Search

Understanding the main factors driving the evolution of mating systems is a major goal of behavioral ecology. In ungulates, the transition from forests to open habitats and the accompanying clustered spatial distribution of females are thought to have promoted an evolutionary shift from monogamy to polygyny. However, no field-based studies to date have tested in the field whether such changes in ecological conditions promote a shift from monogamy to polygyny. We investigated mating systems of the Japanese serow, which is an evolutionarily ancestral and solitary species among caprids, living in the area with subalpine forest and alpine meadows over 7 years. We evaluated the effects of habitat characteristics on mating systems using within population comparisons. In this site, females form solitary territories in subalpine forests but group territories in alpine meadows. Males defended most of their home ranges as territories, and both social monogamy (29.6%; one male with one female) and polygyny (70.4%; one male with 2–5 females) were observed. Males in alpine meadows formed mating units with more females, whereas males in subalpine forests formed mating units with single females. We show that open habitats promote the transition from social monogamy to polygyny and a higher degree of social polygyny. Our findings suggest that the main factor affecting the mating system is the spatial dispersion of females (solitary territory or group territory), which depends on habitat structure (closed or open). Significance statement: The Japanese serow is an ungulate that mainly inhabits forests and is assumed to possess the ancestral social systems for caprids, such as solitary and monogamous with territory. We found that open habitats, such as alpine meadows, promote the transition from monogamous to polygynous territory in the Japanese serow. In the study site, alpine meadows promote the transition from solitary territory to group territory of females. Thus, our results suggest that the main factor affecting the mating system is the spatial dispersion of females (solitary or group territory), which depends on habitat structure (subalpine forests or alpine meadows). Our findings provide evidence for a social evolutionary pattern in caprids, whereby the spread of forest-dwelling ancestors into open mountains promote evolution from social monogamy to polygyny. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the clinical implications and prognostic value of the number of organ/structure invasions (NOI) in patients with thymoma after curative surgical resection. Methods: We retrospectively analyzed 306 consecutive Japanese patients with thymoma who underwent curative surgical resection. Tumor invasions of pericardium, mediastinal pleura, phrenic nerve, lung, and venous structures were examined histopathologically. Cases were classified into four subgroups according to NOI: group 0, no tumor invasion; group 1, tumor invasion into single organ/structure; group 2, tumor invasion of two organs/structures; group 3, invasion of three or more organs/structures. Associations with NOI and several clinical characteristics and their prognostic significance were analyzed. Results: Pleural invasion was found in 100 cases (32.7%), lung invasion in 48 cases (15.7%), pericardial invasion in 46 cases (15%), phrenic nerve invasion in 29 (9.5%), and venous invasion in 22 cases (7.2%). NOI was classed as group 0 in 201 cases (65.0%), group 1 in 42 cases (13.7%), group 2 in 20 cases (6.5%), and group 3 in 43 cases (14.1%). Cases with higher NOI showed significantly worse relapse-free survival (RFS) and overall survival (OS). Cox's proportional hazard model analysis also identified NOI as a prognostic factor affecting RFS and OS. Conclusions: Cases with higher NOI of thymoma after radical surgical resection showed significantly worse recurrence rates and survival. [ABSTRACT FROM AUTHOR]

To understand the nutritional status of culled wild sika deer (Cervus nippon), we compared the ruminal microbes of deer living in habitats differing in food composition (Nagano winter, Nagano spring, and Hokkaido winter) using next-generation sequencing. Twenty-nine sika deer were sampled. Alpha and beta diversity metrics determined via 16S and 18S rRNA amplicon-seq analysis showed compositional differences. Prevotella, Entodinium, and Piromyces were the dominant genera of bacteria, fungi and protozoa, respectively. Moreover, 66 bacterial taxa, 44 eukaryotic taxa, and 46 chloroplastic taxa were shown to differ significantly among the groups by the linear discriminant analysis effect size (LEfSe) technique. Total RNA-seq analysis yielded 397 significantly differentially expressed transcripts (q < 0.05), of which 48 (q < 0.01) were correlated with the bacterial amplicon-seq results (Pearson correlation coefficient > 0.7). The ruminal microbial composition corresponded with the presence of different plants because the amplicon-seq results indicated that chloroplast from broadleaf trees and Stramenopiles-Alveolates-Rhizaria (SAR) were enriched in Nagano, whereas chloroplast from graminoids, Firmicutes and the dominant phylum of fungi were enriched in Hokkaido. These results could be related to the severe snow conditions in Hokkaido in winter and the richness of plants with leaves and acorns in Nagano in winter and spring. The findings are useful for understanding the nutritional status of wild sika deer. [ABSTRACT FROM AUTHOR]

Habitat selection has a significant influence on animals' fitness, and has been well studied in various ungulates. A trade-off between the access to forage and to shelter often occurs for ungulates' habitat selections, which vary temporally. However, habitat selections for primitive ungulates with solitary and sedentary, such as the Japanese serow (Capricornis crispus), are poorly known. We examined habitat selection at the within-home range scale of the Japanese serow in a montane forest of Mt. Asama, central Japan, at two temporal scales, season and time of day (day or night), by radio-tracking. Serows selected shrub-rich habitats with steep slopes and avoided shrub-poor habitats with gentle slopes, and their selection showed little variation according to season. Shrub-rich habitats with steep slopes provide both abundant food and shelter against potential danger, which suggests that it is an adequate habitat for serows throughout the year. The habitat selection of serows had few differences according to time of day, which suggests that shrub-rich habitats with steep slopes are suitable for both feeding and resting (i.e., all times of day). Our results suggest that trade-offs between the access to forage and to shelter may be less likely to occur for serow's habitat selection, unlike other ungulates. [ABSTRACT FROM AUTHOR]

Purposes: Numerous indicators have been discussed as predictive markers for the incidence of chronic allograft dysfunction (CLAD) after lung transplantation (LTX). The aim of this study was to evaluate whether or not the preoperative prognostic nutrition index (PNI) correlated with the development of CLAD. Method: This study is a single-center and retrospective cohort study. Forty-six patients underwent cadaveric lung transplantation between 2000 and 2016 at our institution. The primary endpoint of this study was the CLAD-free survival of the patients. Result: CLAD was diagnosed in 11 patients (23%) during the follow-up period. Potential risk factors included recipient factors, donor factors, number of HLA mismatches, operation-related factors, and preoperative blood test results, including the preoperative PNI. The patients with a higher PNI showed a longer CLAD-free survival after LTX than those with lower values according to univariate and multivariate analyses (p = 0.01, 0.04, respectively). The 5-year CLAD-free survival rates in the higher-PNI patients and lower-PNI patients were 94% and 62%, respectively. Conclusion: We found that a lower preoperative PNI of the recipient was significantly associated with a higher incidence rate of CLAD. The preoperative PNI may, therefore, be useful as a predictor of the development of CLAD. [ABSTRACT FROM AUTHOR]

