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Seizures are uncommon with posterior circulation strokes. They are more often associated with anterior circulation strokes, with only a limited number of cases of status epilepticus reported to be related to brain stem ischemia. The literature includes case reports of generalized tonic-clonic seizures and associated status epilepticus as an initial presentation of acute basilar artery thrombosis. However, there are only rare cases reporting focal motor seizure as status epilepticus in the setting of acute basilar artery thrombosis, an important clinical presentation that should prompt evaluation for acute brain stem ischemia.

In this study, Sc concentration dependence of Sc x Al1−x N/AlN/poly-crystalline diamond/Si surface acoustic wave (SAW) characteristics at high Sc from 23.8% to 44.3% was investigated by fabricating one-port SAW resonator at high frequency. 3.8 GHz one-port resonator fabricated on Sc0.43Al0.57N showed an excellent performance of electro-mechanical coupling coefficient (K 2) as high as 6.34% for 2nd mode Sezawa wave, which enables a wide bandwidth in high frequency applications. The temperature coefficient of frequency was approximately −40 to −50 ppm deg−1 for the device fabricated with Sc concentration of 42.9%. This is a smaller value compared to conventional high K2 bulk materials such as LiNbO3. As the result, a high K2 6.34% material system at a higher Sc concentration of ScAlN/AlN/PCD was found to be possible at a high phase velocity of 7000 m s−1. Combined with the extremely high-power durability of diamond based device, high-power durable wideband SAW device at high frequency can be expected.

Background The diagnosis of epilepsy is at times elusive for both neurologists and nonneurologists, resulting in delays in diagnosis and therapy. The development of screening methods has been identified as a priority in response to this diagnostic and therapeutic gap. EpiFinder is a novel clinical decision support tool designed to enhance the process of information gathering and integration of patient/proxy respondent data. It is designed specifically to take key terms from a patient's history and incorporate them into a heuristic algorithm that dynamically produces differential diagnoses of epilepsy syndromes. Objective The objective of this study was to test the usability and diagnostic accuracy of the clinical decision support application EpiFinder in an adult population. Methods Fifty-seven patients were prospectively identified upon admission to the Epilepsy Monitoring Unit (EMU) for episode classification from January through June of 2017. Based on semiologic input, the application generates a list of epilepsy syndromes. The EpiFinder-generated diagnosis for each subject was compared to the final diagnosis obtained via continuous video electroencephalogram (cVEEG) monitoring. Results Fifty-three patients had habitual events recorded during their EMU stay. A diagnosis of epilepsy was confirmed (with cVEEG monitoring) in 26 patients while 27 patients were found to have a diagnosis other than epilepsy. The algorithm appropriately predicted differentiation between the presence of an epilepsy syndrome and an alternative diagnosis with 86.8% (46/53 participants) accuracy. EpiFinder correctly identified the presence of epilepsy with a sensitivity of 86.4% (95% confidence interval [CI]: 65.0–97.1) and specificity of 85.1% (95% CI: 70.2–96.4). Conclusion The initial testing of the EpiFinder algorithm suggests possible utility in differentiating between an epilepsy syndrome and an alternative diagnosis in adult patients.

Purpose Renal dysfunction is a well-known long-term complication which could increase mortality after non-renal solid organ transplantation. Recently, the UNCX variant (rs10277115), which encodes a paired-type homeobox transcription factor and has essential roles in skeleton formation and kidney development, has been shown to be associated with increased risk for chronic kidney disease in east Asian populations. However, the association between the UNCX variant and renal dysfunction after lung transplantation (LT) has not yet been elucidated. In the present study, we evaluated the association between the UNCX variant and the postoperative change of renal function after LT. Methods A total of 99 recipients of LT more than 18 years were genotyped for the functional polymorphism of the UNCX gene (rs10277115) and divided into two groups: the wild-type allele (AA) group and the heterozygous and homozygous mutant allele (AT/TT) group. The results of renal function tests were compared between the two groups. Delta creatinine (ΔCr) and delta eGFR (ΔeGFR) were defined as the difference between the postoperative level and the preoperative baseline level. Results The clinical characteristics of the patients were similar between the two groups. There were no significant differences in the previously described risk factors for renal function, including age, diabetes mellitus, hypertension and dyslipidemia. The postoperative change of ΔCr was significantly higher in the AA group than the AT/TT group after LT (Figure 1(a)). Moreover, the postoperative change of ΔeGFR was significantly lower in the AA group than the AT/TT group after LT (Figure 1(b)). The multivariate analysis revealed that the UNCX variant was independently associated with the levels of ΔCr and ΔeGFR. Conclusion The UNCX variant was associated with significant differences in Cr and eGFR in the long term and the development of renal dysfunction after LT.

