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Effect of Inhaled Tiotropium as the Perioperative Management of Patients Undergoing Pulmonary Resection for Primary Lung Cancer

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Journal of Cancer Therapy 2014年第9期5卷 845-859页

作者： takanori Ayabe Masaki Tomita Eiichi Chosa Katsuya Kawagoe Kunihide Nakamura Department of Surgery II Faculty of Medicine University of Miyazaki Miyazaki Japan

Background: The purpose of this study was to evaluate the effectiveness of perioperative tiotropium therapy for patients undergoing pulmonary resection for primary lung cancer. The short-term tiotropium effect was investigated by perioperative pulmonary function and “lung age”. Methods: The fifty-five patients who underwent a lobectomy and had tiotropium treatment available from October 2007 through May 2009 were the subjects. The patients were divided into 3 groups according to their airway limitation such as Chronic Obstructive Pulmonary Disease (COPD) or a history of smoking;those with COPD (%FEV1 ≤70%, C-group, n = 22), smokers (%FEV1 > 70%, S-group, n = 10) and non-smokers (%FEV1 > 70%, N-group, n = 23). As the bronchodilator groups, the C- and S-groups received inhaled tiotropium bromide (18 μg once daily) for 1 week before surgery until at least 3 weeks after surgery without interruption, and as a control, the N-group had no treatment. The preoperative baselines, the predicted postoperative values, and the actual postoperative ones were measured by the pulmonary function test. The changed rates were calculated and denoted as ΔVC, ΔFEV1, ΔVC%, and ΔFEV1/FVC, from the baseline of the predicted postoperative values. The mean “real age” and “lung age” were calculated. Results: In the S-group, the parameters of ΔVC, ΔFEV1, ΔVC%, and ΔFEV1/FVC significantly increased compared to those of the N-group. In the C-group, the increased extents of ΔFEV1 and ΔFEV1/FVC were lower compared to those in the S-group (not significant). In the N-group, the parameters of ΔVC, ΔFEV1, and ΔVC% decreased. The postoperative “lung age” and “real age” were increased to 29.5 ± 18.0 year-old in the C-group, 25.8 ± 18.0 in the S-group, and 24.7 ± 17.0 in the N-group. Lung resection affected the “lung age”;the aging was a 28.9 ± 12.7 year-old increase in the N-group. In the C- and S-group, the “lung age” was a 14-year-old increase. The effect of tiotropium treatment affected the “lung age”

关键词： Tiotropium Pulmonary Function Lung Age Lobectomy Lung Cancer

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Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata

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Gastroenterology Report 2021年第6期9卷 543-551页

作者： Masayasu Horibe Eisuke Iwasaki Juntaro Matsuzaki Fateh Bazerbachi Tetsuji Kaneko Kazuhiro Minami Seiichiro Fukuhara Tatsuhiro Masaoka Naoki Hosoe Yuki Ogura Shin Namiki Yasuo Hosoda Haruhiko Ogata takanori Kanai Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineTokyoJapan Division of Gastroenterology and Hepatology Mayo ClinicMNUSA Interventional Endoscopy Program CentraCareSt Cloud HospitalMNUSA Department of Clinical Trial Tokyo Metropolitan Children’s Medical CenterTokyoJapan Teikyo Academic Research Center Teikyo UniversityTokyoJapan Center for Diagnostic and Therapeutic Endoscopy Keio University HospitalTokyoJapan Department of Gastroenterology and Hepatology Tokyo Metropolitan Tama Medical CenterTokyoJapan Division of Gastroenterology Department of Internal MedicineNational Hospital Organization Saitama National HospitalSaitamaJapan