Non-small cell lung cancer (NSCLC) patients with idiopathic pulmonary fibrosis (IPF) show poor prognosis. Periostin is an extracellular matrix protein highly expressed in the lung tissues of IPF. This study aimed to investigate the possibility that periostin secreted by fibroblasts derived from IPF lung might affect proliferation of NSCLC cells. Periostin was more highly expressed and secreted by fibroblasts from diseased human lung with IPF (DIPF) than by normal human lung fibroblasts (NHLF). Cocultivation of NSCLC cells with conditioned media (CM) from DIPF increased proliferation of NSCLC cells through pErk signaling, with this proliferation attenuated by periostin-neutralizing antibodies. Knockdown of integrin β3, a subunit of the periostin receptor, in NSCLC cells suppressed proliferation of NSCLC cells promoted by recombinant human periostin and CM of DIPF. On in vivo examination, DIPF promoted tumor progression more than NHLF, and knockdown of integrin β3 in NSCLC cells suppressed tumor progression promoted by DIPF. Fibroblasts derived from surgical specimens from IPF patients also increased secretion of periostin compared to those from non-IPF patients. Periostin secreted from IPF-activated fibroblasts plays critical roles in the proliferation of NSCLC cells. The present study provides a solid basis for considering periostin-targeted therapy for NSCLC patients with IPF. [ABSTRACT FROM AUTHOR]

Objectives: Currently, inhaled nitric oxide (NO) therapy for lung transplantation is not covered by public health insurance in Japan. In this study, we evaluated the perioperative use and safety of inhaled NO therapy for lung transplantation. Methods: Data regarding the duration of treatment and adverse events of inhaled NO therapy were collected for all lung transplantations performed from January 1, 2015, to December 31, 2019, at nine lung transplant facilities in Japan. Results: During the study period, lung transplants were performed in 357 patients, among whom inhaled NO therapy was administered to 349 patients (98%). The median initial and median maximum inhaled NO doses were 10 and 20 ppm, respectively. Inhaled NO therapy was introduced during surgery and continued postoperatively in 313 patients (90%) for a median of 4 days. Significant improvements in oxygenation and decreases in pulmonary arterial pressure were observed in patients receiving inhaled NO therapy. Side effects of inhaled NO therapy, such as methemoglobinemia, were observed in 15 patients (4%), with a significant incidence in patients aged < 18 years. Conclusions: Inhaled NO therapy was performed in almost all patients who underwent lung transplantation in Japan and showed reasonable efficacy. Therefore, public health insurance coverage for inhaled NO therapy during lung transplantation is recommended. [ABSTRACT FROM AUTHOR]

Background: Peritoneal dialysis (PD) is essential for patients with end-stage renal disease. Peritoneal fibrosis (PF) is a complex inflammatory, fibrogenic process. No effective treatments are available to prevent these processes. Hepatocyte growth factor (HGF) possesses anti-inflammatory and anti-fibrotic properties. The aim of this study was to analyze whether HGF suppresses MGO-induced peritoneal inflammation and fibrosis in a mouse model. Methods: PF was induced by intraperitoneal (IP) injections of MGO for 14 days. C57/BL/6 mice were divided into three groups: Sham group (only vehicle); Sham + MGO group (PF induced by MGO); and HGF + MGO group (PF mice treated with recombinant human-HGF). PF was assessed from tissue samples by Masson's trichrome staining. Inflammation and fibrosis-associated factors were assessed by immunohistochemistry and quantitative real-time PCR. Results: MGO-injected mice showed significant thickening of the submesothelial compact zone with PF. Treatment with HGF significantly reduced PM thickness and suppressed the expression of collagen I and III and α-SMA. Expression of profibrotic and proinflammatory cytokines (TGF-β, TNF-α, IL-1β) was reduced by HGF treatment. The number of macrophages, and M1 and M2 macrophage-related markers, such as CD86, CD206, and CD163, was reduced in HGF + MGO mice. Conclusion: HGF attenuates MGO-induced PF in mice. Furthermore, HGF treatment reduces myofibroblast and macrophage infiltration, and attenuates the upregulated expression of proinflammatory and profibrotic genes in peritoneal tissues. HGF might be an effective approach to prevent the development of PF in patients undergoing PD. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to compare the outcome of lung transplantation (LT) for idiopathic pleuroparenchymal fibroelastosis (IPPFE) with that of LT for idiopathic pulmonary fibrosis (IPF). Methods: We reviewed, retrospectively, all adult patients who underwent LT for IPPFE or IPF in Japan between 1998 and 2018. Results: There were 100 patients eligible for this study (31 with IPPFE and 69 with IPF). Patients with IPPFE tended to have a significantly lower body mass index (BMI) than those with IPF (median, 16.7 vs. 22.6 kg/m2, respectively; P < 0.01). However, Kaplan–Meier survival curves showed no significant difference in overall survival between the groups. The BMI did not increase in patients with IPPFE, even 1 year after LT (pretransplant, 16.5 ± 3.2 kg/m2 vs. 1 year post-transplant, 15.6 ± 2.5 kg/m2; P = 0.08). The percent predicted forced vital capacity (%FVC) 1 year after LT was significantly lower in the IPPFE group than in the IPF group (48.4% ± 19.5% vs. 68.6% ± 15.5%, respectively; P < 0.01). Conclusions: Despite extrapulmonary problems such as a flat chest, low BMI, and associated restrictive impairment persisting in patients with IPPFE, patient survival after LT for IPPFE or IPF was equivalent. [ABSTRACT FROM AUTHOR]

Resection is the mainstay of treatment for thymic epithelial tumors (TETs), with complete removal of the tumor and involved organs being the ultimate aim. The choice of surgical approach plays a major role in defining treatment success, and the optimal choice of method should thus provide an adequate surgical view to achieve complete tumor resection. While median sternotomy is considered the gold standard for access to the mediastinum, several minimally invasive approaches to thymectomy have been described, including video-assisted robotic-assisted thymectomy, although the oncological outcomes of that procedure remain unclear. A multimodal approach incorporating chemotherapy or chemoradiotherapy followed by extended surgery may improve resectability and outcomes for patients with advanced TETs. Surgical debulking is also reportedly acceptable for invasive thymoma because of its potential for achieving favorable outcomes. Re-resection is an acceptable option for patients with recurrent thymoma after initial resection, and repeat resection for recurrent pleural dissemination seems effective. Here, the literature on current clinical practices in the surgical management and treatment of TETs is reviewed. [ABSTRACT FROM AUTHOR]

