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There are many standards for interconnectivity technology in home networks, and many of them use multicast communications. In these standards, the method to implement IGMP, a protocol for group management of multicast in IPv4, is outside the scope for the standard. Therefore, the operation of IGMP at each terminal may be different depending on the interpretation by the developer of the standard regarding IGMP. Some home routers do not implement IGMP according to any standard, so depending on the combination of the terminal and home router, interconnection using multicast communication may not be possible in some cases. In this paper, we investigate the implementation related to IGMP of home routers that prevent interconnectivity of home network technologies. In addition, we clarify the issue and propose a method to improve interconnectivity in the implementation on the terminal side against the home router issue. Furthermore, evaluation and consideration of the proposed method are described.

Background To predict pathological response and survival in T3/T4 non-small cell lung cancer after induction chemoradiotherapy by assessing fluorodeoxyglucose uptake with positron emission tomography. Methods In this retrospective observational study, standard uptake values of whole tumors and extrapulmonary involvement sites were measured after induction chemoradiotherapy. The values were then compared with pathological responses and recurrence-free survival. Results Fifty-seven patients with clinical T3/T4 tumors were treated by chemoradiotherapy followed by surgery. Pathological complete response was observed in 33% of patients (19 of 57). With the cutoff value of 3.3 for whole tumor fluorodeoxyglucose uptake for estimating complete response, 38% patients (9 of 24) with values lower than the cutoff value were false-negative. Tumor remission at extrapulmonary involvement sites was observed in 82% patients (47 of 57), and the cutoff value of the extrapulmonary uptake was 3.0 without any false negatives. Recurrence-free survival was significantly better in patients with values lower than both the whole- and extrapulmonary-uptake cutoff values than in patients with higher values (P = .016 and P = .001, log-rank test, respectively). Among 7 patients who avoided en bloc resections of involved structures because of lowered extrapulmonary uptakes and negative findings in intraoperative frozen sections, none experienced margin recurrence. Conclusions Even when whole tumor uptakes in patients with T3/T4 tumors markedly decrease after induction chemoradiotherapy, surgical treatment is still indicated because of possible residual tumors. Tumor remission at extrapulmonary involvement sites could be predicted by extrapulmonary uptake values. Both whole- and extrapulmonary-uptake values after induction chemoradiotherapy could be used to predict prognosis.

The authors propose an interface for home energy management system (HEMS). This interface is aimed at raising the energy-saving consciousness of users who have little knowledge of energy saving. A possible reason for the low level of consciousness of such users is that HEMS does not provide information which helps users in energy-saving planning. To help users who have insufficient knowledge of energy saving, the interface visualizes power consumption and operational information obtained from network home appliances. In order to show which appliances have potential for significant energy-saving effects, the interface uses icons that visually represent high-power appliances whose power consumption exceeds 400 W, along with their operation periods. By viewing the screen, users can easily recognize how to operate appliances for energy-saving planning as well as which appliances have high energy-saving effects. The authors have developed a tool with a built-in interface and have evaluated it by questionnaire.

Background: Spondylolysis and undiagnosed mechanical low back pain (UMLBP) are the main causes of low back pain (LBP) in adolescent athletes. No studies have evaluated the difference in clinical and radiographic factors between these 2 conditions. Furthermore, it remains unclear which adolescent athletes with LBP should undergo advanced imaging examination for spondylolysis. Purpose: To compare the clinical and radiographic factors of adolescent athletes with spondylolysis and UMLBP who did not have neurological symptoms or findings before magnetic resonance imaging (MRI) evaluation and to determine the predictors of spondylolysis findings on MRI. Study Design: Cohort study, Level of evidence, 3. Methods: The study population included 122 adolescent athletes aged 11 to 18 years who had LBP without neurological symptoms or findings and who underwent MRI. Of these participants, 75 were ultimately diagnosed with spondylolysis, and 47 were diagnosed with UMLBP. Clinical factors and the following radiographic parameters were compared between the 2 groups: spina bifida occulta, lumbar lordosis (LL) angle, and the ratio of the interfacet distance of L1 to that of L5 (L1:L5 ratio, %). A logistic regression analysis was performed to evaluate independent predictors of spondylolysis on MRI scans. Results: Significantly more athletes with spondylolysis were male (82.7% vs 48.9%; P < .001), had a greater LL angle (22.8° ± 8.1° vs 19.3° ± 8.5°; P = .02), and had a higher L1:L5 ratio (67.4% ± 6.3% vs 63.4% ± 6.6%; P = .001) versus athletes with UMLBP. A multivariate analysis revealed that male sex (odds ratio [OR], 4.66; P < .001) and an L1:L5 ratio of >65% (OR, 3.48; P = .003) were independent predictors of positive findings of spondylolysis on MRI scans. Conclusion: The study findings indicated that sex and the L1:L5 ratio are important indicators for whether to perform MRI as an advanced imaging examination for adolescent athletes with LBP who have no neurological symptoms and findings.

