Explore the vast range of titles available.

BackgroundIn clinical practice, various devices are implanted into the body for medical reasons. As X-ray fluoroscopy is necessary to visualize medical devices implanted into the body, the development of a less-invasive visualization method is highly desired. This study aimed to investigate the clinical applicability of our novel solid material that emits near-infrared fluorescence.MethodsWe developed a solid resin material that emits near-infrared fluorescence. This material incorporates a near-infrared fluorescent pigment, with quantum yield ≥ 20 times than that of indocyanine green. It can be sterilized for medical treatment. This resin material is designed to be molded into a catheter and inserted into the body with an endoscope clip. In this preclinical experiment using a swine model, the resin material was embedded into the body of the swine and visualized with a near-infrared fluorescence camera system.ResultsEndoscopic clips were placed in the mucosa of the stomach, esophagus, and large intestine, and the indwelling ureteral catheters were successfully visualized by near-infrared fluorescence laparoscopy.ConclusionsWe confirmed the tissue permeability of the fluorescence emitted by our novel near-infrared fluorescent material and the possibility of its clinical application. This material may allow visualization of devices embedded in the body.

Previous studies suggest that lower BMI is a risk factor for intraoperative core hypothermia. Adipose tissue has a high insulation effect and is one of the major explanatory factors of core hypothermia. Accordingly, determining the respective influence of visceral and subcutaneous fat on changes in core temperature during laparoscopic surgery is of considerable interest. We performed a prospective study of 104 consecutive donors who underwent laparoscopic nephrectomy. Temperature data were collected from anesthesia records. Visceral and subcutaneous fat were calculated by computed tomography (CT) or ultrasound. For ultrasound measurements, preperitoneal fat thickness was used as an index of visceral fat. Multiple linear regression analysis was performed at 30, 60, and 120 minutes after the surgical incision to identify the predictive factors of body temperature change. The potential explanatory valuables were age, sex, BMI, visceral fat, and subcutaneous fat. BMI (β = 0.010, 95%CI: 0.001-0.019, p = 0.033) and waist-to-hip ratio (β = 0.424, 95%CI: 0.065-0.782, p = 0.021) were associated with increased core temperature at 30 minutes after the surgical incision. Ultrasound measured-preperitoneal fat was significantly associated with increased core temperature at 30 and 60 minutes after the surgical incision (β = 0.012, 95%CI: 0.003-0.021, p = 0.009 and β = 0.013, 95%CI: 0.002-0.024, p = 0.026). CT-measured visceral fat was also associated with increased core temperature at 30 minutes after the surgical incision (β = 0.005, 95%CI: 0.000-0.010, p = 0.046). Conversely, subcutaneous fat was not associated with intraoperative core temperature. Male sex and younger age were associated with lower intraoperative core temperature. Visceral fat protects against core temperature decrease during laparoscopic donor nephrectomy.

PurposeInadvertent hypothermia is a relatively common intraoperative complication. Few studies have investigated predictors of body temperature change or the effect of the blanket type used with a forced-air warming device during the intraoperative period. We investigated the predictive factors of intraoperative body temperature change in scheduled abdominal surgery.MethodsWe retrospectively reviewed the data from 2574 consecutive adult patients who underwent scheduled abdominal surgery in the supine position. Temperature data were collected from anesthesia records. Multiple regression analysis was performed at 60, 120, and 180 min after the surgical incision to identify the factors influencing body temperature change. We conducted nonlinear regression analysis using the equation ΔT = α (e−γt—1) + βt, where ΔT represented the change in intraoperative core temperature (°C), t represented the surgical duration (minutes), and α, β, and γ were constants.ResultsThe intraoperative core temperature change was explained by the equation ΔT = 0.59 (e− 0.018t − 1) + 0.0043t. Younger age, higher body mass index (BMI), male sex, laparoscopic surgery, and use of an underbody blanket were associated with increased core temperature at 1 or 2 h after surgical incision. Male sex and an underbody blanket remained strong predictive variables even 3 h after surgical incision, whereas BMI had little explanatory power at this timepoint. The difference in the heating effect of an underbody versus an overbody blanket was 0.0012 °C per minute.ConclusionsThe blanket type of the forced-air warmer, age, sex, laparoscopic surgery, and BMI are predictors of intraoperative core temperature change.