Understanding the factors that drive the evolution of sociality is one of the central issues in behavioural ecology. In ungulates, open habitats, such as alpine meadows, are thought to have promoted the evolution of various gregarious societies from solitary territorial lifestyles. However, the transition from a solitary territorial lifestyle to a gregarious society and the ultimate factors underlying this change remain unclear. The Japanese serow is a primal solitary ungulate. Females in forest-dwelling populations have solitary territorial lifestyles, but the social relationships among females in open-land dwelling populations have not been explored. We evaluated the spatial organisation and social interactions among female Japanese serows in an area with alpine meadows and subalpine forests and examined the effects of alpine meadows on female social relationships through within-population comparisons. We confirmed the presence of both spatially solitary animals (little home range overlap with other individuals) and spatial groups (large home range overlap with two to three individuals), having exclusive territories. Females with more alpine meadows in their home range formed group territories, whereas those with more subalpine forests formed solitary territories. Accordingly, we show, for the first time, that open habitats promote the formation of female spatial groups in a primal solitary ungulate. We suggest that homogenous food distribution and abundant food supply in alpine meadows promote spatial group formation and that the mitigation of exclusive relationships and home range overlapping is a transitional phase for the development of gregarious societies. Significance statement: We found spatial group formations among females in a primal solitary ungulate, the Japanese serow, which were promoted by open habitats, such as alpine meadows. Our findings provide evidence for an evolutionary pattern in ungulates, whereby open habitat structures promote the evolution from solitary, territorial lifestyles, to gregarious societies. This indicates that the mitigation of exclusive relationships (i.e. territoriality) and the overlapping of home ranges among females is a transitional phase for the development of gregarious societies. Homogenous food distribution and an abundant food supply in the alpine meadows appear to promote the formation of spatial groups, suggesting that food abundance and distribution are among the important ultimate factors that potentially contribute to the evolution of gregarious societies. [ABSTRACT FROM AUTHOR]

The Japanese badger (Meles anakuma) is an endemic species in Japan. Although it has been considered a forest-dwelling species, a recent study has shown that badgers use pastures intensively to feed on earthworms, suggesting that pastures comprise an important habitat for them. Therefore, this study investigated the distribution of this species' setts (≥ 1 m deep) and couches (< 1 m deep) in a mosaic habitat composed of grasslands and forests. A significantly higher number of setts and couches were located at the forest edge neighboring to grassland than within the grassland or the inner part of the forest. This suggests that Japanese badgers preferentially construct their setts and couches near grasslands for easier access while avoiding various disturbances. This study found that significantly more setts and couches were situated on the north-facing slope, suggesting that this location avoids the trampling disturbances caused by the sika deer's (Cervus nippon) feeding activities, due to slow snow thawing. The proper conservation of Japanese badgers would require recognizing the grasslands' neighboring forest edge as an important sett or couch site. [ABSTRACT FROM AUTHOR]

Targeting cancer-associated fibroblasts (CAFs), as well as the crosstalk between stroma and cancer cells, could be of value in managing cancers. Pirfenidone (PFD) is an anti-fibrotic agent for idiopathic pulmonary fibrosis. This study aimed to investigate the possibility that PFD might exert an anti-tumor effect through inhibition of fibroblast activation and the tumor-stroma interaction in non-small cell lung cancer (NSCLC) cell lines in vitro and in vivo. PFD significantly inhibited myofibroblast differentiation and activation of both primary cultured normal human lung fibroblasts and CAFs. Cocultivation of NSCLC cells with conditioned media (CM) of fibroblasts changed the morphology or epithelial to mesenchymal transition (EMT) status, and PFD suppressed these changes. Cocultivation of CAFs with CM of NSCLC cells also induced activation of CAFs, and these changes were suppressed by PFD. On in vivo examination, CAFs promoted tumor progression, and PFD suppressed tumor progression with an inhibitory effect on tumor-stroma crosstalk. PFD might inhibit not only fibroblast activity, but also the crosstalk between cancer cells and fibroblasts. PFD may have great potential as a novel treatment for NSCLC from multiple perspectives. [ABSTRACT FROM AUTHOR]

Hepatic hydrothorax refers to significant serous pleural effusion induced by liver cirrhosis, and some reports have suggested that this entity is ascites transferred to the thoracic cavity via a small hole in the diaphragm. There have been a few reports describing radical diaphragmatic repair by suturing the defect. We performed thoracoscopic diaphragmatic repair under abdominal insufflation to clarify the defect points. Air leakage at the diaphragmatic tissue was clearly noted and closed by suturing with polytetrafluoroethylene (PTFE) pledgets. The patient's postoperative course was uneventful, and no recurrence of ascites or hydrothorax has been noted. [ABSTRACT FROM AUTHOR]

Air leak syndrome (ALS) is a rare complication after bone marrow transplantation (BMT) and usually has a fatal outcome because of the high recurrence rate and treatment-refractory nature. A 32-year-old man with a history of BMT for acute lymphoblastic leukemia suffered from metachronous bilateral ALS. Bullectomy and the pleural covering procedure (PLC) were successfully performed for each side of the thorax. After surgery, no relapse of pneumothorax was seen for 2 years on the right side and for 1 year on the left side. A 38-year-old man with a history of BMT for acute myelogenous leukemia (AML) suffered from ALS at the thorax on the left side. Bullectomy and the PLC were successfully performed. After that no recurrence of left pneumothorax for 7 years. We experienced two cases of ALS after BMT successfully treated by the PLC. This technique may be a viable treatment option for future lung transplantation. [ABSTRACT FROM AUTHOR]

Background: Cases of thymoma with pleural dissemination are occasionally encountered, and their management is difficult. Some reports have noted that surgical treatment for dissemination is effective, although the long-term results and clinical course details remain unclear. The current study investigated the short- and long-term outcomes of surgical resection of pleural dissemination. Methods: A retrospective review examined the medical records for 38 patients who underwent surgical resection for pleural dissemination occurring synchronously with a primary thymoma or metachronously after complete surgical resection of a primary thymoma between 1996 and 2017 at the authors' institution. Clinical characteristics and prognostic factors were analyzed. Results: The patients were classified into synchronous (n = 21) and metachronous (n = 17) groups. The 10-year overall survival rate was 59% for the synchronous group and 88% for the metachronous group. The median follow-up period for all the patients was 61 months (range 4–225 months). No perioperative deaths occurred. For all the patients, the 5- and 10-year overall survival rates were respectively 91% and 82%, and the 5- and 10-year relapse-free survival rates were respectively 29% and 19%. A significantly worse prognosis was observed for patients 50 years of age or older than for those younger than 50 years (p = 0.02). For 13 patients who underwent repeat resection for pleural dissemination, the prognosis was better than for those without repeat resection (p < 0.01). Conclusion: Surgical resection of thymoma with pleural disseminated nodules can be safely performed and provides a favorable long-term outcome. Repeat resection is considered to be effective for achieving a good prognosis. [ABSTRACT FROM AUTHOR]