Objective Segmentectomy includes numerous kinds of procedures that may result in decreased postoperative pulmonary function. This causes controversy regarding the functional advantage of segmentectomy over lobectomy. To clarify the difference between the procedures, systemic and regional pulmonary functions of the resected segments must be examined. Methods Pulmonary function tests and lung perfusion single-photon emission computed tomography (SPECT) were prospectively conducted before and after segmentectomy in 117 patients who were divided into groups based on resection of 1 ) of segment and lobe were measured from a fusion image of SPECT and computed tomography. Results Percentage of postoperative/preoperative pulmonary function was the highest in the P 1 of preserved lobes were significantly lower than the predicted value in all segmentectomy groups ( P P P = .02, respectively). Conclusions Segmentectomy decreased the pulmonary function with increasing number of resected segments. LUD segmentectomy decreased both systemic and lobar function significantly due to not only large resection, but also marked depression of the preserved lobe, resulting in similar decrease as lobectomy.

It is often difficult to expose the pulmonary artery buried in a scar tissue, especially in lung cancer patients that responded well to neoadjuvant chemoradiotherapy. Difficulty to access pulmonary artery branches may lead to potentially unnecessary pneumonectomy. To complete lobectomy in such cases, a technique with preceding bronchial cutting for exposure of the pulmonary artery is presented. After dissecting the pulmonary vein, the lobar bronchus is cut from the opposite side of the pulmonary artery with scissors. The back wall of the lobar bronchus is cut using a surgical knife from the luminal face, which can expose the pulmonary artery behind the bronchial stump and then complete lobectomy. Fourteen patients have been treated using the present technique, enabling complete resection by lobectomy (including sleeve lobectomy in 3 patients) without major bleeding. The present procedure can expose pulmonary artery buried in scar tissue, resulting in making the lobectomy safer.

To assess whether a video-assisted thoracoscopic surgery (VATS) procedure is superior to limited thoracotomy (LT) for segmentectomy; postoperative pain was compared between VATS-lobectomy (VATS-L) and LT-segmentectomy (LT-S). Widely opened anterolateral thoracotomy segmentectomy (WT-S) was used as a control. This study was a retrospective analysis of prospectively collected data for 220 consecutive patients with stage I NSCLC treated between 2012 and 2015 at a single institute using VATS-L (n = 58), LT-S (n = 93), or WT-S (n = 69). Pain scores from postoperative days (POD) 1–4 were measured using a visual analog scale three times a day. Chronic pain was assessed by the need for analgesics at 1, 2, and 3 months postoperatively. No significant differences in pain from POD 1 to 4 were observed between VATS-L and LT-S, whereas WT-S showed significantly higher pain scores than these two procedures (p = 0.0001–0.02). Chronic pain did not differ significantly among the procedures. Postoperative pain does not differ significantly between VATS-L and LT-S. LT may be preferable to VATS for segmentectomy to identify the anatomy, dissect the hilar nodes, and establish surgical margins.

Tracheo‐innominate artery fistula (TIF) is a rare but life‐threatening complication of tracheostomy. We describe a 44‐year‐old man who was admitted for a pressure ulcer infection with a third tracheostomy in place. He showed massive hemoptysis from the TIF, followed by cardiopulmonary arrest. The cuff of the tube was hyperinflated; however, even a slight movement of the tube resulted in recurrent massive hemorrhage. Thus, an endovascular stent graft was placed. Our case shows that sentinel bleeding may be found prior to TIF, and an endovascular repair can be a lifesaving temporizing option, when the hemorrhage was not controlled by hyperinflating the cuff of the tube.

