina pectoris. He had incessant ventricular fibrillation attack on the second day of hospitalization. Emergent coronary angiography revealed total obstruction of the anatomically left anterior descending and right coronary arteries, and severe stenosis in the anatomically left circumflex artery. Emergent off-pump coronary artery bypass using saphenous vein grafts was successfully performed. Intraoperatively, the main surgeon continuouly stood on the patient's right side except during anastosiso of a vein graft to the left circumflex artery. Postoperative course was almost uneventful aside from transient renal replacement and prolonged ventilation.

Pulmonary pleomorphic carcinoma arising in mixed squamous and glandular papilloma: A case report.

Solitary pulmonary papillomas (SPPs) are rare lung neoplasms. Histologically, SPP is classified into three subtypes, and mixed squamous and glandular papilloma (MP) is the rarest subtype. Although SPPs are considered benign tumors, there have been several reports on the synchronous malignant transformation in SPPs. An 82-year-old asymptomatic man was referred to our hospital for further examination of a 2.2 cm-sized left lung tumor. Pathology of bronchoscopic specimens showed the possibility of pulmonary papilloma but did not reveal any malignancy. The patient complained of bloody sputum during the eighth month after the initial visit. The size of the lesion had increased to 4.3 cm. These data suggested the existence of malignancy, and the patient underwent an operation. Histologically, the tumor was composed of fibrovascular cores and papillomatous fronds lined by pseudostratified columnar cells and mucin-filled goblet cells. Keratinizing squamous epithelium was also observed. Overall, the diagnosis of MP was obtained by fundamental histology. In addition, a solid part beneath mild atypical squamous epithelia, which was composed of malignant-appearing squamous cells and spindle-shaped atypical cells, was observed. The spindle portion was positive for cytokeratin AE1/AE3 and vimentin, and focally positive for alpha-smooth muscle actin (αSMA). The final diagnosis was pulmonary pleomorphic carcinoma (PPC) arising in the MP. Only two cases have been reported for atypical spindle tumor cells that are found in MP or bronchiolar adenoma/ciliated muconodular papillary tumor (BA/CMPT), which has histologically similar features to MP. This is the second case report of PPC arising in MP.

A Th1-like CD4+ T-cell Cluster That Predicts Disease-free Survival in Early-stage Lung Cancer.

Perioperative immune checkpoint inhibitors have been shown to improve prognosis in early-stage lung cancer. However, no biomarkers are known to indicate the requirement for treatment. This study aimed to identify T-cell clusters responsible for antitumor immunity in patients with early-stage lung cancer. Preoperative blood samples from 50 consecutive patients with lung cancer who were diagnosed as operable and underwent complete resection were analyzed by mass cytometry. Patients were divided into two groups: no recurrence at a minimum observation period of 851 days (median observation period: 1,031.5 days) and recurrence by the last observation date. Mass cytometry and single-cell RNA sequencing analysis of lymph nodes (LN) and tumor-infiltrating T cells were also performed. CCR4-CCR6+ Th7R showed discriminative ability between recurrence and non-recurrence patients with lung cancer. Patients with more than 3.04% Th7R showed significantly favorable disease-free survival. Th7R was a major component of CD4+ T cells in tumor microenvironments and LNs adjacent to lung cancer tissues and was the only cluster that decreased in peripheral blood after the removal of cancer tissues, suggesting that Th7R was primed and proliferated in tumor-draining LNs in the presence of cancer tissues. Th7R had the kinetics that antitumor T cells should have, as indicated by the cancer immunity cycle; thus, peripheral blood Th7R could represent the potency of tumor immunity by reflecting priming and proliferation in tumor-draining LNs and Th7R in the tumor microenvironment. Prediction using peripheral Th7R before surgery could allow the selection of patients who require perioperative drug therapy and optimize therapeutic interventions with clinical implications. Significance: Peripheral Th7R, a Th1-like CD4+ T-cell cluster reflecting priming status in draining LNs and immune status in the tumor microenvironment, predicts disease-free survival after complete resection and has significant clinical relevance in selecting appropriate therapeutic interventions in patients with early-stage lung cancer.

Linguistic representation of vowels in speech imagery EEG.

