Tokushima University Institutional Repository
Not a member yet
12889 research outputs found
Sort by
Achievements of perioperative assist team medical care in esophageal cancer surgery, Tokushima University Hospital
Get PDFBackground : Radical esophagectomy is highly invasive and associated with many postoperative complications. A decline in postoperative QOL is a serious issue for patients, and comprehensive perioperative management through multidisciplinary cooperation is necessary. Our institution has established a perioperative assist team (OPERA) to address this need since 2017. Methods : This study included 109 patients with esophageal cancer who underwent neoadjuvant chemotherapy and esophagectomy from 2009 to 2018. O group, means OPERA intervention group, included 57 patients, and N group, means Non-OPERA intervention group, included 52 patients. The effects of the OPERA intervention on reducing chemotherapy-related adverse events and improving postoperative outcomes were retrospectively investigated. Results : The OPERA intervention significantly reduced the incidence of chemotherapy-related adverse events (P=0.002). In particular, anorexia and diarrhea, febrile neutropenia were significantly reduced (P<0.001, P=0.002, P=0.025, respectively). Postoperatively, the start date of walking was significantly earlier (P<0.001), the incidence of pneumonia was lower (P=0.022). At the time of postoperative discharge, N group was significantly greater weight loss compared to O group (P=0.002). The 5-year survival rate was longer in O group (P=0.003). Conclusion : The OPERA intervention reduced the incidence of chemotherapy-related adverse events and postoperative complications and helped improved prognosis.journal articl
A case of pulmonary Mycobacterium heckeshornense infection coexisted with lung cancer
Get PDFA 71-year-old male was referred to our institution for further examination of chest abnormal shadow. A cavitation in the right apical region, a mass adjacent to the pleura in the right upper lobe, and a nodule in the right middle lobe were observed in a chest computed tomography. The sputum smear and culture of acid-fast bacilli were positive, and Mycobacterium heckeshornense (M. heckeshornense) was identified with the matrix-assisted laser desorption ionization time-of-flight mass spectroscopy. Moreover, computed tomography-guided biopsy of a mass adjacent to the pleura in the right upper lobe yielded the diagnosis of primary lung adenocarcinoma. Taken together, the patient was finally diagnosed as coexistence of pulmonary M. heckeshornense infection and primary lung cancer. An anti-mycobacterial treatment with rifampicin, ethambutol and clarithromycin and a combined chemotherapy were fairly successful for pulmonary M. heckeshornense infection and primary lung adenocarcinoma, respectively. These observations suggest that triple anti-mycobacterial therapy may contribute to good controls of M. heckeshornense infection and that careful selection of anti-cancer drugs against lung cancer might be lead to favorable outcomes even during the course of anti-mycobacterial treatment. To the best of our knowledge, this is the first report of pulmonary M. heckeshornense infection coexisted with lung cancer.journal articl
One-Stage Nerve Repair for Post-Ganglionic Brachial Plexus Injury by Using Ipsilateral Ruptured Ulnar Nerve as a Donor for Axillary Artery Rupture with Open Wound
Get PDFOpen axillary arterial injury is life-threatening, and upper-extremity reperfusion must be performed within approximately 6 h. We present the case of a patient who underwent reperfusion of the upper limb and nerve reconstruction of the post-ganglionic brachial plexus injury in one stage while maintaining stable vital signs. The injury was an avulsion with no fracture. Nerve grafting was necessary to reconstruct the nerves without tension. Although the sural nerve is commonly used, we decided to sacrifice the ipsilateral ruptured ulnar nerve because it was less likely to recover over a long reinnervation distance. Nine months postoperatively, the patient was able to flex the elbow and rotate the forearm, although finger function was poor. Nevertheless, the patient could use the hand to assist her in performing daily activities and return to the previous workplace as a clerk.journal articl
IDO1 and FOXP3 : Possible immune-regulating genes alleviating cedar pollinosis via L. plantarum YIT 0132
No full textjournal articl
Biopsychosocial Consideration of Ikigai in Older Adults in Japan through a Cross-Sectional Study
No full textIkigai—a Japanese concept that includes elements such as life’s purpose and meaning—has been reported to be associated with various systemic health conditions, such as the risk of developing physical dysfunction or death in older adults. However, there are no reports that comprehensively examine the psychological and social aspects of Ikigai. We attempted to clarify the characteristics of Ikigai by examining it from a biopsychosocial model using physical, psychological, and social perspectives through a cross-sectional study on sarcopenia, frailty and healthy life expectancy in a hilly and mountainous area of Japan. Koyadaira in Mima City, which is located in a hilly and mountainous region on Shikoku Island in Japan, was targeted. This cross-sectional study included 105 outpatients aged 65 and over, with an average age of 79.02 ± 6.91 years. Ikigai (self-rating score on a scale of 0 (no Ikigai) to 5 (the highest Ikigai)) participants’ level of physical activity (the Physical Activity Scale for the Elderly, PASE), degree of depression (the Geriatric Depression-15 Scale, GDS-15), cognitive function (the Mini-Mental State Examination, MMSE) and social isolation (the abbreviated Lubben Social Network Scale, LSNS-6) was assessed. Significant positive correlations were found between PASE and MMSE. The LSNS-6 significantly correlated with the MMSE and GDS-15. In a path model, out of four paths from PASE, GDS-15, MMSE, and LSNS-6 to Ikigai, the path from the GDS-15 alone was significant (correlation coefficient −0.271, p < 0.01). The adaptability of this model was good. This study indicates that depressive status has a large impact on Ikigai, along with physical, cognitive, and social conditions; thus, it is appropriate to consider that an affective psychological status, such as depressive symptoms, is a fundamental condition for having Ikigai.journal articl