Background: The 2-year overall survival (OS) of c-Stage IIIA/B non-small cell lung cancer (NSCLC) is each 53% and 34% in IASLC Staging Project (7th) and the treatments remain controversial. Especially, multimodal treatment at stage III (T3/4-AOI) is poorly studied. Method: This retrospective observational study aimed to elucidate the efficacy and safety of tri-modality therapy in pts with stage III NSCLC (T3/4-AOI). We included all pts who received ICRT (2 cycles of DOC/CDDP or PAC/CBDCA plus 40–46 Gy of thoracic radiation) between 2014 and 2017 at our institution. Results: 35 pts (mean age, 66y) with stage III NSCLC (T3/4-AOI, any-N proven by EBUS-TBNA) judged as pre-ICRT resectable by a multidisciplinary tumor board, were enrolled. There were 21 T3 and 14 T4 cases; and 17 adenocarcinoma, 17 squamous cell carcinoma, and 1 not-otherwise-specified case. One pneumonectomy and 28 lobectomies; and 11 tracheobronchial, 6 chest wall, 7 great vessel, and 6 cardiac resections were performed. 26 pts (90%) achieved R0 resection. 6 pts did not undergo surgery due to disease progression (n=3), performance status decline (n=1), and severe radiation pneumonitis (n=2). No pts died during ICRT or within 6 months post-surgery. The 2-year OS and recurrence-free survival (RFS) rate in those who completed the 2-year follow-up was each 74% (17/23) and 68% (15/22), respectively. In total, each 12 and 13 pts have not reached 2-year follow-up yet. Conclusion: Surgery after ICRT in pts with stage III NSCLC (T3/4-AOI) was well tolerated and potentially benefitted survival.

Diffusion-weighted magnetic resonance imaging (DWI) frequently shows heterogeneity of signal intensity (SI) in non-small cell lung cancer (NSCLC). The purpose of our study was to examine the association of SI and DWI patterns with histology, tumor invasiveness, lymph node metastasis, and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) uptake in NSCLC.One hundred forty-five patients with NSCLC underwent preoperative DWI and FDG-PET. DWI patterns were visually classified as homogenous (HOM) (n = 81) or heterogeneous (HET) (n = 64). The former was further classified as faint (faint-HOM) (n = 27) or dark (dark-HOM) (n = 54) according to a cutoff value of SI. Associations of SI and DWI patterns with tumor histology, lymphatic or vascular invasion, pleural invasion, lymph node metastasis, and FDG uptake were evaluated.All faint-HOM tumors were well-differentiated adenocarcinoma, whereas dark-HOM and HET tumors were less-differentiated adenocarcinoma or non adenocarcinoma. Although the dark areas in HET tumors showed a dense aggregation of tumor cells, their faint areas showed abundant fibrovascular stroma or necrosis, or a well-differentiated part of adenocarcinoma. Tumor size and the frequencies of lymphatic or vascular invasion, pleural invasion, and nodal metastasis were highest in HET tumors, followed by dark-HOM and faint-HOM (P = .1-P.001) tumors. Sixty-five tumors having at least 1 of the invasions or metastasis showed significantly higher SI than the 81 tumors without (P.001). HET tumors had the highest FDG uptake, followed by dark-HOM and faint-HOM tumors; differences between the groups were significant (P.01 to P.001).The SI and heterogeneity of DWI reflect the histologic heterogeneity, tumor aggressiveness, and FDG-PET uptake in NSCLC.

In recent years, there are many studies on Home Energy Management System, HEMS for short. HEMS reduces electric power consumption by a visualization function and a remote control function. However, an action for a trouble of apparatuses and a setting of a system are complicated in using HEMS. If a user has no clue for solving, it is necessary to ask the maker or seller. Thus we focus on the trouble shoot problems for HEMS apparatuses. This study develops user experience to support long-term operation for HEMS.

After Great East Japan Earthquake, we increase importance to conserve electric power consumption by using Home Energy Management System, HEMS for short. However, HEMS is insufficient approaches other than change in figure. This study develops user experience as a service for consumers and estimates the system.

This paper proposes a knowledge discovery system from annotated time series data, they are expressed as sequences of numerical values. They generally have a lot of important information in background, but it is not included in data. Analysis methods without background information have limitations. Several studies propose meta data approaches, which is often expressed as a short text, the techniques are insufficient for our purpose. We therefore develop a method that uses annotations which are compact expressions of back ground information. Subsequences obtained by using domain knowledge are organized into groups based on a distance measure. Among the groups some of them are identified as important features. In order to measure importance, we develop a method that uses global and local frequencies of subsequences. This idea is similar to the TF*IDF method, which is used in text mining. A subsequence that represents an important group is regarded as a feature pattern. In addition, we extract association rules over feature patterns and annotations. We introduce a new concept, called max allowance length, to focus only on influential annotations to a pattern. We demonstrate an effect of the proposed method by using financial data.