Background: The prognostic factors of pulmonary metastasectomy in patients with osteosarcoma and soft tissue sarcoma remain controversial. The purpose of our analysis was to explore the prognostic factors and outcomes of patients with osteosarcoma and soft tissue sarcoma who underwent pulmonary metastasectomy at our institution. Methods: We reviewed the data of 44 patients who underwent resection of pulmonary metastases from 1996 to 2016 at our institution. The Kaplan–Meier method, log-rank test and multivariate Cox hazard model were used for comparison and survival analyses. Results: There was no perioperative mortality. The median post-metastasectomy overall survival was 24.8 months, and the 5-year overall survival rate of all patients was 43.5%. The 5-year survival rate of the patients who underwent repeat thoracotomies was 60.0%. Incomplete resection, a largest tumor size > 2 cm and a disease-free interval < 12 months were associated with poor survival in multivariate analyses. Among eight patients, who underwent repeat pulmonary resection, two remain alive with no evidence of disease. These patients had the longest DFI and DFI-2 (time from first pulmonary metastasectomy to the diagnosis of recurrent pulmonary metastasis), respectively. Conclusion: The survival of patients with a relatively long disease-free interval, small tumor size and complete resection was favorable following the treatment of osteosarcoma and soft tissue sarcoma with pulmonary metastasectomy. Repeat pulmonary metastasectomies also provide favorable prognosis in select patients. [ABSTRACT FROM AUTHOR]

Freezing behavior is frequently observed among forest-dwelling ungulates and is thought to function as a method of concealment from predators. However, because of the difficulty of observing such behaviors, detailed observations have not previously been conducted to provide evidence for this interpretation. Therefore, we have examined the response to human observers of the Japanese serow ( Capricornis crispus), a typical forest dweller, in relation to visibility and group size based on direct observations conducted over 3 years. From a total of 221 sightings, freezing behavior was observed more frequently in the closed habitat (14.3% of 196 sightings) and during the growing season (22.8% of 92 sightings) than in the open habitat (0% of 25 sightings) and during the non-growing season (5.2% of 129 sightings). Freezing behavior was also frequently observed in solitary animals (15.2% of 184 sightings) than in groups (0% of 37 sightings). These results suggest that the function of this freezing behavior is concealment from predators. Japanese serows fled more frequently in the open habitat (72%) and during the non-growing season (58.7%) than in the closed habitat (18%) and during the growing season (41.3%). Japanese serows selected closed habitat significantly more often regardless of the season. These results suggest that Japanese serow adopt cryptic anti-predator strategy to avoid detection by predators in the dense forest habitat, and their strategy changes according to visibility. [ABSTRACT FROM AUTHOR]

Purpose: To clarify the role of pulmonary metastasectomy in colorectal cancer in the era of modern multidisciplinary therapy. Methods: The characteristics and outcomes of the patients who underwent pulmonary metastasectomy for colorectal cancer through 2002 ( n = 26) and from 2003 ( n = 68) were compared. Results: The patients treated from 2003 had a smaller tumor size and more frequently had a history of extra-pulmonary relapses than did those treated through 2002. There was a significant improvement in the 5-year overall survival (42.0% vs. 73.1%, p = 0.03) but not the 5-year relapse-free survival (41.4% vs. 37.5%, p = 0.85) after pulmonary metastasectomy from 2003. The rate of patients who received local therapy with curative intent after the first pulmonary metastasectomy was significantly higher in patients treated from 2003 than in those treated through 2002 [4/13, (31%) vs. 25/39 (64%), p = 0.04]. The survival after relapse after the first pulmonary metastasectomy was significantly longer in patients treated from 2003 than in those treated through 2002 (median survival time: 14 vs. 47 months). Conclusions: Pulmonary metastasectomy for colorectal cancer remains an important treatment option in the sense that it can achieve a good relapse-free survival. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the surgical outcomes of surgery for non-small cell lung cancer (NSCLC) in patients with atrial fibrillation (AF) as a preoperative comorbidity. Methods: Among 805 patients who underwent surgery for NSCLC, 27 (3.4%) had a history of AF. We analyzed the perioperative and long-term outcomes of these 27 patients. Results: Fourteen patients (52%) had chronic AF and 13 (48%) had paroxysmal AF; being high rates of a comorbid illness. Nineteen patients (70%) underwent lobectomy, and 8 (30%) underwent sublobar resection. Ten patients (37%) received perioperative heparinization. There was no mortality. Other non-AF postoperative complications developed in 8 patients (30%), this incidence being higher than among the patients without AF (16%, 127 out of 778, p = 0.09). A thromboembolic event occurred in one patient (4%). With respect to the long-term outcomes, the 5-year overall survival and disease-free survival rates among the patients with AF were 70.3 and 60.8%, respectively, which were similar to those in the patients without AF (79.8 and 72.6%, p = 0.30 and 0.31). Conclusions: Lung cancer surgery in patients with AF is safe and provides favorable long-term outcomes; however, thoracic surgeons should monitor these patients carefully for postoperative thromboembolic events. [ABSTRACT FROM AUTHOR]