Background Guidelines recommend that all patients with upper gastrointestinal bleeding(UGIB)undergo endoscopy within 24 *** is unclear whether a subgroup may benefit from an urgent *** aimed to evaluate the influence of endoscopic hemostasis and urgent endoscopy on mortality in UGIB patients with high-risk stigmata(HRS).Methods Consecutive patients with suspected UGIB were enrolled in three Japanese hospitals with a policy to perform endoscopy within 24 *** primary outcome was 30-day *** hemostasis and endoscopy timing(urgent,6h;early,>6h)were evaluated in a regression model adjusting for age,systolic pressure,heart rate,hemoglobin,creatinine,and variceal bleeding in multivariate analysis.A propensity score of 1:1 matched sensitivity analysis was also *** HRS were present in 886 of 1966 patients,and 35 of 886(3.95%)patients *** urgent-endoscopy time(n=769)was 3.0h(interquartile range[IQR],2.0–4.0 h)and early endoscopy(n紏117)was 12.0h(IQR,8.5–19.0 h).Successful endoscopic hemostasis and urgent endoscopy were significantly associated with reduced mortality in multivariable analysis(odds ratio[OR],0.22;95%confidence interval[CI],0.09–0.52;P=0.0006,and OR,0.37;95%CI,0.16–0.87;P=0.023,respectively).In a propensity-score-matched analysis of 115 pairs,adjusted comparisons showed significantly lower mortality of urgent vs early endoscopy(2.61%vs 7.83%,P<0.001).Conclusions A subgroup of UGIB patients,namely those harboring HRS,may benefit from endoscopic hemostasis and urgent endoscopy rather than early endoscopy in reducing *** triage scores that predict the presence of such lesions is important.

关键词： UGIB urgent endoscopy non-variceal bleeding variceal bleeding HARBINGER GBS upper gastrointestinal bleeding

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Pneumonectomy of Primary Pulmonary Angiosarcoma with Malignant Effusion and Intrapleural Hypotonic Hyperthermic Chemotherapy: Case Report and Review of the Literature

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Journal of Cancer Therapy 2015年第2期6卷 227-236页

作者： takanori Ayabe Masaki Tomita Eiichi Chosa Katsuya Kawagoe Kunihide Nakamura Department of Surgery II Faculty of Medicine University of Miyazaki Miyazaki Japan

Background: Primary pulmonary angiosarcoma is extremely rare and the prognosis is very poor. We report a combination therapy of pneumonectomy and intrapleural hypotonic hyperthermic chemotherapy (IPHHC). Case report: A 48-year-old male with exertional dyspnea was found to have a left massive pleural effusion. Bronchoscopic examination displayed endobronchial stenosis of the left lower bronchus B8,9,10?and diagnosed with pulmonary angiosarcoma. Chest computed-tomographic scanning revealed a 5-cm mass in the left inferior lobe, which invaded the left upperbronchus. Intrapleural dissemination and malignant pleural effusion were also suspected (cT3N1M1a,?c-stage IV). As a palliative initial therapy, we performed a pneumonectomy. On the 7th?postoperative day, under general anesthesia, we performed video-assisted IPHHC (43°C, 60 min, 200 mg/m2?of CDDP). After the IPHHC, there was no major adverse event (more than Grade 3) during the postoperative course. Histological examination of the resected specimen revealed a highly-cellular growth of atypical spindle cells with a storiform pattern. By immunohistochemical testing, the tumor cells stained positive for markers including CD31 and the factor VIII related antigen, and the diagnosis of pulmonary angiosarcoma was made. No adjuvant chemoradiotherapy was given, and the postoperative clinical course was uneventful. Although there had been a recurrence in the chest wall, the patient eventually died twenty-one months later. Conclusion: As a new therapeutic option, we performed IPHHC after the pneumonectomy for an advanced pulmonary angiosarcoma with malignant pleural effusion. Although the patient had a recurrence in the chest wall, he had a reasonable postoperative outcome, that is, he returned to a work, retained a good quality of life and had a longer survival in spite of the poor prognosis of the pulmonary angiosarcoma.