Speech imagery recognition from electroencephalograms (EEGs) could potentially become a strong contender among non-invasive brain-computer interfaces (BCIs). In this report, first we extract language representations as the difference of line-spectra of phones by statistically analyzing many EEG signals from the Broca area. Then we extract vowels by using iterative search from hand-labeled short-syllable data. The iterative search process consists of principal component analysis (PCA) that visualizes linguistic representation of vowels through eigen-vectors φ(m), and subspace method (SM) that searches an optimum line-spectrum for redesigning φ(m). The extracted linguistic representation of Japanese vowels /i/ /e/ /a/ /o/ /u/ shows 2 distinguished spectral peaks (P1, P2) in the upper frequency range. The 5 vowels are aligned on the P1-P2 chart. A 5-vowel recognition experiment using a data set of 5 subjects and a convolutional neural network (CNN) classifier gave a mean accuracy rate of 72.6%.

Prognostic significance of lymph node dissection for lung cancer surgery: a narrative review.

Background and Objective: Theoretically, systematic lymph node dissection (SLND) in lung cancer surgery is a technique that leaves less cancer cells behind and is speculated to improve the prognosis, but its prognostic significance still remains controversial. In addition, the social environment surrounding lymph node dissection has changed with the advent of limited surgery for peripheral small-sized lung cancer and emergence of immune check inhibitor (ICI). Therefore, we reconsidered the role of lymph node dissection. Methods: By referring to past reports, we reviewed the process leading up to the establishment of SLND in lung cancer surgery. We compared five randomized prospective comparative studies on SLND and lymph node sampling (LNS) in lung cancer surgery. Key Content and Findings: Of the five randomized prospective comparative studies, two reported an improvement in overall survival (OS) with SLND, but the remaining three reported no significant difference in OS between SLND and LNS. One out of the five reports revealed a significant increase in complications with SLND. For peripheral non-small cell lung cancer (NSCLC) cases with tumor diameter ≤2 cm and consolidation-to-tumor ratio >0.5 segmentectomy was found to significantly improve the hazard ratio of OS, when compared to a lobectomy. However, the proportion of SLND and lobe-specific lymph node dissection (L-SLND) in each group seems to be unclear. In segmentectomy, the dissection of intersegmental lymph nodes tends to be lenient, and therefore it seems necessary to examine the significance of lymph node dissection in segmentectomy. ICIs are already showing excellent effects, and it may be necessary to examine how they will be affected by removal of regional lymph nodes where cancer-specific cytotoxic T lymphocytes (CTLs) are concentrated. SLND is essential for accurate staging, but ideally-in a host with no cancer cells in the lymph node or a host with cancer cells having a high sensitivity to ICI-it might be better to leave the regional lymph node. Conclusions: SLND may not be the right choice in all cases. A time may come when the extent of lymph node dissection is determined individually for each case. Future verification results are awaited.

Integrin-Dependent Transient Density Increase in Detergent-Resistant Membrane Rafts in Platelets Activated by Thrombin.

Platelet lipid rafts are critical membrane domains for adhesion, aggregation, and clot retraction. Lipid rafts are isolated as a detergent-resistant membrane fraction via sucrose density gradient centrifugation. The platelet detergent-resistant membrane shifted to a higher density on the sucrose density gradient upon thrombin stimulation. The shift peaked at 1 min and returned to the control level at 60 min. During this time, platelets underwent clot retraction and spreading on a fibronectin-coated glass strip. Thrombin induced the transient tyrosine phosphorylation of several proteins in the detergent-resistant membrane raft fraction and the transient translocation of fibrin and myosin to the detergent-resistant membrane raft fraction. The level of phosphatidylserine (36:1) was increased and the level of phosphatidylserine (38:4) was decreased in the detergent-resistant membrane raft fraction via the thrombin stimulation. Furthermore, Glanzmann's thrombasthenia integrin αIIbß3-deficient platelets underwent no detergent-resistant membrane shift to a higher density upon thrombin stimulation. As the phosphorylation of the myosin regulatory light chain on Ser19 was at a high level in Glanzmann's thrombasthenia resting platelets, thrombin caused no further phosphorylation of the myosin regulatory light chain on Ser19 or clot retraction. These observations suggest that the fibrin-integrin αIIbß3-myosin axis and compositional change of phosphatidylserine species may be required for the platelet detergent-resistant membrane shift to a higher density upon stimulation with thrombin.

Factors associated with low prevalence of Fuchs' uveitis syndrome in Japan.