Introduction Information is limited regarding health-related quality of life (QOL) status of long-term (greater than 5 years) lung cancer survivors (LTLCS). Obtaining knowledge about their QOL changes over time is a critical step toward improving poor and maintaining good QOL. The primary aim of this study was to conduct a 7-year longitudinal study in survivors of primary lung cancer which identified factors associated with either decline or improvement in QOL over time. Methods Between 1997 and 2003, 447 LTLCS were identified and followed through 2007 using validated questionnaires; data on overall QOL and specific symptoms were at two periods: short-term (less than 3 years) and long-term postdiagnosis. The main analyses were of clinically significant changes (greater than 10%) and factors associated with overall QOL and symptom burden for each period and for changes over time. Results Three hundred two (68%) underwent surgical resection only and 122 (27%) received surgical resection and radiation/chemotherapy. Recurrent or new lung malignancies were observed in 84 (19%) survivors. Significant decline or improvement in overall QOL over time were reported in 155 (35%) and 67 (15%) of 447 survivors, respectively. Among the 155 whose QOL declined, significantly worsened symptoms were fatigue (69%), pain (59%), dyspnea (58%), depressed appetite (49%), and coughing (42%). The symptom burden did not lessen among the 67 who reported improvement in overall QOL, suggesting that survivors had adapted to their compromised physical condition. Conclusions LTLCS suffered substantial symptom burden that significantly impaired their QOL, indicating a need for targeted interventions to alleviate their symptoms.

Venous thrombus is subsequently organized and replaced by fibrous connective tissue. However, the sequential changes in venous thrombi are not reliably detected by current noninvasive diagnostic techniques. The purpose of this study is to reveal whether magnetic resonance (MR) can detect venous thrombus, define thrombus age and predict thrombolytic responses. Thrombus in the rabbit jugular vein was imaged with a 1.5-T MR system at 4 h and at 1, 2 and 4 weeks using three-dimensional (3D) fast asymmetric spin echo T2-weighted (T2W) and 3D-gradient echo T1-weighted (T1W) sequences. The jugular veins were histologically assessed at each time point. Magnetic resonance imaging (MRI) was also performed in vivo before and 30 min after tissue plasminogen activator (t-PA) administration. The thrombi in MRI were comparable in size to histological sections. The signal intensity (SI) of thrombi at 4 h was heterogeneously high or low on T2W or T1W images, respectively. The SI of thrombi on T2W images decreased time-dependently, but increased on T1W images at 1 and 2 weeks. Morphological analysis showed time-dependent decreases in erythrocyte, platelet and fibrin areas and time-dependent increases in smooth muscle cell, macrophage, collagen and iron areas. The t-PA administration significantly decreased thrombus volume at 4 h but not at 1, 2 and 4 weeks. Venous thrombosis can be reliably and noninvasively detected by MRI. Measurement of SI might support assessments of thrombus age and thrombolytic response.

Summary. Background: Plaque erosion is a cause of atherothrombosis that preferentially occurs on smooth muscle cell (SMC)- and proteoglycan-rich rather than lipid-rich plaques. However, its underlying mechanisms remain unknown. Objective: To determine whether disturbed blood flow induces erosive injury and thrombus formation on SMC-rich neointima. Methods: Three weeks after balloon injury, SMC-rich neointima with increased tissue factor (TF) activity developed in rabbit femoral arteries that were narrowed with a vascular occluder to disturb blood flow after stenosis. Neointimal injury and thrombus formation were assessed at 15, 30, and 180 min after the vascular narrowing. Results: Endothelial detachment, platelet adhesion and neointimal cell apoptosis became evident at the post-stenotic regions of all femoral arteries (n = 5) within 15 min of narrowing. Mural thrombi composed of platelet and fibrin developed after 30 min, and then occlusive thrombi were generated in three out of five vessels after 180 min. The identical vascular narrowing of normal femoral arteries also induced endothelial detachment with small platelet thrombi at post-stenotic regions, but fibrin and occlusive thrombi did not develop. Computational simulation analysis indicated that oscillatory shear stress contributes to the development of erosive damage to the neointima. Conclusions: These results suggest that disturbed post-stenotic blood flow can induce erosive injury in SMC-rich plaques and promote thrombus formation that results in vascular events.

Our study aim was to determine whether there are differential changes in whole-lung and regional lung functions after lobectomy for lung cancer between propensity score-matched patients treated with and without induction chemoradiotherapy, by using single-photon emission computed tomography lung perfusion.This study was a retrospective matched cohort study of consecutively acquired data. Pulmonary function test and perfusion scintigraphy were conducted before lobectomy and 6 months after lobectomy in patients treated with induction therapy (n = 72) and in those not treated (n = 170), for measuring functional changes of whole lung, contralateral lung, and lobes. After exact matching on resected lobe site, propensity scores for age, smoking status, preoperative pulmonary functions, and predicted postoperative pulmonary function were used to match the groups.After the matching, 46 patients were selected from the groups. Standardized mean differences of the 5 matched variables were0.1. Whole lung function significantly decreased after lobectomy in the induction therapy group than in the noninduction therapy group (P .001). Although ipsilateral preserved lobe function before surgery was not different between the groups (P = .33), postoperative value was significantly lower in the induction therapy group than in the noninduction therapy group (P .001). Although both groups showed a significant increase of contralateral lung function after lobectomy (P .01), the increases were not significantly different between the groups (P = .81).Induction chemoradiotherapy was associated with reduced pulmonary function after lobectomy because of a decrease in ipsilateral preserved lobe function, which could be caused by the chronic effects of the induction chemoradiotherapy.