Purpose Chronic lung allograft dysfunction (CLAD) is known as one of the major fatal disorders in the long-term phase after lung transplantation. Because CLAD is a heterogeneous disease, proper classification of phenotypes is important to understand each pathogenesis. In this study, we retrospectively evaluated the impact of new 2019 ISHLT classification system on living-donor lobar lung transplantation (LDLLT). Methods Between 1998 and 2019, a total of 96 patients underwent LDLLT at our hospital, and 73 patients who underwent bilateral LDLLT were included in this study. CLAD after bilateral LDLLT were diagnosed and classified according to the ISHLT consensus report in 2019. Results The median follow-up time was 10.3 years. A total of 27 (37.0%) patients were diagnosed as CLAD, including bronchiolitis obliterans syndrome (BOS) (n = 8, 29.6%), restrictive allograft syndrome (RAS) (n = 11, 40.7%), mixed (n = 1, 3.7%), undefined (n = 2, 7.4%), and unclassified (n = 5, 18.5%). CLAD developed in the unilateral lung in 26 patients. Five-year survival of the patients developing CLAD after LDLLT was 84.1%, whereas 5-year survival of the patients after CLAD onset was 58.4%. Survival after CLAD onset was worse in the patients with RAS (p=0.008) and undefined (p=0.003) than those with BOS. Though survival after CLAD onset did not differ between the patients with or without CT opacities (p=0.40), the patients with restriction on pulmonary function test had significantly worse survival than those without restriction (Figure, p=0.001). Conclusion While the patients with BOS had better prognosis, the presence of restriction on pulmonary function test could predict worse prognosis of the CLAD patients after bilateral LDLLT.

Purpose Histidine-rich glycoprotein (HRG) is a 75 kDa plasma glycoprotein produced in and secreted from the liver. Recently, supplementary HRG treatment has been shown to inhibit acute respiratory distress syndrome (ARDS) and prevent septic lethality. The pathogenesis of primary graft dysfunction (PGD) after lung transplantation (LT) could be similar to that of ARDS. However, the relationship between plasma levels of HRG and PGD after LT remains unknown. Methods Blood samples were collected from a total of 68 patients who underwent LT, including the patients with PGD grade 0-1 (the non-PGD group, n = 43), those with PGD grade 2 (the moderate PGD group, n = 18) and those with PGD grade 3 (the severe PGD group, n = 7) at 72 hours after LT. Plasma levels of HRG were quantified using ELISA and compared among the three groups. Appropriate cut-off values of HRG levels were set for overall survival (OS) after LT. Results The median follow-up period was 1208 (286-2982) days. Plasma levels of HRG at 72 hours after LT in the severe PGD group were significantly lower than those of the other groups (the non-PGD group vs. the severe PGD group, P = 0.042; the moderate PGD group vs. the severe PGD group, P = 0.040) (Fig. 1). An ROC analysis of the performance of plasma levels of HRG as a marker of overall survival yielded an AUC of 0.61 at a threshold level of 34.4 µg/mL. Patients with plasma levels of HRG ≥ 34.4 µg/mL showed significantly better OS and chronic lung allograft dysfunction (CLAD) free survival than those with plasma levels of HRG Conclusion Plasma level of HRG at 72 hours after LT was associated with the development of PGD, suggesting its usefulness as a predictor of the development of CLAD and survival after LT.