Purpose: To propose a treatment strategy for simultaneously discovered non-small cell lung cancer (NSCLC) and cardiovascular disease (CVD). Methods: Of 1302 patients who underwent surgery for NSCLC, CVD requiring invasive treatment was simultaneously discovered in 33 (3 %). The details of the treatments as well as the short- and long-term outcomes of pulmonary resection were analyzed. Results: CVD included coronary artery disease in 20 patients, valvular disease in 6, abdominal aortic aneurysm in 5, and congenital heart disease in 2. Twenty-six patients underwent two-stage treatment, while seven received simultaneous surgery. In 23 patients whose treatment for CVD preceded that for lung cancer, the median interval between those treatments was 78 days (range 18-197 days). Postoperative complications occurred in 8 (31 %) of 26 patients who underwent 2-stage treatment and in 3 (43 %) of 7 who underwent simultaneous surgery. Notably, of 3 patients who underwent lobectomy or bilobectomy, 2 (67 %) experienced respiratory dysfunction that required intubation. The 5-year overall survival rate of all 33 patients was 84.5 %. Conclusion: The outcomes of two-stage treatment in the present cohort were favorable. Given our experience, simultaneous surgery for lung cancer and CVD should, therefore, be selected only for patients who may benefit from that strategy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to investigate the surgical outcomes of surgery for non-small cell lung cancer (NSCLC) in patients with coronary artery disease (CAD). Methods: Among 805 patients who underwent surgery for NSCLC at our hospital within a recent 10-year period, 43 (5.3 %) had a history of CAD. We analyzed the surgical outcomes and risk factors for postoperative complications in these 43 patients. Results: The postoperative mortality and morbidity rates were 2 and 42 %, respectively. The morbidity rate was significantly higher in the patients with CAD than in those without CAD ( P < 0.01). Postoperative cerebrovascular or cardiovascular events occurred in four patients (9 %). Having two of the following was significantly associated with the development of postoperative complications: decreased cardiac function, respiratory dysfunction, or deteriorated renal function ( p = 0.04). The 5-year overall and disease-free survival rates of the patients with CAD were 75.6 and 64.5 %, respectively; comparable with those of the patients without CAD; at 77.9 % and 72.5 %, respectively ( p = 0.46 and 0.69). Conclusions: Patients with NSCLC and a history of CAD are at higher risk of complications after pulmonary resection. Combined decreased organ function is a risk factor for postoperative complications. CAD did not influence the long-term outcomes of patients after pulmonary resection for NSCLC. [ABSTRACT FROM AUTHOR]

Background: PSF1 (Partner of SLD Five 1) is an evolutionarily conserved DNA replication factor that is part of the GINS (Go, Ichi, Nii, and San) complex . The objective of this study was to evaluate the relationship between PSF1 expression and prognosis in patients with non-small cell lung cancer (NSCLC) treated with surgery following preoperative chemotherapy or chemoradiotherapy. Methods: Sixty-nine patients with NSCLC treated with surgery following preoperative chemotherapy or chemoradiotherapy who did not achieve pathologic complete response were enrolled. The status of PSF1 expression was evaluated by immunohistochemistry, and the relationship between expression of PSF1 and Ki-67 was determined, as well as correlations between PSF1 expression and prognosis. Results: We found that 27 of 69 patients' tumors (39 %) were positive for PSF1 expression. The Ki-67 index was significantly higher in the PSF1-positive versus the PSF1-negative group ( p = 0.0026). Five-year, disease-free survival of the PSF1-positive group was significantly worse (17.7 vs. 44.3 %, p = 0.0088), and the 5-year overall survival also was worse (16.6 vs. 47.2 %, p = 0.0059). Moreover, PSF1 expression was found to be a significant independent prognostic factor for shorter survival by Cox multivariate analysis (hazard ratio 2.43, 95 % confidence interval 1.27-4.60, p = 0.0076). Conclusions: PSF1 is a useful prognostic biomarker to stratify NSCLC patients treated with surgery following preoperative chemotherapy or chemoradiotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Intraoperative alveolar air leaks remain a significant problem in thoracoscopic surgery (TS) cases. We examined the usefulness of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative air leakage in patients with non-small cell lung cancer (NSCLC).Methods: Patients with NSCLC underwent a thoracoscopic lobectomy or segmentectomy. When alveolar air leakage from the superficial pulmonary parenchyma was found, fibrin glue in combination with an absorbable mesh sheet was applied (S group; n = 100). When leakage originated from deep within the pulmonary parenchyma, a subcutaneous fat pad about 2 × 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and sutures (F group; n = 66). Patient characteristics, air leak duration, and chest-tube removal time were analyzed.Results: The homogeneity of each group was consistent, with no statistical differences for age, respiratory function, surgical procedures, pathologic stage, and histological type. The air leak duration was significantly shorter (p = 0.015), and the chest tube was removed significantly earlier (p = 0.002) in patients in the F group.Conclusion: Use of a free subcutaneous fat pad during pulmonary resection for TS patients with NSCLC reduced the duration of air leakage and chest tube drainage. The present method is easy, safe, and effective for repairing an air leak from remaining lung tissues in such cases. [ABSTRACT FROM AUTHOR]

Introduction: We previously introduced video-assisted thoracoscopic ET (VATS-ET) as a therapeutic option for MG with acceptable results. We have conducted further investigations to improve the procedure without deterioration of operative results, including myasthenia gravis (MG) remission rate and palliation rate. Here, we report the details of our current procedure, as well as surgical results and patient outcomes as compared with the original VATS-ET procedure. Material and methods: From January 2002 to September 2013, we performed a VATS-ET procedure with an anterior chest wall lifting method for 77 patients who had MG with or without a thymoma. During that period, we investigated the appropriate indications and improved the procedure. Results: Our current indication for this procedure is MG with the anti-acetylcholine receptor antibody or sero-negative type, or MG with a thymoma <5 cm in diameter without invasion to adjacent organs. With our procedure, the thymus and surrounding tissue are sufficiently resected using a bilateral thoracoscopic surgical method without neck incision. Remission and palliation rates were found to be equivalent to those obtained with the original VATS-ET procedure. Conclusion: VATS-ET is suitable for select patients with MG with or without a thymoma. In addition, our current method has shown to be effective while also offering cosmetic advantages as compared with the original, neck incision needed, VATS-ET method. [ABSTRACT FROM AUTHOR]

Objective: We reviewed our institutional experience with cases of multimodality treatment for advanced thymic carcinoma to determine patient outcomes and prognostic indicators. Methods: Between 1998 and 2014, 16 patients with a Masaoka stage III or IV thymic carcinoma underwent surgical resection after induction therapy at Osaka University Hospital. These were considered to have great vessel invasion or metastasis to the mediastinal or intrathoracic lymph nodes based on the preoperative workup findings, and received induction therapy. Results: Complete tumor resection was achieved in 11 (69 %) after the induction therapy. Pathological findings revealed that 10 patients had Masaoka stage III disease, 1 had IVa, and 5 had IVb. The histological diagnosis was squamous cell carcinoma in 13, neuroendocrine carcinoma in 2, and undifferentiated carcinoma in 1. The 5-year survival rate for all patients was 71 %. Survival was significantly better in patients who underwent a complete resection (R0 disease) as compared to those with incompletely resected tumors (R1 or R2 disease). Conclusions: Multimodality treatment offers encouraging results and complete resection provides high survival rate for patients with advanced thymic carcinoma. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility of aspirin continuation during the perioperative period for pulmonary resection in lung cancer patients. Methods: A retrospective study was conducted in 46 patients who were taking aspirin and underwent pulmonary resection. The indications for aspirin were generally a cardiovascular or cerebrovascular comorbidity. Whether to continue or discontinue aspirin was determined based on the severity of the cardiovascular or cerebrovascular comorbidity, along with the patient's overall condition. The intraoperative and postoperative outcomes were compared between patients continuing and those discontinuing aspirin. Results: Twenty patients continued (group C) and 26 patients discontinued (group D) aspirin. The length of the operation (226 ± 97 min in group C vs. 189 ± 90 min in group D), intraoperative bleeding (234 ± 232 vs. 204 ± 367 g) and average pleural discharge on postoperative days 1, 2 and 3 (331, 230 and 215 vs. 304, 210 and 174 ml/day) showed no significant differences between the two groups. The postoperative complication rates were also not significantly different between the two groups [eight patients (40 %) in group C vs. nine patients (35 %) in group D]. Conclusions: Continuous administration of aspirin during the perioperative period for pulmonary resection in lung cancer patients appears to be clinically feasible in the Japanese population. [ABSTRACT FROM AUTHOR]