Rationale and Objectives Atherothrombosis usually occurs on macrophage- and lipid-rich unstable plaque, but rarely on smooth muscle cell (SMC)-rich stable plaque. Magnetic resonance imaging (MRI) has been extensively applied for noninvasive vascular imaging. We therefore investigated whether MRI provides valuable information about the characteristics of atherosclerotic vessels using rabbit models of macrophage-rich or SMC-rich atherosclerotic arteries. Materials and Methods Rabbits were fed with a conventional (CD group, n = 3) or 0.5% cholesterol (ChD group, n = 3) diet for 1 week before and 3 weeks after balloon injury of the left iliac arteries. Three weeks later, these arteries were investigates by 1.5 T MRI and by conventional angiographic imaging, followed by histological and immunohistochemical analyses. Results Three weeks after balloon injury, injured iliac arteries of both groups formed neointima with luminal stenosis. Conventional and MRI angiographic findings of the luminal diameter significantly and positively correlated. T1 relaxation time was significantly shorter and the lipid content was much higher in injured arteries from the ChD than from the CD group. The injured arteries from the ChD also contained more macrophages and less SMCs that those from the CD group. The T1 relaxation time and lipid content in injured arteries negatively and positively correlated with the degree of macrophage accumulation, respectively. Conclusion These results showed that MRI could provide valuable information about luminal stenosis and the characteristics of atherosclerotic vessels in rabbits.

手術支援ロボットダヴィンチSサージカルシステムは，より複雑で細やかな手術操作を可能とし，3次元による正確な画像情報を取得できるため，より安全かつ侵襲の少ない手術を可能とするかもしれない．我々は肺癌症例に対し，このダヴィンチSサージカルシステムを使用し，肺葉切除＋縦隔リンパ節郭清を行った．症例は56歳女性．右上葉肺腺癌cT1bN0N0 stage IAに対し，右上葉切除＋縦隔リンパ節郭清を施行した．剥離操作はすべてダヴィンチシステム下に行い，術野展開，吸引操作とステープリングは助手が行った．手術時間は6時間48分，出血量は234gであった．多関節を有する器具は自由度が高く，胸腔内における剥離操作をより自然なものにする．これは，通常のVATSにおける直線的な器具での操作と比較して大きな利点であった．ダヴィンチシステムによるロボット支援は，今後のさらなるシステムの改良と相まって，これまで技術的に困難と考えられていた手術を可能とするかもしれない．

ObjectiveThe study objectives were to assess 1) postoperative satisfaction and the occurrence of compensatory sweating after endoscopic thoracic sympathetic clipping in a consecutive series of patients and 2) the reversibility of adverse effects by removing the surgical clips.MethodsBetween June 1998 and March 2006, 727 patients undergoing bilateral endoscopic thoracic sympathetic clipping for hyperhidrosis or facial blushing were prospectively followed for postoperative satisfaction and subjective compensatory sweating. The effect of removing the surgical clips was assessed in 34 patients who underwent a subsequent reversal procedure after endoscopic thoracic sympathetic clipping. Satisfaction and compensatory sweating were assessed using a visual analogue scale ranging from 0 to 10, with 10 indicating the highest degree.ResultsFollow-up was complete in 666 patients (92%). The median age was 26.9 years, and 383 (53%) were men. The level of sympathetic clipping was T2 in 399 patients (55%), T2+3 in 55 patients (8%), and T3+4 in 273 patients (38%). Median follow-up was 10.4 months (range 0–83 months). Excellent satisfaction (8–10 on visual analogue scale) was seen at last follow-up in 288 (74%) of the T2 group, 33 (62%) of the T2+3 group, and 184 (85%) of the T3+4 group. Postoperative satisfaction was significantly higher in the T3+4 group when compared with the T2 or T2+3 groups (P < .01). Severe compensatory sweating (8–10 on the visual analogue scale) was reported in 42 (13%) of the T2 group, 11 (28%) of the T2+3 group, and 17 (8%) of the T3+4 group. Postoperative compensatory sweating was significantly lower in the T3+4 group when compared with the T2 or T2+3 groups (P < .05). Thirty-four patients have subsequently undergone removal of the surgical clips after endoscopic thoracic sympathetic clipping. Follow-up was complete in 31 patients. The reasons for removal included severe compensatory sweating in 32 patients, anhydrosis of the upper limb in 4 patients, lack of improvement or recurrence of hyperhidrosis in 5 patients, and other adverse symptoms in 5 patients. The reversal procedure was done after a median time of 11.0 months (range 1–57 months) after endoscopic thoracic sympathetic clipping. The initial level of clipping was T2 in 21 patients, T2+3 in 7 patients, and T3+4 in 6 patients. There was a trend toward fewer subsequent reversal procedures in the T3+4 group when compared with the T2 or T2+3 groups (P = .06). Fifteen patients (48%) reported a substantial decrease in their compensatory sweating (5–10 on the visual analogue scale) after reversal. Thirteen patients (42%) reported that their initial hyperhidrosis or facial blushing has remained well controlled (8–10 on the visual analogue scale) after reversal. There was no significant relationship between the original level of clipping and the interval between endoscopic thoracic sympathetic clipping and the subsequent reversal and reversibility of symptoms.ConclusionWhen compared with endoscopic thoracic sympathetic clipping at the T2 or T2+3 levels, endoscopic thoracic sympathetic clipping at the T3+4 level was associated with a higher satisfaction rate, a lower rate of severe compensatory sweating, and a trend toward fewer subsequent reversal procedures. Subjective reversibility of adverse effects after endoscopic thoracic sympathetic clipping was seen in approximately half of the patients who underwent endoscopic removal of surgical clips. Although yet to be supported by electrophysiologic studies, reversal of sympathetic clipping seems to provide acceptable results and should be considered in selected patients.