Purpose Recently, various disciplines have recognized the importance of preoperative nutritional and inflammatory status in influencing postoperative clinical outcomes. However, the usefulness of existing prognostic scoring methods has not yet been validated in lung transplantation (LT), except for the prognostic nutrition index. In the present study, we evaluated the usefulness of 9 prognostic scoring methods related to nutrition and inflammation in LT, which have been shown to be useful for predicting surgical prognosis in other fields. We also analyzed most accurate combination of the scoring methods in predicting prognosis after LT. Methods We conducted a single-center retrospective cohort study of 150 recipients of LT. We used 9 prognostic scoring methods (Figure 1A) for survival analysis by the log-rank test. Next, we performed a receiver operating characteristic analysis for overall mortality on all 36 combinations of two scoring methods out of the 9 scoring methods to detect the best combination to improve prognostic accuracy in LT. Survival analysis was performed on the best combination of scoring methods by the log-rank test. Results All of the 9 scoring methods significantly predicted prognosis after LT (Figure 1A). Among the 36 combinations, the combination of neutrophil to lymphocyte ratio (NLR) and Glasgow prognostic score (GPS) demonstrated the highest concordance index (c-index, 0.706), enabling the prognostic stratification in LT (NLR low and GPS 0: 0 point, NLR low and GPS 1-2 or NLR high and GPS 0: 1 point, NLR high and GPS 1-2: 2 point) (Figure 1B). Conclusion All of the 9 scoring methods significantly predicted prognosis even after LT. The combination of NLR and GPS predicted prognosis most accurately of 36 combination of two scoring methods, which could be a more accurate prognostic predictor than a single scoring method.

Purpose Lung ischemia reperfusion (IR) injury increases the mortality and morbidity in patients undergoing lung transplantation. Inflammatory mediators called Damage Associated Molecular Patterns (DAMPs) concern with inflammatory response to develop the organ damages during IR injury and High Mobility Group Box 1 (HMGB1) is one of the most important DAMPs. We had previously developed anti-HMGB1 monoclonal antibody (mAb) and assessed the therapeutic effect of the antibody in lung IR injury. Methods A mice hilar clamp model of IR was used, and animals were divided into sham groups and IR groups with or without administration of anti-HMGB 1 mAb. We analyzed the effect of anti-HMGB 1 mAb against IR injury by assessing lung oxygenation, injury, neutrophil infiltrations, expression of proinflammatory cytokines and chemokines, MAPK signaling and apoptosis. Results The severity of IR injury represented by oxygenation capacity, lung injury score and neutrophil infiltrations was significantly improved by anti-HMGB1 mAb treatment. The expressions of proinflammatory factors including IL-1b, IL-6, IL-12, TNFα, CXCL1 and CXCL2 and phosphorylation of p38 MAPK were significantly reduced by the anti-HMGB1 mAb treatment. Furthermore, the antibody decreased TUNEL positive cells to detect apoptosis. Conclusion Anti-HMGB1 mAb obviously ameliorated lung IR injury by reduction of inflammatory responses and apoptosis. Our findings indicate that anti-HMGB1 mAb have a potential as therapeutic drug to improve IR injury in lung transplantation.

Purpose Post-transplant lymphoproliferative disorder (PTLD) affects 3-9% of lung transplant (LTx) recipients, with a mortality range of 20-50%. Despite this high morbidity and mortality, few large studies on Asian population are reported, therefore, we lack fixed consensus regarding specific predictive risk factors in LTx recipients. This study was aimed at uncovering the risk factors of PTLD and evaluating the treatment strategy and outcome of Japanese PTLD cases. Methods We retrospectively reviewed 195 patients (re-transplantation cases were excluded) who underwent LTx at our hospital between October 1998 and February 2020. Results Seven PTLD patients (3.6%) were identified. The indication for LTx in PTLD group was 2 (28.6%), 3 (42.8%), 2 (28.6%) patients for idiopathic pulmonary fibrosis, other interstitial pneumonia including connective tissue disease, lung disease after hematopoietic stem cell transplantation, respectively. The proportion of indication was significantly different from those in non-PTLD patients (p=0.046). All PTLD patients had taken corticosteroid at the time of LTx (p Conclusion Long-term preoperative corticosteroid therapy can be a risk factor of PTLD after LTx. Regardless of the state of PTLD, opportunistic infection was a lethal complication and should be desperately prevented. CLAD may occur at a higher rate after treatment of PTLD, therefore, close monitoring and adjustment of immunosuppressants are needed.