The number of organ donations after brain death has significantly increased since the revised Japanese Organ Transplant Law took effect in July 2010. Sixty-one lung transplantations were conducted throughout Japan in 2013, including 20 living-donor lung transplantations and 41 brain-dead-donor lung transplantations (23 bilateral lungs, 17 single lungs, and 1 heart-lung transplantation). The number of lung transplant candidates newly registered at the Japan Organ Transplantation Network also increased to 126 in 2013, suggesting a severe donor shortage in Japan. More than 60 % of offered brain-dead-donor, lungs were used for transplantation, indicating the effort of Japanese lung transplant centers to overcome the challenge of donor shortage. After lung transplantation, patients generally enjoyed a good quality of life with excellent survival of 86.2 % at 1 year, 79.6 % at 3 years, and 73.7 % at 5 years post-transplantation. There was no significant difference in patient survival between living-donor and brain-dead-donor lung transplantation. Early mortality of lung transplant recipients within 90 days was attributable to graft failure followed by infection, while long-term mortality was mostly explained by chronic lung allograft dysfunction (chronic rejection), infection, and malignancy. Eight lung transplant centers are currently approved to conduct lung transplantation in Japan (Tohoku, Dokkyo, Chiba, Kyoto, Osaka, Okayama, Fukuoka, and Nagasaki Universities). These centers are expected to continue to make a special effort to save critically ill patients waiting for lung transplantation. [ABSTRACT FROM AUTHOR]

Purpose: Lung transplantation (LTx) is an established therapy for end-stage lung failure. However, in Japan, the donor organ shortage is extremely severe compared with other developed countries, because of the strict Japanese Organ Transplantation Law. To maximize LTx opportunities in Japan, we have established a special donor evaluation and management system termed the medical consultant (MC) system. Methods: Data from 171 lung donor candidates registered in Japan from May 1998 to May 2012 were obtained and investigated in a retrospective manner. The candidates were separated into the non-MC-intervened and MC-intervened groups, and then data regarding the PaO/FiO ratio, donation rate and organ survival rate were analyzed and compared between the groups. Results: The PaO/FiO ratio of the MC-intervened group was ameliorated from the time of first brain death diagnosis to organ harvest. Although the base condition of the MC-intervened group was significantly worse than that of the non-MC-intervened group, the donation rates showed no significant difference (0.64 and 0.66, respectively; p = 0.89). There was a difference in the organ survival rate between the non-MC and MC-intervened groups (5-year survival rates of 67.2 and 88.3 %, respectively; p = 0.16). Conclusion: The MC system used for organ donor evaluation and management in Japan has achieved acceptable interim results. [ABSTRACT FROM AUTHOR]

Purpose: To examine the perioperative and long-term outcomes of surgery for malignancies of the lungs in patients with a history of head and neck squamous cell carcinoma (HNSCC) and to evaluate the risk factors associated with postoperative complications. Methods: The data of 39 patients with a history of HNSCC who underwent pulmonary resection were reviewed. The perioperative and long-term outcomes were analyzed. Results: Eight patients (21 %) had difficult airways, and nine patients (23 %) developed postoperative complications. A low body mass index (<18.5), a history of malignancy besides HNSCC and chronic obstructive pulmonary disease were each found to be significantly associated with the development of postoperative complications. The 5-year survival rate of all patients was 80 %. Conclusions: The airway management of patients with a history of HNSCC should be carefully undertaken. Preoperative assessment of their nutritional status and careful prevention of air leakage during surgery are important. Because favorable outcomes can be achieved, aggressive surgical management should be considered for the treatment of pulmonary malignancies in patients with a history of HNSCC. [ABSTRACT FROM AUTHOR]

Purpose: A new diagnosis of chronic obstructive pulmonary disease is often made during the evaluation of patients requiring lung cancer surgery. The objective of the present study was to evaluate the clinical effects of inhaled tiotropium on the postoperative cardiopulmonary complications in patients with untreated chronic obstructive pulmonary disease requiring lung cancer surgery. Methods: A retrospective study involving 104 consecutive patients with moderate to severe chronic obstructive pulmonary disease who underwent a lobectomy for lung cancer at two specialized thoracic centers between April 2008 and October 2011 was performed. The results were compared between patients who did and did not receive inhaled tiotropium during the perioperative period. The primary endpoint was the incidence of postoperative cardiopulmonary complications. The postoperative white blood cell counts and C-reactive protein levels as biomarkers of inflammation were also examined. Results: The incidence of postoperative cardiopulmonary complications was significantly lower in the tiotropium group than in the control group (18 vs. 48 %, P = 0.001). Patients in the tiotropium group also showed significantly lower white blood cell counts and C-reactive protein levels postoperatively. Conclusions: Inhaled tiotropium treatment during the perioperative period had a prophylactic effect on postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery. [ABSTRACT FROM AUTHOR]

Correction to: I Scientific Reports i https://doi.org/10.1038/s41598-022-09855-w, published online 15 April 2022 The Supplementary Information section published with this Article contained an error where the Supplementary Figures were omitted. In addition, in the Supplementary Tables the cells N8 in Table S1 and E4 in Table S14 were incorrectly highlighted. [Extracted from the article]

Although legislation regarding organ transplantation from brain-dead donors in Japan was approved in 1997, no heart–lung transplantation procedures were performed for some time. Herein, we report the first case of successful heart–lung transplantation in Japan. The recipient was a 35-year-old man with Eisenmenger syndrome, caused by a double outlet right ventricle, who had been suffering hemoptysis and continued NYHA class 3–4 symptoms for 66 months since being registered on the waiting list. He underwent heart–lung transplantation from a 30-year-old donor. The organ ischemic time was 247 min, the postoperative course was uneventful, and the patient was discharged 66 days after the transplant surgery. [ABSTRACT FROM AUTHOR]