Background Survival characteristics of patients who have recurrent nonsmall-cell lung cancer after surgical resection are not well understood. Little objective evidence exists to justify treatment for these patients. Methods We prospectively followed 1,361 consecutive patients with nonsmall-cell lung cancer who underwent complete surgical resection at our institution from January 1997 to December 2001. Only patients having recurrent cancer were included in the analysis. Multivariable Cox proportional hazards models were used to evaluate the effect of prognostic factors on postrecurrence survival. Results Follow-up was achieved in 1,073 patients, and recurrent cancer developed in 445. Complete information was available on 390 patients for analysis. There were 262 men and 128 women. Median age at time of recurrence was 69 years. Median time from surgical resection to recurrence was 11.5 months, and median postrecurrence survival was 8.1 months. Recurrence was intrathoracic in 171 patients, extrathoracic in 172, and a combination of both in 47. Treatments after recurrence included surgery in 43 patients, chemotherapy in 59, radiation in 73, and a combination in 96. All patients who received treatment survived longer than those who received no treatment. Preoperative chemotherapy and postoperative radiotherapy for the primary lung cancer, poor Eastern Cooperative Oncology Group Performance Status, decreased disease-free interval from initial resection to recurrence, symptoms at recurrence, and certain location of recurrence significantly decreased postrecurrence survival. Conclusions In our experience, treatment for recurrent nonsmall-cell lung cancer significantly prolongs survival. Various treatment modalities including surgery should be considered in patients with postoperative recurrent nonsmall-cell lung cancer.

In this paper, we propose information living to integrate home appliances and web services. The system has several functions which display information of web services and control home appliances. The system is controlled by natural actions which are gestures and voice in order to simple control apparatus and is assembled by three major modules which the sound recognition, the gesture recognition and a projector. We describe the entire process, the implementation and the evaluation of a prototype system.

One of the limitations of fluorodeoxyglucose-positron emission tomography (PET) for N-staging in non-small cell lung cancer (NSCLC) is false-positive results due to lymphadenitis. This study was performed to examine whether DWI can correctly identify false-positive nodes on PET in NSCLC. Both PET and DWI were performed in 157 patients before surgery, which involved dissection of 1033 nodal stations. Of the 157 patients, 26 patients had pathological N1 or N2 disease. Each nodal station was classified as positive or negative on PET and DWI according to the cutoff value determined by the receiver operating characteristic curve. Short-axis diameters of lymph nodes were measured on computed tomography. While hilar nodes did not show significant differences in the number of false-positives between PET and DWI, DWI showed fewer false-positives than PET in the mediastinum (p = 0.011). Of the 43 false-positive mediastinal nodes on PET, 35 (81 %) were negative on DWI. The mean size of the 43 false-positive nodes on PET was 9 ± 1 mm, which was significantly larger than mean size of 7 ± 3 mm of the 24 false-positive nodes on DWI (p = 0.002). DWI can correctly identify false-positive nodes on PET in the mediastinum. The larger size of false-positive nodes on PET could be due to enlargement by lymphadenitis.