Purpose Since 1998 our center has performed not only cadaveric lung transplantation (CLTx) but living-donor lobar lung LTx (LDLLTx), especially recently, including non-standard procedures of middle lobe LTx and segmental LTx in order to save younger children. The aim of this study was to show outcomes of pediatric LTx of a lung transplant center in Japan. Methods We retrospectively reviewed 203 consecutive LTx recipients between 1998 and 2020 including 43 pediatric ( Results The 1-, 5-, and 10-year overall survival (OS) in pediatric vs adult recipients were 93% vs 91%, 84% vs 74% and, 79% vs 61%, respectively (p = 0.11). The 1-, 5-, and 10-year lung-graft survival (GS) in pediatric vs adult recipients were 85% vs 83%,62% vs 62% and 36% vs 48%, respectively (p = 0.26). There was no significant difference in survival rates between pediatric and adult recipients. In pediatric recipients, the 1- and 5-year OS in 0-6 years old vs 7-17 years old were 70% vs 100% and 56% vs 92%, respectively (p = 0.004). The 1- and 5-year GS in 0-6 years old vs 7-17 years old were 60% vs 93% and 24% vs 72%, respectively (p = 0.02). Although the number is small, younger children under 7 years old have poorer OS and GS when compared with older children of 7-17 years old. From patient characteristics, lower height (p Conclusion Outcome of pediatric LTx is comparable with that of adult LTx. However, younger children under 7 years old have poorer OS and GS compared with older children of 7-17 years old.

The local resistance to fatigue crack propagation (FCP) in a friction stir welded (FSWed) Ti-6Al-4V alloy joint was investigated, by extracting the miniature CT specimens. Special attention was paid to the role of specific microstructures developed accompanying with a transformation induced lamellar structure (TILS) during the stirring process. Experimental works indicated that the FCP rates were higher in the stirred zone, especially in the coarse TILS zone which consisted of the prior non-transformed duplex structure and the beta-transformed coarse structure, compared with those in the base metal. These backgrounds were discussed on the basis of fracture mechanics with Reference to the measurement of residual stress.

Purpose Irisin is a skeletal muscle cell-derived myokine associated with physical activity. Recently, decreased serum irisin levels have been shown to cause alveolar epithelial apoptosis resulting in lung emphysema in patients with chronic obstructive pulmonary disease. Similar to the patients with emphysema, the patients with chronic lung allograft dysfunction (CLAD) after living-donor lobar lung transplantation (LDLLT) could show emphysematous changes, because in LDLLT, small lobar grafts expand to fit into the recipient's chest cavity due to the size mismatch. However, the relationship between serum irisin levels and CLAD after LDLLT remains unknown. Methods Blood samples were collected from a total of 33 patients who underwent bilateral LDLLT, including patients with CLAD (the CLAD group, n=11) and those without CLAD (the non-CLAD group, n=22). Serum samples were assayed for irisin using ELISA kit and compared between the two groups. Appropriate cut-off values of irisin level were set for the diagnosis of CLAD. Results The median follow-up period was 4366 (1055-7180) days. Serum irisin levels of the CLAD group were significantly lower than those of the non-CLAD group (9.5 ± 3.4 vs. 13.2 ± 4.2 ng/mL, P = 0.018) (Fig. 1). An ROC analysis of the performance of the serum irisin level as a marker of CLAD yielded an AUC of 0.76 (sensitivity=0.91 and specificity=0.64 at a threshold level of 12.6 ng/mL). Moreover, patients with irisin level ≥12.6 ng/mL (n=16) showed significantly better CLAD-free survival than those with irisin level Conclusion Decreased serum irisin levels are associated with the development of CLAD after bilateral LDLLT. Irisin might be a novel biomarker for the diagnosis of CLAD after LDLLT.