关键词： Pneumonectomy Intrapleural Hypotonic Hyperthermic Chemotherapy Pulmonary Angiosarcoma

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Elasticity Mapping Analysis of Apical Cell Periphery Actin Structures of Normal Fibroblasts and Cervical Cancer Cells

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Journal of Analytical Sciences, Methods and Instrumentation 2013年第2期3卷 124-129页

作者： takanori Kihara Takuji Yoshida Seyed M. Ali Haghparast Jun Miyake Department of Mechanical Science and Bioengineering Graduate School of Engineering Science Osaka University Osaka Japan

The cell mechanical features are largely regulated by actin cytokeleton. By analyzing the mechanical features, it is possible to evaluate the characteristics of the complicated actin cytoskeleton in diverse cell types. In this study, we examined the sub-membrane mechanical structures of normal fibroblasts TIG-1 cells, and cervical cancer Hela cells using local elasticity mapping method of atomic force microscope. Especially we aimed at clarifying the regulatory mechanisms of sub-membrane actin structures in these cells by activation of actomyosin formation using calyculin A. This technique revealed that TIG-1 and Hela cells bore clearly different sub-membrane mechanical structures. TIG-1 cells had aligned stiff filamentous structures, whereas Hela cells had crooked and relatively soft filaments. The surface stiffness of TIG-1 cells increased slightly by actomyosin formation due to stiffness increase of the aligned filamentous structures. On the other hand, the surface stiffness of Hela cells increased by actomyosin formation due to upregulation of the apical actin filaments. Therefore, the structural and regulatory differences of the apical actin filaments could be demonstrated by atomic force microscopy elasticity mapping analysis.

关键词： Atomic Force Microscopy Actin Cytoskeleton Elasticity Mapping Analysis Mechanical Structure

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Randomized Control Trial on the Efficacy of Dual Bronchodilator of Glycopyrronium/Indacaterol for Lung Cancer Surgery: Improvement of Postoperative Pulmonary Function in Both Patients with Chronic Obstructive Pulmonary Disease and Normal Pulmonary Function

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Surgical Science 2020年第6期11卷 133-165页

作者： takanori Ayabe Masaki Tomita Ryo Maeda Koichiro Ochiai Tomoka Hamahiro Kunihide Nakamura Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

Background: A dual bronchodilator, long-acting anticholine drugs (glycopyrronium, LAMA) and the long running β-2 stimulant (indacaterol, LABA), are effective for the treatment of chronic obstructive pulmonary disease (COPD). To evaluate the effectiveness of the perioperative intervention of LAMA/LABA, a randomized prospective trial was performed for the lung cancer patients receiving a lobectomy with normal pulmonary function and COPD. Methods: Based on the results of the preoperative pulmonary function test, 25 patients were diagnosed with COPD [% forced expiratory volume in 1 second (%FEV1) 1), who were randomized into two groups, the LAMA/LABA (n = 19) and the Control group (n = 18). The LAMA/LABA and the COPD groups daily received inhaled LAMA (50 μg) and LABA (110 μg) for 1 week before surgery and for least 4 weeks after surgery. The Control group had no treatment of the dual bronchodilator. The actual values were measured during the perioperative pulmonary function at three points of the preoperative baseline, the postoperative 1 week and the postoperative 4 weeks;these changes and changed ratios were then calculated. The patient-reported outcomes of the quality of life (PRO-QOL) were evaluated by the Cancer Dyspnea Scale (CDS), the COPD assessment test, and the St. George’s Respiratory Questionnaire. Results: Regarding the value of FEV1 at the baseline, that in the LAMA/LABA group was 79.2% ± 6.4% and that in the Control group was 80.9% ± 6.4%, but that in the COPD groups was 57.9% ± 8.7%;there was a significant difference between the COPD and the Control group (p 1 value in the Control group was 1.3 ± 0.5 L and that in the LAMA/LABA group was 1.7 ± 0.5 L. On the other hand, that in the COPD group was 1.7 ± 0.5 L

关键词： Glycopyrronium/Indacaterol Pulmonary Function Lobectomy Lung Cancer Randomized Control Trial

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Unexpected Intraoperative Resecting of Common Trunk of Pulmonary Vein Resulted in an Incidental Pneumonectomy from Left Upper Lobectomy

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Open Journal of Thoracic Surgery 2016年第3期6卷 18-24页