The Japanese Organ Transplant Law was amended, and the revised law took effect in July 2010 to overcome extreme donor shortage and to increase the availability of donor organs from brain-dead donors. It is now possible to procure organs from children. The year 2011 was the first year that it was possible to examine the results of this first extensive revision of the Japanese Organ Transplant Law, which took effect in 1997. Currently, seven transplant centers, including Tohoku, Dokkyo, Kyoto, Osaka, Okayama, Fukuoka and Nagasaki Universities, are authorized to perform lung transplantation in Japan, and by the end of 2011, a total of 239 lung transplants had been performed. The number of transplants per year and the ratio of brain-dead donor transplants increased dramatically after the revision of the Japanese Organ Transplant Law. The survival rates for lung transplant recipients registered with the Japanese Society for Lung and Heart-lung Transplantation were 93.3 % at 1 month, 91.5 % at 3 months, 86.3 % at 1 year, 79.0 % at 3 years, and 73.1 % at 5 years. The survival curves for brain-dead donor and living-donor lung transplantation were similar. The survival outcomes for both brain-dead and living-donor lung transplants were better than those reported by the International Society for Heart and Lung Transplantation. However, donor shortage remains a limitation of lung transplantation in Japan. The lung transplant centers in Japan should continue to make a special effort to save critically ill patients waiting for lung transplantation. [ABSTRACT FROM AUTHOR]

A 44-year-old woman, who had been diagnosed as having null type alpha-1 antitrypsin (AAT) deficiency, was admitted with right recurrent pneumothorax. She had undergone right visceral pleural strengthening and pleural adhesion-preventing surgery, the total pleural covering technique (TPC), with oxidized regenerative cellulose (ORC). Three years after the operation, she developed left recurrent pneumothorax and underwent left TPC. AAT deficiency is a rare inherited disease in Japan that causes early-onset emphysema and secondary pneumothorax. In addition, null/null phenotype has the highest risk of emphysema and may require lung transplantation. For future lung transplantation, pleural adhesion should be prevented. However, pleurodesis and surgery for pneumothorax generally cause adhesion. TPC with ORC is a surgical treatment for pneumothorax that is done to strengthen visceral pleura and prevent pleural adhesions. The patient has had no recurrence of pneumothorax 3.5 years after right TPC and 6 months after left TPC. [ABSTRACT FROM AUTHOR]

Because the number of ideal brain-dead donors is limited, active use of marginal donors is currently one of the major issues discussed in regard to lung transplantation. We report a case in which the patient underwent single-lung transplantation for chronic pulmonary emphysema. The lung came from a marginal, ABO blood group nonidentical, compatible donor. Because the donor was marginal (pneumonia in the right lung and lobar atelectasis in both lungs), all recipient candidates with ABO blood group identical declined. Thus, a nonidentical, compatible recipient had a chance to receive a lung transplant. This 49-year-old man underwent single-lung transplantation for chronic pulmonary emphysema with severe respiratory failure. He had a good postoperative clinical course. [ABSTRACT FROM AUTHOR]

Lymphatic and venous malformations (LVM) are tumor-like lesions combining dysplastic lymphatic and venous vessel structures. They are rarely found in the mediastinum. We present a case of mediastinal LVM, with review of the literature. An asymptomatic 60-yearold man presented for evaluation of an anterior mediastinal mass. On chest computed tomography (CT), the mass demonstrated contrast enhancement and its 7-mm vein draining directly into the left brachiocephalic vein. The tumor was resected completely using video-assisted thoracoscopic surgery. The surgical specimen revealed combined features of venous and lymphatic dysplasia, and was diagnosed it as LVM, so-called mediastinal lymphangiohemangioma. Management plans based on precise imaging studies using magnetic resonance imaging and multi-detector-row CT phlebography could be helpful in guiding both preoperative diagnosis and subsequent treatment decisions for mediastinal LVM. [ABSTRACT FROM AUTHOR]

We report the first case with Eisenmenger syndrome secondary to an isolated perimembranous ventricular septal defect (VSD) in a patient who underwent bilateral lung transplantation and closure of the VSD in Japan. This male patient was diagnosed as having a VSD associated with severe pulmonary hypertension at the age of 7, and right unilateral pulmonary artery banding was performed at age 9. At 38 years of age, we performed bilateral cadaveric lung transplantation with patch closure of the VSD. Explant pathology revealed grade 3 for the right lung and grade 4 for the left lung by the Heath-Edwards classification. The ventricular contractility had gradually improved, and ventricular arrhythmia requiring amiodarone prior to lung transplantation had disappeared. When cardiac function is preserved, bilateral lung transplantation is an option for patients with Eisenmenger syndrome secondary to VSD and should be considered as an alternative to heart-lung transplantation, especially in Japan, where donor organ shortage is critical. [ABSTRACT FROM AUTHOR]

A 23-year-old woman was admitted to our hospital because of an intrapulmonary mass that had been observed for 7 years. Chest computed tomography revealed a 3.5-cm well-defined mass with enhancement in the left lower lobe. During the 7 years of observation, she had been asymptomatic and the tumor size was unchanged. She underwent surgical resection for diagnosis and treatment. Histological examination revealed Castleman’s disease of the hyaline vascular type. We present this rare case of solitary Castleman’s disease arising from an intrapulmonary lymph node. [ABSTRACT FROM AUTHOR]

The year 2008 marked the 10th anniversary of the Japanese lung transplantation program started in accordance with the Japanese Organ Transplant Law, which took effect in 1997. A total of 105 lung transplantations, including 39 deceased-donor transplants and 66 living-related transplants, had been performed as of the end of 2007. This article is the 2008 official report of the Japanese Society of Lung and Heart-Lung Transplantation. It summarizes the data for clinical lung transplantation during the period 1998–2007 and discusses the current status of Japanese lung transplantation. The overall 5-year survival rate was 67.0%: including 53.4% and 74.6% for deceased-donor lung transplantation and living-donor lobar lung transplantation groups, respectively. The total operation-related and 1-month mortality rates after surgery were 3.8% and 10.4%, respectively. These data are better, or at least acceptable, in comparison with the international registry data. [ABSTRACT FROM AUTHOR]