Aim: To investigate the causes of low prevalence of Fuchs' uveitis syndrome (FUS) in Japan. Methods: Medical records of 160 patients diagnosed with FUS at 14 uveitis specialty facilities in Japan were reviewed retrospectively. Results: In 160 FUS patients, mean follow-up period before referral to our uveitis facilities was 31.6 ± 50.9 months. The most common reason for referral was idiopathic uveitis (61.9%), followed by cataract (25.0%), high intraocular pressure (IOP) including glaucoma (16.3%), and FUS (14.4%). Unilateral involvement was 96.9%. The most frequent ocular finding of FUS was anterior inflammation (91.9%), followed by stellate-shaped keratic precipitates (88.1%), cataract/pseudophakia (88.1%), diffuse iris atrophy (84.4%), vitreous opacity (62.5%), heterochromia (53.1%) and high IOP including glaucoma (36.3%). As treatments of these ocular findings, cataract surgery was performed in 52.5%, glaucoma surgery in 10.6%, and vitrectomy in 13.8%. Mean logMAR VA was 0.28 ± 0.59 at the initial visit, and decreased significantly to 0.04 ± 0.32 at the last visit. Proportions of FUS patients with BCVA <0.1 and 0.1 to <0.5 decreased, while that of ≥0.5 increased at the last visit compared with the initial visit. Conclusions: Ocular findings of FUS in Japanese FUS patients were consistent with the characteristic features. The low prevalence of FUS in Japan may be a result of being overlooked and misdiagnosed as mild idiopathic uveitis, cataract, and/or glaucoma.

Automatic selection of coordinate systems for learning relative and absolute spatial concepts.

Robots employed in homes and offices need to adaptively learn spatial concepts using user utterances. To learn and represent spatial concepts, the robot must estimate the coordinate system used by humans. For example, to represent spatial concept "left," which is one of the relative spatial concepts (defined as a spatial concept depending on the object's location), humans use a coordinate system based on the direction of a reference object. As another example, to represent spatial concept "living room," which is one of the absolute spatial concepts (defined as a spatial concept that does not depend on the object's location), humans use a coordinate system where a point on a map constitutes the origin. Because humans use these concepts in daily life, it is important for the robot to understand the spatial concepts in different coordinate systems. However, it is difficult for robots to learn these spatial concepts because humans do not clarify the coordinate system. Therefore, we propose a method (RASCAM) that enables a robot to simultaneously estimate the coordinate system and spatial concept. The proposed method is based on ReSCAM+O, which is a learning method for relative spatial concepts based on a probabilistic model. The proposed method introduces a latent variable that represents a coordinate system for simultaneous learning. This method can simultaneously estimate three types of unspecified information: coordinate systems, reference objects, and the relationship between concepts and words. No other method can estimate all these three types. Experiments using three different coordinate systems demonstrate that the proposed method can learn both relative and absolute spatial concepts while accurately selecting the coordinate system. The proposed approach can be beneficial for service robots to flexibly understand a new environment through the interactions with humans.

Metachronous lesions in the orbit, retroperitoneum, and pleura of mucosa-associated lymphoid tissue lymphoma: A case report.

BACKGROUND: Mucosa associated lymphoid tissue (MALT) lymphoma of the orbit is rare, often indolent, but can recur, and spread to extra-nodal sites. Pleural and retroperitoneum recurrences of MALT lymphoma are rare. CASE: A 65-year-old man was referred to our hospital due to right pleural effusion and difficulty in breathing. He had a medical history of having undergone surgery for MALT lymphoma of the left orbit. A chest computed tomography (CT) scan showed right pleural thickness, pleural effusion, and a retroperitoneal mass, spreading from the muscular layer to the subcutaneous layer. The thickened pleural lesion was surgically biopsied and diagnosed as a recurrence of MALT lymphoma. CONCLUSION: Pleural effusion should be carefully examined and monitored for the possibility of recurrence in MALT lymphoma patients.

Right-Sided Chylothorax: A Case Report of an Uncommon Manifestation After Cervical Debranching Thoracic Endovascular Aneurysm Repair.

A 70-year-old man was admitted to our hospital with a thoracic aortic aneurysm. He underwent elective thoracic endovascular aneurysm repair with left common carotid artery-left subclavian artery bypass via the left supraclavicular approach. During the bypass, the thoracic duct was injured and ligated. On postoperative day 3, the patient complained of dyspnea. Chest radiography revealed a massive right-sided pleural effusion. On postoperative day 5, he was diagnosed with right-sided chylothorax and underwent chest tube insertion. The next day, a left-sided chylothorax was noted, and chest tube drainage was performed. Conservative management, including nil per os and subcutaneous octreotide (300 µg/day) injection, was carried out for 2 weeks; subsequently, the chylothorax improved. This report highlights the diagnostic challenge of right-sided chylothorax after debranching thoracic endovascular aneurysm repair.