作者： takanori Ayabe Masaki Tomita Naohiro Nose Eiichi Chosa Kazuhiro Higuchi Kunihide Nakamura Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-year-old male with suspected left lung cancer (lt.U, S3, 20 × 20 mm, P0, E0, D0, PM0, N0, T1aN0M0, c-stage IA). Preoperatively, we did not recognize the existence of the common trunk of the left pulmonary vein. After the open thoracotomy, due to a severe intrathoracic adhesion, we omitted releasing the adhesion of the lower lobe. We did not exactly confirm the location of the inferior pulmonary vein (IPV). After cutting the interlobular pulmonary arterial branchies, we resected the superior pulmonary vein (SPV) using auto sutures. After division of the lung parenchyma and incomplete fissures using auto sutures, we intended to resect the upper bronchus. However, we could not find an IPV at the normal IPV site. A thin IPV was found to be returned to the peripheral site of the resected SPV. The SPV and IPV formed a common trunk at the normal site of the SPV. Although we considered reconstructing the resected common trunk, we finally made a decision of performing an incidental pneumonectomy in order to prevent any postoperative complications on the reconstruction of the IPV such as thrombus occlusion at the anastomosis site and venous return congestion. Retrospectively, we confirmed the preoperative images of the computed tomographic scanning, which showed a narrow IPV that returned to the peripheral site of the SPV. It is important to confirm both accurate locations of the SPV and IPV when performing a lobectomy.

关键词： Incidental Pneumonectomy Common Trunk Lobectomy Unexpected Lung Cancer

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Severity of Chronic Obstructive Pulmonary Disease and the Prognosis of Non-Small Cell Lung Cancer Patients

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Advances in Lung Cancer 2016年第2期5卷 13-20页

作者： Masaki Tomita takanori Ayabe Eiichi Chosa Naohiro Nose Kazuyo Tsuchiya Kunihide Nakamura Department of Thoracic and Breast Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan Department of Cardiovascular Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

Objectives: We retrospectively analyzed whether the severity of Chronic Obstructive Pulmonary Disease (COPD) affected disease-specific survival in Non-Small-Cell Lung Cancer (NSCLC) patients after surgical resection. Methods: We enrolled 210 NSCLC patients who underwent curative surgery between 2009 and 2011. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Results: A total of 55 patients were diagnosed with COPD. The 5-year disease-specific survival of patients with COPD was not different compared with that of patients without COPD. Among the COPD patients, 40 were classified as GOLD 1, 13 as GOLD 2, and 2 as GOLD 3. Although the number of patients with GOLD 2 - 3 was small, the 5-year disease-specific survival of patients with GOLD 2 - 3 was significantly poorer. We found the prognostic significance of GOLD 2 - 3 in univariate analysis, but failed to find this in multivariate analysis. Conclusions: There is a possibility that the severity of COPD might be useful to predict the prognosis of NSCLC patients. Further studies with large study population are needed.

关键词： Non-Small Cell Lung Cancer COPD GOLD Prognosis

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Implementation of Resilience Engineering for Thoracic Surgery. Reconciling Work-as-Imagined and Work-as-Done

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Surgical Science 2020年第9期11卷 257-273页

作者： takanori Ayabe Masaki Tomita Ryo Maeda Manabu Okumura Kunihide Nakamura Kazue Nakajima Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan Department of Patient Safety Management University of Miyazaki Hospital Miyazaki Japan Division of Cardiovascular Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan Department of Clinical Quality Management Osaka University Hospital Osaka Japan