Thymoma and thymic carcinoma are the representative tumors arising from the thymic epithelium. Thymoma is well known for association with autoimmune diseases including myasthenia gravis, suggesting its biological activity. Herein, recent progress in research of thymoma is reviewed with reference to its immunological function. Myasthenia gravis is frequently associated with WHO type B1 and B2 thymomas. These types of thymomas hold a significant number of CD4+CD8+ double-positive T cells, and at the same time, the neoplastic epithelial cells express HLA-DR molecules at a slightly reduced level compared with the normal thymus. The impaired expression of HLA-DR molecules in neoplastic epithelial cells of thymomas possibly affects positive selection of CD4+CD8− single-positive T cells and may result in alteration of its repertoire. The function of thymoma neoplastic cells as the cortical epithelium of the thymus and the morphological resemblance of thymomas to the cortex suggest that thymoma is of cortical epithelial origin; this might imply that thymoma lacks the functional medulla where professional antigenpresenting cells are engaged in negative selection. These findings suggest that thymoma generates autoreactive T cells causing autoimmunity. Further investigation on immunological function of thymoma is supposed to elucidate the pathogenesis of thymoma-related autoimmunity and the high affinity of thymoma with myasthenia gravis. In addition, studying the biology of thymoma is also expected to contribute to further understanding of T-cell development and immunological tolerance in the human, because thymoma can be considered an acquired thymus. [ABSTRACT FROM AUTHOR]

A total of 87 lung transplants has been performed for the 9 years since 1998 in Japan. Because of the shortage of brain-dead donors, living-donor lobar lung transplantation accounted for two-thirds of lung transplantation in Japan. The most common indication was primary pulmonary hypertension. The distributions of procedure type and indication were characteristic for Japan. Despite the limited number and the short follow-up period, the survival for Japanese recipients was better than the international average, and the quality of life after lung transplantation was excellent. To increase the number of available pulmonary grafts, we have tried various strategies, such as active use of marginal donors, careful donor management, and development of new preservation solutions, but the shortage of brain-dead donors remains a serious problem. The current transplant laws need to be reconsidered. [ABSTRACT FROM AUTHOR]

A histological classification of thymic epithelial tumors was presented by the World Health Organization (WHO) in 1999 and again in 2004 following slight modifications, in which thymic epithelial tumors were categorized as thymomas and thymic carcinomas. Whereas thymoma is defined as an organotypic (thymuslike) tumor, thymic carcinoma is a malignant epithelial neoplasm with a morphology similar to that of malignant neoplasms arising from other organs. Herein, the recent progress in research of thymic epithelial tumors is reviewed with reference to the WHO histological classification system, with the focus on thymomas. Thymomas are classified into five types—A, AB, B1, B2, B3—according to the shape and atypia of their epithelial cells as well as the abundance of lymphocytes. The invasiveness, prognosis, and genetic imbalance of thymomas have been shown to be related to this classification system. Myasthenia gravis is frequently associated with types B1 and B2. The WHO histological classification of thymomas is not only useful for treatment but reflects their biological characteristics, including genetic alterations. Advances are expected in future studies of thymomas from the standpoint of their clinical, pathological, and biological aspects. [ABSTRACT FROM AUTHOR]

Preoperative therapy is an optional strategy for locally advanced lung cancer, although the indication for pulmonary resection is often marginal, when considering the survival benefit and perioperative risks. The aim of the present study was to identify prognostic predictors by assessing clinical factors including prethoracotomy co-morbidity. This was a retrospective analysis of 54 patients who underwent complete resection after preoperative therapy was performed. The overall 5-year survival rate was 38%. In patients without cardiopulmonary co-morbidity the 5-year survival rate was 49%, whereas it was 0% for those who had associated cardiopulmonary co-morbidity ( P = 0.004). When analyzing only those who died from lung cancer, the group without cardiopulmonary co-morbidity showed a tendency for longer survival than those in the co-morbidity group ( P = 0.092). The 5-year survival rate for patients—evaluated with a Charlson Co-morbidity Index (CCI)—with a CCI score of 0, was 45%, which tended to be better than that for those with a CCI score of 1–2 ( P = 0.066). Furthermore, patients with a normal prethoracotomy level of carcinoembryonic antigen (CEA) had a 5-year survival rate of 44%, which was better than the 22% for patients with elevated CEA ( P = 0.013). The 5-year survival rate for patients without lymph node metastasis was 52%, whereas it was 14% for those with residual node involvement ( P = 0.002). Lymph node metastasis and cardiopulmonary co-morbidity were shown to be independent poor prognostic predictors by multivariate analysis. In addition to nodal status, preoperative cardiopulmonary co-morbidity should be noted when considering the operative indications following preoperative therapy for lung cancer patients. [ABSTRACT FROM AUTHOR]

A 6-year-old boy was diagnosed as having atrial septal defect with oversystemic pulmonary hypertension, and gradually developed hypoxia and heart failure. At the age of 11, living-related bilateral lobar lung transplantation from his parents was indicated, because of his critical condition. The estimated forced vital capacity calculated by the donors’ lower lobes was 104% of his age. The operation was carried out with simultaneous closure of the atrial septal defect under full cardiopulmonary bypass. The postoperative course was complicated with pulmonary edema and phrenic nerve palsy, which were eventually resolved. Six months after surgery he was free from heart failure and rehabilitating at home without oxygen. The final diagnosis was primary pulmonary hypertension with atrial septal defect. Living-related bilateral lobar lung transplantation with simultaneous intracardiac repair may be an optional strategy for children with Eisenmenger syndrome or primary pulmonary hypertension with intracardiac defect when cadaveric transplantation is not possible. [ABSTRACT FROM AUTHOR]

A 19-year-old woman with von Recklinghausen's disease was admitted with symptoms of hoarseness. A computed tomography scan showed a bilateral cervicomediastinal tumor. An extirpation of the left cervicomediastinal tumor was performed for the purpose of diagnosis and treatment. On thoracotomy, the tumor, which measured 9 × 8 × 4 cm in size, arose from the intrathoracic vagal nerve and the left tumor was resected with a segment of the vagal nerve and recurrent nerve. The pathological diagnosis of the tumor was a neurofibroma. The tumor on the right side was left untreated due to concerns about possibly causing palsy of the bilateral recurrent nerve and also because of the asymptomatic state of the right tumor. Mediastinal neuofibroma in a patient with von Recklinghausen's disease often arises from the intrathoracic vagal nerve. To our knowledge, this is the first report of bilateral cervicomediastinal neurofibroma originating from the vagal nerves. [ABSTRACT FROM AUTHOR]

Two single lung transplants from a single cadaveric donor were successfully conducted at 2 institutions on March 29, 2000, the first such procedure in Japan under newly introduced legislation. Our patient was a 48-year-old woman with idiopathic pulmonary fibrosis who underwent left single-lung transplantation under cardiopulmonary support. The donor lung was preserved in 4°C modified Euro-Collins solution. Total ischemic time was 5 hours and 37 minutes. The postoperative course was uneventful. The patient was discharged on postoperative day 62 with satisfactory respiratory function. [ABSTRACT FROM AUTHOR]