Purpose In the diagnosis of chronic lung allograft dysfunction (CLAD) after living-donor lobar lung transplantation (LDLLT), lung ventilation scintigraphy using 133 Xe has been shown to be useful. However, the supply of 133 Xe has been discontinued worldwide in 2016 and a new diagnostic tool is required for CLAD after LDLLT. Generally, because CLAD has been shown to develop predominantly on one side after bilateral LDLLT, lung perfusion scintigraphy (LPS) could show a perfusion shift to the unilateral healthy lung ( Figure 1A ). Nevertheless, the usefulness of LPS in the diagnosis of CLAD after LDLLT is unknown. Methods We conducted a single-center retrospective cohort study of 58 recipients who underwent bilateral LDLLT at Okayama University Hospital between October 1998 and June 2016. The unilateral shift values in LPS were calculated, and compared between the CLAD group (N=27) and the non-CLAD group (N=31) from 5 years before the CLAD onset to 5 years after the CLAD onset. Results The median time to the CLAD onset was 2176 days (326-4763 days). The unilateral shift values in LPS of the CLAD group were significantly higher than those of the non-CLAD group during 5 years before the CLAD onset (P Figure 1B ). An ROC analysis of the performance of the unilateral shift value in LPS as a marker of CLAD yielded an AUC of 0.79 (sensitivity=0.54 and specificity=1.00 at a unilateral shift threshold level of 8.6%). The unilateral shift values in LPS were significantly correlated with the results of the forced expiratory volume in 1 second (P = 0.036, r = - 0.322) ( Figure 1C ). Conclusion In the patients with unilateral CLAD after bilateral LDLLT, LPS showed the unilateral perfusion shift to the healthy lung even during 5 years before the CLAD onset. LPS might have a potential to diagnose unilateral CLAD early after bilateral LDLLT.

Purpose When extended criteria donor was transplanted to reduce on waitlist time and mortality for severe donor shortage, it had a potential risk to cause worse outcome. Furthermore, using marginal donor for single lung transplant (LT) was more difficult than double LT. In case of adult male recipients, living donor lobar lung transplant (LDLLT) might not be established due to the lung volume and function after LT. We reported good outcome due to new technique which was combined merits of LDLLT with cadaveric LT as called “hybrid LT”. Methods The relatively high-quality cadaveric single lung was choose and transplanted to unilateral chest, living donor lower lobe was transplanted to the other when extended criteria donor lung was allocated for severe illness recipient. Results Both of recipients were diagnosed idiopathic pulmonary fibrosis . They were registered on waiting list. However, they were considered no survive on the list for their severe illness, because long waiting time, approximately 3 years, was needed in Japan for severe donor shortage. On the other hand, donors were rejected by all other transplant centers because of the lungs on the basis of the initial conventional assessments. PaO2/FiO2 ratio of case 1 was at less than 250 and case 2 was at less than 188. Left cadaveric and right living donor lower robe was transplanted on case 1. The recipient experienced grade 2 primary graft dysfunction (PGD) but rapidly recovered. The other was transplanted right cadaveric and left living donor lower robe on case 2 and had no severe PGD. Both of them returned to their normal daily life and is doing well for 2 years after lung transplantation. Conclusion Hybrid LT using unilateral cadaveric lung and living donor lower lobe is feasible and reasonable option for a high-risk recipient when using marginal lung grafts. Hybrid LT reduce perioperative risk due to overcome lung volume, function and quality at the same time and have merit of bilateral LT at the long term outcome.