Sentinel node identification using indocyanine green (ICG) is not only simpler, but also more cost-effective, than using radioisotope tracers. We herein examined the utility and pitfalls of sentinel node (SN) identification using ICG during segmentectomy in patients with cT1N0M0 non-small cell lung cancer (NSCLC).ICG was injected around the tumor after thoracotomy, followed by segmentectomy and lymph node dissection, in 135 patients with cT1N0M0 NSCLC. The dissected nodes were examined using an ICG fluorescence imaging system.SNs could be identified in 113 patients (84 %). The mean number of SNs was 2.3 ± 1.3. The percentages of being an SN were 57 % for both stations #12 and #13, which was significantly higher than the 18 % for #10 and 22 % for #11 (p 0.001). Fourteen patients had N1 or N2 disease. Of these, the SNs were true positive (i.e., SNs contained metastasis) in 11 patients (79 %) and false negative (i.e., SNs did not contain metastasis, while non-SNs contained metastasis) in three patients (21 %). Of the three patients with false-negative results, all non-SNs containing metastases were at station #12 or #13.While ICG makes it simple to identify SNs during segmentectomy for cT1N0M0 NSCLC, stations #12 and #13 should be submitted for frozen sections along with the identified SNs to avoid missing true SNs.

While outcome research in lung cancer has focused mainly on short-term survival and quality of life (QoL), information on long-term (ie, > 5 years postdiagnosis) lung cancer survivorship remains limited. This review addresses the epidemiologic significance of long-term lung cancer (LTLC) survivors, summarizes the current knowledge on their health and QoL, and suggests areas for further research in LTLC survivorship. Based on a small body of literature, lung cancer survivors do not experience the same quantity and QoL as their age-matched peers or as survivors of other cancers. Survival among 5-year survivors of lung cancer relative to the general US population with the same demographic characteristics is approximately 60%, and lung cancer survivors score lowest in health utility among long-term survivors of other cancers. Approximately one-quarter of long-term lung cancer (LTLC) survivors were significantly restricted in physical ability or reported significant depressive symptoms. There is a need to identify and intervene with subgroups of survivors who are at an elevated risk of premature death and diminished QoL. Lung cancer-specific survival alone does not reflect the overall illness burden in LTLC survivors. Patient care in lung cancer survivors should be continuous and comprehensive in considering multiple causes of health deterioration. Multidisciplinary research in epidemiologic, clinical, and basic science approaches is warranted to further our knowledge base for optimal long-term management and to develop the necessary intervention strategies among LTLC survivors.

Objective— It has become clear that von Willebrand factor (vWF) plays important roles in platelet adhesion and aggregation under high blood-flow velocity conditions observed in stenotic atherosclerotic arteries. However, its roles in thrombus formation in vivo on diseased arteries have not been fully understood. We examined the contribution of vWF to thrombus formation and subsequent intimal growth by using a repeated balloon-injury model in rabbits. Methods and Results— Rabbit iliac arteries 4 weeks after a first balloon injury showed 37% luminal stenosis by neointimal growth, and blood velocity increased by 2.1 times compared with that of uninjured arteries. The second balloon injury induced fibrin-rich thrombus formation on the injured neointima. Intravenous administration of a monoclonal antibody against vWF (AJW200, 1.0 mg/kg body weight) remarkably prevented botrocetin-induced platelet aggregation ex vivo for 2 days; moreover, thrombus formation, cell proliferation, and subsequent neointimal growth were significantly reduced at 30 minutes, 5 days, and 4 weeks, respectively, after the second balloon injury. Conclusions— These results indicate that vWF plays a potent role in fibrin-rich thrombus formation on the neointima under high blood-flow velocity conditions. Inhibition of plasma vWF activity might be effective for the reduction of thrombus formation and/or subsequent neointimal development after coronary interventions.

In this paper, we propose a system to superpose information of web services into living space. The system is controlled by natural actions which are gestures and voice in order to simple control apparatus. The system is assembled by three major modules which the sound recognition, the gesture recognition and a projector. We describe the entire process, the implementation and the evaluation of a prototype system, and confirmed an usefulness of proposal system by using a questionnaire.

To examine whether diffusion-weighted magnetic resonance imaging (DWI) is as useful as fluorodeoxyglucose positron emission tomography (FDG-PET) for discriminating between malignant and benign pulmonary nodules measuring less than 3 cm in size, as well as for predicting tumor aggressiveness.PET and DWI were carried out on 87 pulmonary nodules measuring from 1 to 3 cm in size (66 NSCLCs and 21 benign nodules). The signal intensity (SI) of DWI was measured by the contrast ratio (CR) between the lesions and spinal cord, i.e., SI-CR. The maximum standard uptake value (SUV) of PET was measured by CR between the lesions and contralateral lung, i.e., SUV-CR.DWI and PET showed sensitivities of 0.86 and 0.71, and specificities of 0.90 and 0.81, respectively. While there was no significant difference in the specificity between the two, DWI showed a significantly higher sensitivity than PET (p = 0.013). While the difference in the sensitivity was significant in lung adenocarcinoma (p = 0.012), there was no difference in the other histological types. Both the SI-CR and SUV-CR were significantly higher in the tumors with either histological invasiveness or lymphatic metastasis than in those without.DWI is thus considered to be useful, not only to diagnose NSCLCs, especially in lung adenocarcinoma, but also for predicting tumor aggressiveness as well as FDG-PET.