Background: The Work-As-Imagined (WAI) is a plan that is expected to be performed before surgery, and the Work-As-Done (WAD) is the result of work actually done. In order to perform safe and high-quality surgery for the individual surgeon, the surgical team, and hospital organization as a system, we have to reconcile the WAI and the WAD in resilience engineering for the real world of surgical healthcare. Objective: Based on the resilient healthcare theory, we would like to clarify the actual way of reconciling the WAI and WAD in surgery. Material and Methods: As a typical model of thoracic surgery, we use a lobectomy case for lung cancer. We describe a surgeon’s WAI and WAD, and we explain the anticipating, monitoring, responding, and learning based on the resilient healthcare theory. We reveal the gaps between the WAI and WAD during an operation, we consider the surgeon’s thinking and actual performance, and we describe the actual way of reconciling the WAI and WAD for the surgeon and surgical team. Outcomes: We described three scenes in the operating room, which are 1) by individual surgeon: adjustment for intrathoracic adhesion;2) by surgical team: adjustment for pulmonary artery bleeding;and 3) by surgical team with multi-professionals in the operating room: adjustment for life threatening pulmonary artery critical bleeding. Conclusion: In order to implement a resilient healthcare theory in everyday surgical work, it is important that 1) learning of incidents and the experience of doing well for unexpected events as lessons, and 2) constructing a circulation mechanism of anticipating, monitoring, responding, and learning.

关键词： Work-as-Imagined (WAI) Work-as-Done (WAD) Surgery Resilience Engineering

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Neurological Changes after Surgical Intervention for Intrinsic Cavernous Anigoma

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Open Journal of Modern Neurosurgery 2012年第4期2卷 63-65页

作者： Takafumi Nishizaki Norio Ikeda Shigeki Nakano Tomomi Okamura takanori Sakakura Department of Neurosurgery Ube Industries Central Hospital Nishikiwa Ube Yamaguchi Japan

We report neurological changes and circulatory and pulmonary symptoms after surgical intervention in cases of brainstem cavernous angioma. Eight patients who underwent surgical intervention for brainstem cavernous angiomas were retrospectively reviewed. Two of 4 patients who underwent total removal of the mass showed marked resolution of the preoperative signs including IX nerve palsy, MLF syndrome, cerebellar sign and homonymous hemianopsia, and two patients who underwent partial removal of the lesions had permanent neurological deficits. Inadequate excision results in not only recurrence of hemorrhage, but also postoperative neurological deterioration. Bradycardia can occur during the surgical intervention, and careful monitoring is mandatory for a couple of days after operation to detect circulatory and pulmonary failure such as atrial flutter.

关键词： Surgical Intervention Brainstem Cavernous Angioma Postoperative Neurological Changes Circulatory Pulmonary Symptoms

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Intention Formation Process for the Use of Tracheostomy and Invasive Ventilation in Patients with Amyotrophic Lateral Sclerosis

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Open Journal of Nursing 2017年第10期7卷 1101-1114页

作者： Woojung Shin Tomoko Inoue Yuki Nakayama takanori Yokota Hide Yoshino Makoto Tanaka Department of Critical and Invasive-Palliative Care Nursing Graduate School of Health Care Sciences Tokyo Medical and Dental University Tokyo Japan National College of Nursing Tokyo Japan ALS Nursing Care Project Tokyo Metropolitan Institute of Medical Science Tokyo Japan Department of Neurology and Neurological Science Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan Yoshino Neurology Clinic Chiba Japan

Background: Little is known about the intention formation process regarding the use of tracheostomy and invasive ventilation (TIV) in amyotrophic lateral sclerosis (ALS) patients in the course of disease progression. Objective: To clarify the intention formation process in the use of TIV in ALS patients for the purpose of providing decision-making support. Methods: We conducted a follow-up study of 14 patients using semi-structured interviews, participant observation, and medical records review. Results: The patients’ various intentions regarding the use of TIV were formed as their symptoms progressed (e.g., declining motor, swallowing, and respiratory functions). Other factors influencing their decision were their considerations, such as their ability to communicate after receiving TIV treatment, the degree of support they would receive from professionals after TIV treatment, palliative care for physical distress, value of life after TIV treatment, and to what degree they would be a burden on their families. Conclusion: Patients’ intentions regarding the use of TIV were diverse and changeable. The decision of whether or not to use TIV was made out of conviction as well as considering individual experiences of symptom progression and quality of life after TIV use.

关键词： Amyotrophic Lateral Sclerosis Tracheostomy and Invasive Ventilation Decision-Making Case Study Research Design Qualitative Approach

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