Species-specific restriction fragment length polymorphism in the intron of the androgen receptor gene (ar5) was found in glass to silver-stage individuals of Anguilla japonica (n = 51) and A. marmorata (n = 21). The sequence analysis of 16S rDNA from 328 anguillid leptocephali collected in the North Equatorial Current of the western North Pacific Ocean revealed the specimens to be A. japonica (n = 194), A. marmorata (n = 128), A. bicolor pacifica (n = 5) and A. luzonensis (n = 1). All leptocephali of A. japonica and A. marmorata were monomorphic and did not share an allele at the ar5 locus, indicating that the two species are reproductively isolated.

Amyloid beta-related angiitis (ABRA) is a subtype of cerebral amyloid angiopathy-related inflammation, with distinctive pathology and prognosis compared with cerebral amyloid angiopathy (CAA). On a spectrum of increasing severity, ABRA is considered to be in-between the less aggressive inflammatory-CAA and the more severe primary central nervous system (CNS) angiitis. Whereas retinal pathological changes were described in subjects with primary or secondary CNS angiitis, and non-inflammatory CAA, bilateral posterior pole superficial and peripapillary retinal hemorrhages have not been reported as initial signs in patients with pathology-confirmed ABRA, accompanying neurological spells and characteristic neuroimaging findings.

The long, complex documents that medical writers often work with can place unusual demands on a word processing program. Microsoft Word® is a powerful program, but that does not mean using it properly is always easy or intuitive. Many problems that writers encounter are the result of not knowing exactly how Word works, what unintended effects its options may have, or the best practices for performing certain writing and editing tasks. This article explains some of Word's more troublesome quirks and shows you how to avoid them.

Introduction Lung transplantation (LTx) is still limited by a shortage of suitable donor lungs. Evolving flexible surgical procedures help increase the chances of LTx by unfolding recipient-to-donor matching options based on the pre-existing organ allocation concept. In particular, right single LTx using an inverted left donor lung may be considered under the following conditions: 1) Despite a right-side-predominant lung dysfunction in a recipient candidate, the option is limited to the use of a left single donor lung due to evidence of lung injury in the right donor lung or necessity to share the organ with another candidate prioritized on the waitlist; 2) Left side LTx in the recipient is impossible due to a past history in the recipient of thoracic surgery. One of the key challenges in performing inverted LTx is to adjust the positional relationship between the recipient's and graft's hilar structures. Herein, we report a case of successful left-to-right inverted LTx using interposition of a pericardial conduit for pulmonary venous anastomosis. Case Report A left lung graft was offered to a 59-year-old male who had predominant damage of the right lung by idiopathic pulmonary fibrosis (Fig.1A). We decided to transplant the left donor lung into the right thorax of the recipient, considering his serious disease condition. Due to the anterior-posterior position gap, adjustment of the cuff length of the pulmonary artery and vein was required. Pulmonary artery anastomosis could be performed by leaving both the donor and recipient cuff long, but an extension of the pulmonary vein by interposition of a pericardial conduit was required for anastomosis (Fig.1B). The patient developed no anastomotic complications after the LTx. Summary left-to-right inverted LTx is technically feasible by using an autologous pericardial conduit in selected cases. The technique has the potential benefit of encouraging exploration and expansion of unprecedented donor-recipient matching patterns in LTx.