Novel Bending Sensor Based on a Solution-Processed Cu2O Film with High Resolution Covering a Wide Curvature Range.

A Cu2O film is prepared on a flexible polyethylene terephthalate substrate for a bending sensor using the spin-spray method, a facile and low-environmental-load solution process. The Cu2O bending sensor shows high sensitivity and high resolution not only over a wide range of curvatures (0 < κ < 0.21 mm-1) but also for very small curvature changes (Δκ = ∼ 0.03 mm-1). The bending response of the sensor exhibited a curvature change of high linearity with a good gauge factor (18.2) owing to the grain-boundary resistance and piezoresistive effects of the fabricated Cu2O film. In addition, the sensor possesses good repeatability, stability, and long-term (>30 days) and mechanical fatigue durability (1000 bending-release cycles). The sensor is capable of detailed monitoring of large- and small-scale human motions, such as finger bending, wrist bending, nodding, mouth opening/closing, and swallowing. In addition, excellent stability and repeatability of the monitoring performance is observed over a wide range of motion angles and speeds. All of these results demonstrate the potential of the flexible bending sensor based on the Cu2O film as a candidate for healthcare monitoring and wearable electronics.

[Spontaneous Renal Rupture of Acquired Cystic Kidney Disease after Coronary Artery Bypass Grafting:Report of a Case].

We described a hemodialysis patient with spontaneous renal rupture of acquired cystic kidney disease (ACKD) after off-pump coronary artery bypass grafting(OPCAB). A 53-year-old man was transfer to our hospital with a diagnosis of unstable angina pectoris. He became ventilated due to congestive heart failure 3 days and underwent OPCAB on schedule 6 days after hospitalization. He suddenly complainted of colicky frank pain 31 days after surgery. Computed tomography (CT) demonstrated bulky hematoma with swollen kidney. Treatment included blood transfusions, withdrawal of anticoagulation, administration of vitamin K, and bed rest. The patient's symptom disappeared. A month later CT showed that the hematoma had been absorbed.

Tumor immunity is related to 18 F-FDG uptake in thymic epithelial tumor.

BACKGROUND: 2-deoxy-2-[fluorine-18] fluoro-d-glucose (18 F-FDG) positron emission tomography (18 F-FDG-PET) is a convenient modality to assess the metabolic activity within tumor cells. However, there is no consensus regarding the relationship between 18 F-FDG uptake and the immune environment in thymic epithelial tumors (TETs). We conducted a clinicopathological study to elucidate the relationship between 18 F-FDG uptake and programmed death ligands 1 and 2 (PD-L1/PD-L2) expression in patients with TETs. METHODS: A total of 108 patients with histologically confirmed TETs classified as thymomas or thymic carcinomas who underwent surgical resection or biopsy or needle biopsy and 18 F-FDG PET before any treatment between August 2007 and March 2020 were enrolled in this study. Tumor specimens underwent immunohistochemical staining for PD-L1, PD-L2, GLUT1, HIF-1α, VEGFR2, VEGF-C, and ß2 adrenergic receptor. RESULTS: High uptakes of SUVmax , SUVmean , MTV, and TLG were identified in 28 (25.9%), 61 (56.5%), 55 (50.9%), and 55 (50.9%) of 108 patients, respectively. High uptake of SUVmax significantly correlated with PS (performance status) of 1-2, thymic carcinoma, and advanced stage, and SUVmax on 18 F-FDG uptake displayed a close association with PD-L1 and PD-L2 expressions, but not with MTV and TLG. Our analysis revealed that SUVmax was identified as being significant relationship for positive PD-L1/PD-L2 expression. GLUT1, HIF-1α, and VEGFR2 were significantly associated with the expression of PD-L1/PD-L2 from the biological viewpoint. CONCLUSION: 18 F-FDG accumulation was closely associated with the expression of PD-L1/PD-L2, which, in turn, was correlated with glucose metabolism and hypoxia. PD-L1/PD-L2 could affect the glucose metabolism and hypoxia in thymic tumor cells.

Chylothorax associated with lymphatic reflux in a thoracic duct tributary after lung cancer surgery.