INTRODUCTION: Metastasis to the hilar and mediastinal lymph nodes in gynecological cancer is rare, and isolated hilar or mediastinal lymph node metastases are even rarer. In this report, we describe the results of lymph node dissection performed on 3 patients with hilar mediastinal lymph node metastasis but no lung metastasis from uterine or ovarian cancer.CASE PRESENTATION: Case 1 was a 50-year-old woman diagnosed with ovarian cancer with mediastinal lymph node metastasis. After 4 courses of chemotherapy, a total hysterectomy, omentectomy, and mediastinal lymph node dissection were performed simultaneously. The patient is still alive 58 months after surgery. Case 2 was a 68-year-old woman who underwent a total hysterectomy after chemotherapy for endometrial cancer with multiple lymph node metastases. Forty-two months after surgery, mediastinal lymph node dissection was performed for metastasis of uterine cancer. She is still alive 75 months after surgery. Case 3 was a 69-year-old woman who underwent a hysterectomy for endometrial cancer. One year after surgery, she underwent thoracoscopic hilar and mediastinal lymph node dissection due to metastasis. Thirty-nine months have passed with no recurrence. Aggressive local control, particularly surgical resection of isolated hilar mediastinal lymph nodes in gynecological cancer, may contribute to prolonging patient survival.CONCLUSIONS: Aggressive local control, especially surgical resection, for isolated hilar mediastinal lymph nodes due to gynecological cancer is safe and may contribute to prolonging survival.

Objective To determine the appropriate amount of indocyanine green for bronchial insufflation. Methods We enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope. Results The targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume. Conclusions The setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.

Background Visceral pleural invasion (VPI) is known to have a significant impact on staging and prognosis in NSCLC and is an important factor in determining surgical strategy. The aim of this study was to compare the outcomes of surgical procedure (segmentectomy vs. lobectomy) with VPI positive patients. Methods A retrospective study was conducted on 218 VPI positive NSCLC patients were studied, with the segmentetomy group ( n  = 42) designated as cohort.1, cases with tumor diameter less than 2 cm ( n  = 22) designated as cohort.2, and cases with greater than 2 cm ( n  = 20) designated as cohort.3. Each group and 150 cases of lung lobectomy were analyzed. Cause of death and recurrence mode were investigated. Results There was no difference in OS, DSS and RFS between segmentectomy and lobectomy after propensity matched analysis. There was no difference in OS and RFS in the group of cases < 2 cm. In patients with tumors > 2 cm, recurrence-free survival was numerically higher in the lobectomy group than in the segmentectomy group, although this difference was not statistically significant ( p  = 0.08). There was no difference in lung cancer deaths, but there was a trend toward more deaths from multiple disease in the lobectomy group ( p  = 0.07), and pleural dissemination recurrence was significantly more common in the segmentectomy group than in the lobectomy group in the > 2 cm group ( p  = 0.03). Conclusion In patients with VPI-positive lung cancer, segmentectomy may offer a better prognosis for those with tumors measuring < 2 cm. Nevertheless, lobectomy should be considered first for patients with tumors measuring > 2 cm. Our study provides novel insights by stratifying outcomes based on tumor size, highlighting pleural dissemination risk and death causes, which may support individualized surgical decision-making. Although no statistically significant difference was found, lobectomy may be more appropriate for patients with tumors > 2 cm based on the observed recurrence patterns and potential for better local control.

Background The aim of this study was to assess the solid% using 3D-CT and analyze its potential value in selecting a segmentectomy as the surgical procedure. Methods A retrospective study was conducted on 198 NSCLC patients who underwent segmentectomy. Of these, 93 cases who were evaluated as pure-solid on 2D-CT scans were included in the analysis. Receiver operating characteristics analysis was used to calculate cut-off levels for prognostic markers. The univariate analysis included variables such as age, whole tumor size, smoking history, gender, 2D-mCT value, whole tumor volume, 3D-mCT value, solid%, solid volume, standardized uptake value, and carcinoembryonic antigen value. Multiple logistic regression analyses were performed to determine the independent variables for the prediction of tumor recurrence. Results A cutoff of 71.1% yielded the maximum specificity and sensitivity to predict recurrence based on the solid%. In the group consisted of 62 cases with a solid% of 71.1% or higher on 3D-CT background-matched lobectomy group, the RFS was significantly better ( p  = 0.046) for the lobectomy group compared to the segmentectomy group. Preoperatively determined variables were used in multiple logistic regression models, revealing that the solid% ( p  = 0.04) and SUV ( p  = 0.03) were predictive and independent factors of tumor recurrence. Conclusions Solid % on 3D-CT has a potential to predict recurrence after segmentectomy in a group of cases rated as pure solid on 2D-CT. A future prospective study should be conducted to establish optimal treatment strategies for this disease.