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

Objective The aim of this study was to evaluate right and left ventricular functions in patients with pulmonary arterial hypertension after living-donor lobar lung transplantation compared with those without hypertension. Methods Thirty-three recipients of living-donor lobar lung transplantation were divided into two groups: those with pulmonary arterial hypertension (PAH group; n=12) and those without (non-PAH group; n=21). Their systolic pulmonary artery pressure was 93.1 ± 6.7 mm Hg versus 31.4 ± 2.9 mm Hg, respectively. Right and left ventricular ejection fractions, systolic pulmonary artery pressure, and cardiac index were serially measured by radionuclide ventriculography and right heart catheterization, respectively. Results Pretransplant right and left ventricular ejection fractions were lower in the PAH group (29.8% ± 7.0%, 49.9% ± 6.6%) than in the non-PAH group (49.7% ± 3.3%, 65.2% ± 1.9%) ( P = .010, .068). Two months after living-donor lobar lung transplantation, right ventricular ejection fraction and systolic pulmonary artery pressure in the PAH group (57.3% ± 5.1%, 25.7 ± 1.8 mm Hg) improved dramatically, equal to those in the non-PAH group. In contrast, left ventricular ejection fraction and cardiac index in the PAH group (50.9% ± 3.7%, 2.66 ± 0.12 L · min −1 · m −2 ) were still significantly lower than in the non-PAH group (65.4% ± 2.8%, 3.13 ± 0.15 L · min −1 · m −2 ) ( P = .0038, .037). At 6 to 12 months, the PAH group demonstrated a significant rise in left ventricular ejection fraction and cardiac index that reached similar values in the non-PAH group measured at 2 months. These values were stable for up to 3 years. Conclusions Right ventricular function recovered early after living-donor lobar lung transplantation in the PAH group. In contrast, recovery of left ventricular function required 6 to 12 months. Improved cardiac function was sustained for up to 3 years, suggesting long-term durability of cardiac function recovery after living-donor lobar lung transplantation.

For the purpose of a nationwide surveillance of the antimicrobial susceptibility of bacterial respiratory pathogens in patients in Japan, the Japanese Society of Chemotherapy conducted their second year survey, during the period from January to August, 2007. A total of 1178 strains were collected from clinical specimens obtained from adult patients with well-diagnosed respiratory tract infections. Susceptibility testing was evaluable for 1108 strains (226 Staphylococcus aureus, 257 Streptococcus pneumoniae, 6 Streptococcus pyogenes, 206 Haemophilus influenzae, 120 Moraxella catarrhalis, 122 Klebsiella pneumoniae, and 171 Pseudomonas aeruginosa). A total of 44 antibacterial agents, including 26 beta-lactams (four penicillins, three penicillins in combination with beta-lactamase inhibitors, four oral cephems, eight parenteral cephems, one monobactam, five carbapenems, and one penem), three aminoglycosides, four macrolides (including ketolide), one lincosamide, one tetracycline, two glycopeptides, six fluoroquinolones, and one oxazolidinone were used for the study. Analysis was conducted at the central reference laboratory according to the method recommended by the Clinical and Laboratory Standards Institute (CLSI). The incidence of methicillinresistant Staphylococcus aureus (MRSA) was high, at 59.7%, and the incidences of penicillin-intermediateresistant and -resistant Streptococcus pneumoniae (PISP and PRSP) were 30.4% and 5.1%, respectively. Among Haemophilus influenzae strains, 19.9% of them were found to be beta-lactamase-non-producing ampicillin (ABPC)-intermediately-resistant (BLNAI), 29.1% to be beta-lactamasenon-producing ABPC-resistant (BLNAR), and 6.7% to be beta-lactamase-producing ABPC-resistant (BLPAR) strains. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae was not isolated. Two isolates (1.2%) of Pseudomonas aeruginosa were found to be metallo-beta-lactamase-producing strains, including one (0.6%) suspected multidrug-resistant strain showing resistance to imipenem, amikacin, and ciprofloxacin. These data will be a useful reference for future periodic surveillance studies and for investigations to control resistant infections as well. Continued surveillance is required to prevent the further spread of these antimicrobial resistances.