Chyle leaks are attributed to damage to the thoracic duct itself or its tributaries during surgery. Chylothorax after lung cancer surgery can occur due to damaged thoracic duct tributaries; however, little is known of the mechanism involved. A 71-year-old female underwent a left upper lobectomy with hilar and mediastinal lymphadenectomy for a 1.8-cm primary squamous cell carcinoma, and developed a chylothorax a day later. Catheter lymphangiography revealed high-flow chyle leaks from a damaged thoracic duct tributary, known as a bronchomediastinal lymph trunk, due to a lymphatic reflex from the thoracic duct. Subsequently, catheter embolization of the tributary repaired the chylothorax. The potential for persistent chylothorax after lung cancer surgery and successful lymphatic intervention should be noted.

An aorto-right-atrial fistula caused by infective endocarditis in a patient with an anomalous coronary artery from the opposite sinus.

A 35-year-old man presented with an anomalous right coronary artery from the opposite Valsalva sinus. He developed an aorto-right-atrial fistula due to destructive infective endocarditis undetected during preoperative computed tomography. Intraoperative retrograde cardioplegia and direct insertion of the coronary probe demonstrated that the right coronary ostium was in the left Valsalva sinus near the left coronary ostium. The right-sided aortic root and right atrium were severely damaged. This coronary anomaly allowed us to perform a unique aortic root reconstruction without touching or injuring the right coronary artery. Two years later, the patient remains well without complications. This novel reconstruction treatment is feasible for destructive infective endocarditis in such patients.

Reversible dementia due to vitamin B12 deficiency in a lung cancer patient: Relevance of preoperative evaluation.

OBJECTIVE: Cognitive dysfunction has a negative effect on cancer treatment; however, in a cancer setting, specific treatments can restore cognitive function. Such conditions are known as reversible dementia, with one of these being vitamin B12 (VB12) deficiency. However, there have been no reports of VB12 deficiency identified by preoperative evaluation in cancer patients. METHOD: We studied a patient who was referred to the Department of Psycho-oncology on suspicion of cognitive decline prior to lung cancer surgery. Preoperative evaluation revealed VB12 deficiency. RESULTS: The patient was an 82-year-old woman diagnosed with lung cancer. She also presented with cognitive decline and, therefore, was referred to the Department of Psycho-oncology for preoperative evaluation. The patient scored 19 points on a Mini-Mental State Examination (MMSE), which is indicative of cognitive decline. As the onset of symptoms occurred several months previously and they were subacute, the possibility of reversible dementia was considered. Extensive examination revealed VB12 deficiency, and VB12 replacement therapy normalized the MMSE score to 25 points before surgery. SIGNIFICANCE OF THE RESULTS: When cognitive decline is observed in cancer patients, it is necessary to actively evaluate the serum levels of some B vitamins, including VB12.

Quantitative analysis of bending hysteresis by real-time monitoring of curvature in flexible polymeric films.

Flexibility, viscoelasticity and stress-strain relation in bending polymeric films are key factors in designing mechanically durable flexible electronic devices and soft robots. However, bending hysteresis, which appears as a precursor phenomenon of fracture and fatigue, remains unclear; no one quantitatively evaluated a bending curvature causing hysteresis. Herein, we report the bending hysteresis of polymeric films used as common substrates in flexible electronics by precisely monitoring bending curvatures. By real-time measuring curvatures of films upon bending and subsequent unbending, we have successfully determined the curvatures that cause the hysteresis. These curvatures also depend on a film thickness. Furthermore, we revealed that the occurrence of bending hysteresis is explained by bending strains that have a nonlinear relation with internal stresses. This enables us to predict strain limits that cause the bending hysteresis, based on a stress-strain curve of polymeric films.

Bed Exit Action Detection Based on Patient Posture with Long Short-Term Memory.

It has been known that the fall of a patient in a hospital is a serious accident. In order to prevent such accidents, we have been studying the fall prevention using image processing technology. Our previous studies have detected the patient's end sitting position with high accuracy, but have problems responding to the sitting position of patients who are eating or responding to visitors. In order to solve these problems, this paper proposes a method to detect the patient's bed exit action by analyzing the posture of the patient extracted from the image of the monocular camera by long short-term memory (LSTM). Our proposed method introduces two strategies - abstraction of input information and use of relative position information for the input time-series human images, achieving a 99.2[%] detection rate of bed exit action with a 5.7[%] false detection rate. Detecting the bed exit action with high accuracy contributes to preventing the patient from falling down. The proposed solution handles only posture information that abstracts camera images for patient privacy purposes.