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Maeda H.,National Hospital Organization Toneyama Hospital | Matsumura A.,Kinki chuo Chest Medical Center | Kawabata T.,NHO Okinawa Hospital | Suito T.,NHO Ibaraki Higashi Hospital | And 4 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2012

OBJECTIVES: An adenosquamous carcinoma (ASC) of the lung is a relatively rare tumor. In this multi-institutional cohort study, we tested the hypothesis that an ASC exhibits more aggressive clinical behavior as compared to adenocarcinoma (AC) and squamous cell carcinoma (SC). METHODS: This retrospective cohort study used a prospective database produced by the Japan National Hospital Organization Study Group for Lung Cancer over a 7-year period (operations from 1997 to 2003, follow-up data until March 2010). During that period, 4668 cases underwent an operation for various types of primary malignant lung tumors. When a sample from a tumor comprised at least 20% each of SC and AC, the case was classified as ASC. Pathologic staging was done according to the seventh edition of the International Union against Cancer (UICC) Tumor Node Matastasis (TNM) classification of malignant tumors. RESULTS: We identified 114 patients with ASC (2.4%), 2993 withAC (64.2%), and 1369 with SC (29.3%). Kaplan-Meier survival curves for all stage cases, p-stage IA, IB, and IIIA tumors indicated that ASC cases had the least favorable survival. The 5-year survival rates for all stage cases were 23.3% for ASC, 58.0% for AC (p < 0.0001), and 40.8% for SC (p < 0.0001). The 5-year survival rates for p-stage IA were 42.0%for ASC, 81.8% for AC (p = 0.0005), and 63.4% for SC not significant (NS), while those for p-stage IB were 19.3%, 65.3% (p = 0.0024), and 46.8% (NS), respectively, and those for p-stage IIIA were 17.8%, 24.8% (p = 0.0154), and 18.8% (NS), respectively. There was a tendency for greater survival differences between ASC and AC in earlier tumor stages. A step-wise multivariable model demonstrated that sex, age, performance status, histology, tumor size, p-stage, operative method,and neoadjuvant/adjuvant therapy were independent prognostic factors. CONCLUSION: ASC of the lung is more aggressive than AC and SC. The decreased survival of patients with ASC as compared with either of those single histology tumors suggests the need for a clinical trial of adjuvant chemotherapy that includes early-stage patients. © The Author 2011. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Source


Nojiri T.,National Hospital Organization Toneyama Hospital
General thoracic and cardiovascular surgery | Year: 2011

Postoperative atrial fibrillation is the most common complication encountered during the early postoperative period following a pulmonary resection procedure. Landiolol is a newly developed, ultrashortacting, β-adrenoceptor antagonist. The objective of the present study was to evaluate the efficacy and safety of low-dose landiolol for postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer. Of 553 patients who underwent an elective pulmonary resection procedure for lung cancer at National Toneyama Hospital from January 2005 to December 2009, this analysis involved 30 consecutive patients who developed atrial fibrillation after surgery and needed treatment. These patients were divided into two groups: the landiolol group (n = 15) and the historical control group (treated with a combination of verapamil and digoxin, n = 15). Hemodynamic changes before and 30 min, 2 h, and 12 h after medication, the time required to restore sinus rhythm, and adverse events were evaluated. There were no significant differences between the two groups regarding blood pressure before and after medication. Heart rate was reduced immediately in both groups after medication and was significantly lower in the landiolol group than in the control group. The time to restore sinus rhythm was significantly shorter in the landiolol group than in the control group (8.1 ± 11.0 h vs. 23.0 ± 26.0 h, P < 0.05). In none of the subjects with the landiolol infusion was it discontinued because of side effects. Low-dose landiolol can be effective quickly and used safely in patients who develop atrial fibrillation after pulmonary resection for lung cancer. Source


Suenaga K.,Hyogo College of Medicine | Lee K.-Y.,University of Florida | Nakamori M.,Osaka University | Nakamori M.,University of Rochester | And 10 more authors.
PLoS ONE | Year: 2012