Background The indication of lung transplantation for patients with pulmonary complications of hematopoietic stem cell transplantation (HSCT) remains controversial, and only few such cases have been reported. We reviewed our experiences regarding living-donor lobar lung transplantation (LDLLT) in patients with pulmonary complications of HSCT. Methods We reviewed and assessed seven patients (age, 6-45 yr) who underwent LDLLT at Okayama University Hospital for pulmonary complications of HSCT (HSCT group). Their characteristics and postoperative results were compared with those of 41 LDLLT without HSCT patients (non-HSCT group). In the HSCT group, indications for LDLLT included bronchiolitis obliterans (n=6) and pulmonary fibrosis (n=1) that had developed after treatments involving HSCT. Preexisting hematologic diseases included acute lymphocyte leukemia (n=4), acute promyelocystic leukemia (n=1), myelodysplastic syndrome (n=1), and aplastic anemia (n=1). Results In the HSCT group, two patients died due to infectious complications, whereas five are currently alive (an overall survival of 71.4%) without any recurrence of the hematologic diseases (mean follow-up period, 35.7 months). The mean of acute rejection episodes was 1.1 per patient in the HSCT group and 1.8 in the non-HSCT group. One of the seven HSCT (14.4%) and 10 non-HSCT (24.4%) patients have currently developed bronchiolitis obliterans syndrome. Conclusion Our results showed that LDLLT for patients with respiratory failure because of pulmonary complications of HSCT could be an effective approach with less rejection episodes; however, it has a possibly higher risk of the development of infectious complications.

Living-donor lobar lung transplantation (LDLLT) is performed in critically ill patients, although the outcome is generally expected to be poor for those who are ventilator dependent. The aim of this study was to compare the outcomes of LDLLT in ventilator-dependent patients compared with those in ventilator-independent patients.We reviewed 31 consecutive patients who received LDLLT between October 1998 and May 2004.Five patients were ventilator dependent and 26 were ventilator independent. All five ventilator-dependent patients were female, with a mean age of 29.6 years. The duration of preoperative ventilation was 23.4 +/- 5.7 days. The underlying diagnoses in the ventilator-dependent patients included only obstructive (n = 3) and infectious lung diseases (n = 2), whereas those in the ventilator-independent patients included hypertensive and restrictive diseases (P = 0.004). There were no significant differences between the groups in early postoperative clinical values. The incidences of acute rejection and bronchiolitis obliterans syndrome (BOS) were comparable. The 5-year survival rates were 100% for the ventilator-dependent patients and 92.3% for the ventilator-independent patients (P = 0.45).Our findings suggest that LDLLT can have a favorable outcome in selected ventilator-dependent patients.

The living-donor lobar lung transplantation procedure has been developed clinically as an alternative approach for patients considered too ill to await cadaveric transplantation. With this procedure, 2 lobes are implanted in the recipient in place of whole right and left lungs, respectively. However, the shortage of graft volume can be a problem when compared with full-sized cadaveric grafts. In an attempt to solve this problem, we have developed a native lobe-preserving lobar transplant technique using a large animal model. We report a first successful case of a patient undergoing native lobe-preserving lobar lung transplantation for severe pulmonary emphysema.

In this study we report the case of a 28-year-old female patient with recurrent lymphangioleiomyomatosis (LAM) in the allografts after bilateral living-donor lobar lung transplantation. Although her post-operative course under immunosuppression with tacrolimus and prednisolone had been uneventful without rejection episodes, she had developed shortness of breath and a progressive chylous effusion with diffuse cystic changes in both lungs 5 years after transplantation. In spite of a diagnosis of having a recurrence of LAM based on radiologic findings and deteriorating pulmonary function, her clinical symptoms, which included dyspnea and chylothorax, were significantly improved after treatment with sirolimus. Although a beneficial effect of sirolimus in the treatment of LAM has not been definitively determined, this report may provide useful information for management of recurrent LAM after lung transplantation.

Although there have been a number of studies investigating the flows and pressures on a cube using wind tunnel experiments and numerical simulations, there have only been a few actual field experiments conducted. The results of these previous experiments have helped us to clarify the characteristics of surface pressures or wind flows on or around a cube. However, almost all these studies focus on either pressure or flow field only. In this study, a field experiment was arranged where the pressure and flow measurements were carried out simultaneously with a 2.4 m cube on the ground. The velocity field of the approaching flow was observed with a number of anemometers arrayed around the cube that was located in an open area of reclaimed land. The three-dimensional characteristics of the turbulent flows and the fluctuating surface pressures on the cube were examined.