We report the case of a 63-year-old woman with adenoid cystic carcinoma of the lower trachea treated by resection of 11 of the 18 cartilaginous rings (61 %) of the total length. The little remaining membranous portion of the carina was sewn up to create a margin for anastomosis. The anastomotic sites could be approximated by the mobilization of the cervical trachea and the left main bronchus, pulling across the traction sutures, and anteflexion of the neck. The patient’s postoperative course was uneventful without any complications associated with anastomosis. Because both the proximal and distal margins showed microscopic tumors, radiation therapy was performed with 50 Gy 2 months after surgery. The patient has a good social life without recurrence 20 months after surgery.

Objective: The effect of terminal warm blood cardioplegia was analyzed in 191 patients undergoing either coronary artery bypass grafting (CABG) or prosthetic heart valve replacement between Jan. 1990 and Dec. 1995.Methods: Patients were subdivided into 3 historical cohorts based on the method of myocadial protection: Group A (n = 106), multidose cold crystalloid glucose-potassium cardioplegia alone; Group B (n = 37), cold crystalloid glucose-potassium cardioplegia plus terminal warm blood cardioplegia, Group C (n = 48), cardioplegia induction with cold crystalloid glucose-potassium cardioplegia, maintenance with multidose cold blood cardioplegia, and terminal warm blood cardicplegia.Results: Of patients undergoing CABG, 5.6% of group A, 70.4% of group B, and 86.7% of group C spontaneously resumed sinus rhythm after aortic declamping, as did 9.1% of group A, 60.0% of group B, and 55.6% of group C of patients undergoing prosthetic heart valve replacement. The incidence of spontaneous recovery was significantly better in groups B and C than in group A (p < 0.05). Over 90% of patients without terminal warm blood cardioplegia developed ventricular fibrillation or tachycardia requiring electrical cardioversion (p ≪ 0.05). Postoperatively, patients without terminal warm blood cardioplegia required temporary epicardial pacing more frequently than those with terminal warm blood cardioplegia (p < 0.05). In patients undergoing prosthetic heart valve replacement, groups B and C, the incidence of postoperative atrial fibrillation was significantly lower than in group A.Conclusion: Terminal warm blood cardioplegia thus promoted better postoperative electrophysiological cardiac recovery.

緊急手術により救命し得た鈍的外傷性胸部大動脈破裂の4例を経験した. 4例とも交通事故で受傷し, 胸部大動脈峡部の破裂であった. 症例1は19歳の男性でIV-DSAのみで, 症例2は41歳の女性でIV-DSAと造影CTで, 症例3の32歳の男性と症例4の50歳の男性は造影ヘリカルCTのみで胸部大動脈破裂と診断し, 緊急手術を施行した. 症例1は一時的バイパス, 症例2は肺動脈-大腿動脈バイパス, 症例3と4は左心バイパスを補助手段に用い, 全例自己回収装置を併用した. 症例2は端々吻合で再建したが, 他の3例は人工血管で置換した. 全例術後対麻痺の合併もなく回復した. 鈍的外傷性胸部大動脈破裂の早期診断には造影ヘリカルCTは他の合併損傷の有無や程度を知るためにも非常に有用であり, 術中の経食道心エコーも有用であった.

患者は東南アジア渡航歴の多い58歳の男性である. 軽度耐糖能低下を指摘されていた. 平成6年11月から平成7年7月に2度の東南アジア渡航を経験し, 渡航先で高熱を発し, 帰国後肺炎で入院した. 腹部CTで傍腎動脈部に非定型の腹部大動脈瘤がみられ, 遷延する発熱の原因として細菌性腹部大動脈瘤が疑われた. 経過観察中に, 発熱に引き続いて, CTで瘤の急速な増大を認めたため, 平成8年3月21日, 動脈瘤切除人工血管置換術を施行した. 術後12日目に発熱し, 血液培養で Burkholderia pseudomallei を検出した. メリオイドーシスと診断し, 感受性試験に基づき抗生剤の長期投与を行った. 術後55日目に感染の再燃徴候なく退院した.