Background The aim of this research was to investigates the prognostic importance of change in carcinoembryonic antigen (CEA) levels (particularly abnormal high concentration) in patients with non-small cell lung cancer (NSCLC) between before and after surgery. Methods The study involved 68 patients with NSCLC ( preoperative CEA value ≥ 10 ng/ml) who received curative operation from 2012 to 2020. Preoperative and postoperative serum CEA levels, CEA reduction, and other clinicopathological factors were determined on medical records. Receiver operating characteristic curves were used to calculate cut-off levels for prognostic markers. Multivariate analyses with a Cox proportional hazards regression model were performed to identify Independent prognostic variables. Results The optimal cut-off was value for the CEA reduction rate was 77.3%. The area under the curve for the CEA reduction rate was greater compared with those for preoperative and postoperative CEA levels. The Kaplan–Meier method revealed a significantly worse prognosis in the low CEA reduction rate group versus the high CEA reduction rate group regarding overall survival (OS) ( p  = 0.002). In the multivariate analysis, the CEA reduction rate (hazard ratio: 3.36, 95% confidence interval: 1.32–8.51, p  = 0.011) was identified as an independent and exclusive prognostic marker for OS. Conclusions In NSCLC, which is characterized by high preoperative CEA levels, the CEA reduction rate after surgery is a useful prognostic factor. Importantly, it is a more powerful indicator for OS compared with postoperative CEA levels. Further, large-sample-size cohort studies focusing on this issue are warranted.

PurposeArterial hypotension is a major adverse effect of general anesthesia. Patients with pre-existing autonomic dysfunction are at greater risk of hypotension. This study was performed to examine whether objective measurement of the pupillary light reflex is predictive of intraoperative hypotension.MethodsWe studied 79 patients who underwent scheduled surgery under general anesthesia. Patients with severe cardiovascular disease or receiving antihypertensive agents were excluded. The light reflex was measured preoperatively using a portable infrared pupillometer, and the hemodynamic parameters were obtained from the anesthesia records. The patients were divided into two groups according to the development of hypotension: the hypotension and normotension groups. Multivariate logistic regression analysis was performed to determine the pupil parameters predictive of hypotension.ResultsPatients in the hypotension group were older and had a greater pupil size or constriction velocity than those in the normotension group. Logistic regression analysis showed that post-induction hypotension was significantly associated with maximum pupil size or constriction velocity after adjustment for age and other clinical variables. Latency of the light reflex and the percent reduction of pupil size were not associated with hypotension. Age was a relatively strong predictor of hypotension; other confounding factors were not associated with hypotension.ConclusionMeasurement of maximum pupil size is useful to identify patients at risk for intraoperative hypotension. The influence of age must be considered during measurement of the pupil response.Clinical trial numberUMIN000023729Registry URLhttps://www.umin.ac.jp

Background The aim of this study was to assess the ability of radiologic factors such as mean computed tomography (mCT) value, consolidation/tumor ratio (C/T ratio), solid tumor size, and the maximum standardized uptake (SUVmax) value by F-18 fluorodeoxyglucose positron emission tomography to predict the presence of spread through air spaces (STAS) of lung adenocarcinoma. Methods A retrospective study was conducted on 118 patients those diagnosed with clinically without lymph node metastasis and having a pathological diagnosis of adenocarcinoma after undergoing surgery. Receiver operating characteristics (ROC) analysis was used to assess the ability to use mCT value, C/T ratio, tumor size, and SUVmax value to predict STAS. Univariate and multiple logistic regression analyses were performed to determine the independent variables for the prediction of STAS. Results Forty-one lesions (34.7%) were positive for STAS and 77 lesions were negative for STAS. The STAS positive group was strongly associated with a high mCT value, high C/T ratio, large solid tumor size, large tumor size and high SUVmax value. The mCT values were − 324.9 ± 19.3 HU for STAS negative group and − 173.0 ± 26.3 HU for STAS positive group ( p  < 0.0001). The ROC area under the curve of the mCT value was the highest (0.738), followed by SUVmax value (0.720), C/T ratio (0.665), solid tumor size (0.649). Multiple logistic regression analyses using the preoperatively determined variables revealed that mCT value ( p  = 0.015) was independent predictive factors of predicting STAS. The maximum sensitivity and specificity were obtained at a cutoff value of − 251.8 HU. Conclusions The evaluation of mCT value has a possibility to predict STAS and may potentially contribute to the selection of suitable treatment strategies.