Myotonic dystrophy type 1 (DM1) is a multi-systemic disorder caused by a CTG trinucleotide repeat expansion (CTG exp) in the DMPK gene. In skeletal muscle, nuclear sequestration of the alternative splicing factor muscleblind-like 1 (MBNL1) explains the majority of the alternative splicing defects observed in the HSA LR transgenic mouse model which expresses a pathogenic range CTG exp. In the present study, we addressed the possibility that MBNL1 sequestration by CUG exp RNA also contributes to splicing defects in the mammalian brain. We examined RNA from the brains of homozygous Mbnl1 ΔE3/ΔE3 knockout mice using splicing-sensitive microarrays. We used RT-PCR to validate a subset of alternative cassette exons identified by microarray analysis with brain tissues from Mbnl1 ΔE3/ΔE3 knockout mice and post-mortem DM1 patients. Surprisingly, splicing-sensitive microarray analysis of Mbnl1 ΔE3/ΔE3 brains yielded only 14 candidates for mis-spliced exons. While we confirmed that several of these splicing events are perturbed in both Mbnl1 knockout and DM1 brains, the extent of splicing mis-regulation in the mouse model was significantly less than observed in DM1. Additionally, several alternative exons, including Grin1 exon 4, App exon 7 and Mapt exons 3 and 9, which have previously been reported to be aberrantly spliced in human DM1 brain, were spliced normally in the Mbnl1 knockout brain. The sequestration of MBNL1 by CUG exp RNA results in some of the aberrant splicing events in the DM1 brain. However, we conclude that other factors, possibly other MBNL proteins, likely contribute to splicing mis-regulation in the DM1 brain. © 2012 Suenaga et al. Source


Izawa K.,National Hospital Organization Toneyama Hospital
Nihon rinsho. Japanese journal of clinical medicine | Year: 2011

As the incidence of tuberculosis in Japan decreases, osteoarticular tuberculosis becomes relatively rare. Therefore, it is often overlooked or misdiagnosed that leads to cryptic aggravation of the disease. On the other hand, because of population aging in Japan, degenerative conditions such as compression vertebral fracture or osteoarthritis should be considered as differential diagnoses of osteoarticular tuberculosis. In addition, we should beware of extra-pulmonary tuberculosis in the patients who undergo biological agent therapy for rheumatoid arthritis that has been advanced drastically in recent years. Surgical treatment for osteoarticular tuberculosis is still an essential part of its treatment in order to achieve early rehabilitation and rapid healing of the lesion. Source


Nojiri T.,National Hospital Organization Toneyama Hospital | Nojiri T.,Osaka University | Inoue M.,Osaka University | Maeda H.,National Hospital Organization Toneyama Hospital | And 5 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2013

OBJECTIVES: Lung cancer patients with chronic obstructive pulmonary disease are at an increased risk of respiratory and cardiovascular complications after pulmonary resection. The objective of the present study was to evaluate the clinical effects of low-dose human atrial natriuretic peptide (hANP) on postoperative cardiopulmonary complications in untreated chronic obstructive pulmonary disease patients undergoing lung cancer surgery. METHODS: Of 824 patients who underwent an elective pulmonary resection procedure for lung cancer in two specialized thoracic centres between 2008 and 2011, 202 consecutive patients who had airflow limitation before surgery were included in this retrospective study. The results were compared between patients who did and those who did not receive hANP during the perioperative period. The primary endpoint was the incidence of postoperative cardiopulmonary complications. Postoperative haemodynamics, white blood cell (WBC) counts and C-reactive protein (CRP) levels were also examined. Furthermore, propensity score matching analysis was used to reduce treatment selection bias from patient characteristics. RESULTS: The incidence of postoperative cardiopulmonary complications was significantly lower in the hANP group than in the control group (14 vs 36%, P < 0.01). The propensity score matching analysis confirmed the significantly decreased frequency of postoperative cardiopulmonary complications in the hANP group. Patients in the hANP group showed significantly lower WBC counts and serum CRP levels postoperatively. CONCLUSIONS: Treatment with hANP during the perioperative period had a prophylactic effect against postoperative cardiopulmonary complications in chronic obstructive pulmonary disease patients undergoing lung cancer surgery. Trial registration number: JPRN-UMIN000003631. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. Source

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