First Study of the PIKACHU Project : Development and Evaluation of High-Purity Gd3Ga3Al2O12 : Ce Crystals for 160Gd Double Beta Decay Search
No full textUncovering neutrinoless double beta decay (0ν2β) is crucial for confirming neutrinos’ Majorana characteristics. The decay rate of 0νββ is theoretically uncertain, influenced by nuclear matrix elements that vary across nuclides. To reduce this uncertainty, precise measurement of the half-life of neutrino-emitting double beta decay (2ν2β) in different nuclides is essential. We have launched the PIKACHU (Pure Inorganic scintillator experiment in KAmioka for CHallenging Underground sciences) project to fabricate high-purity Ce-doped Gd3Ga3Al2O12 (GAGG) single crystals and use them to study the double beta decay of 160Gd. Predictions from two theoretical models on nuclear matrix element calculations for 2ν2β in 160Gd show a significant discrepancy in estimated half-lives, differing by approximately an order of magnitude. If the lower half-life estimation holds true, detecting 2ν2β in 160Gd could be achievable with a sensitivity enhancement slightly more than an order of magnitude compared to prior investigations using Ce-doped Gd2SiO5 (GSO) crystal. We have successfully developed GAGG crystals with purity levels surpassing previous standards through refined purification and selection of raw materials. Our experiments with these crystals indicate the feasibility of reaching sensitivities exceeding those of earlier studies. This paper discusses the ongoing development and scintillator performance evaluation of high-purity GAGG crystals, along with the anticipated future prospects of the PIKACHU experiment.journal articl
Lenvatinib treatment strategy for thyroid carcinoma with malignant pleurisy : a case report
Get PDFBackground: Although lenvatinib is effective for unresectable thyroid carcinoma, it may cause adverse events owing to rapid tumor shrinkage or necrosis. Pneumothorax during lenvatinib therapy is rare. However, once it occurs, it can become a refractory and fatal complication. Herein, we report two cases of thyroid carcinoma with malignant pleurisy treated with lenvatinib and discuss treatment strategies to prevent pneumothorax.
Case Description: The first case involved a 78-year-old male with papillary thyroid carcinoma and malignant bilateral pleural effusion. He underwent pleurodesis with talc for the left pleural effusion due to respiratory distress, and lenvatinib therapy was initiated. Forty days after lenvatinib therapy, the patient developed a right pneumothorax and underwent surgery for a prolonged air leak. However, the left pneumothorax was prevented by pleurodesis. During surgery, the visceral pleura was fragile, and repair of the pulmonary fistula was difficult. Pathological examination revealed an anaplastic carcinoma in the visceral pleura. The air leak disappeared 20 days after surgery; however, the patient died 22 days after surgery due to progression of the underlying disease. The second case involved a 65-year-old female with a poorly differentiated thyroid carcinoma and lung metastasis. She underwent ablation with 30 mCi 131I after total thyroidectomy, and there was no accumulation in the metastatic sites. Chest computed tomography (CT) revealed the progression of malignant pleurisy in the right thoracic cavity, and iodine-resistant disease was confirmed. She was treated with lenvatinib after talc pleurodesis and showed good progress without any adverse events.
Conclusions: The presence of malignant pleurisy results in a risk of developing lenvatinib-associated pneumothorax. Therefore, pleurodesis should be considered before lenvatinib therapy for thyroid carcinomas with malignant pleurisy.journal articl
Intraoperative transbronchial metallic coil marking guided by mobile 3D C-arm for resection of a small peripheral lung lesion
Get PDFSublober resection of small peripheral lung lesions using video-assisted thoracoscopic surgery may require marking and confirmation using 3D imaging in the interventional radiology suite or in the hybrid operating room (HOR) before surgery is started. We report a novel approach for intraoperative transbronchial metallic coil marking followed by thoracoscopic wedge resection in a conventional operating room under mobile 3D C-arm guidance. Under general anesthesia, an ultrathin video-bronchoscope was inserted into an objective bronchus guided with virtual bronchoscopic navigation, and a coil-feeding microcatheter was introduced through the bronchoscope’s channel. After the position of the catheter tip was confirmed with cone-beam computed tomography (CT) images rendered via a mobile 3D C-arm, a metallic coil was subsequently deployed through the catheter as a marker. During surgery, the nodule with the metallic coil was grasped with pulmonary forceps and fully resected with endostaplers under fluoroscopic guidance. This method has advantages because the transbronchial approach carries a lower risk of complications such as pneumothorax and air embolism compared with a percutaneous approach, and the metallic coil provides more accurate, pinpoint localization compared with liquid dye. Mobile 3D C-arm-guided transbronchial metallic coil marking followed by thoracoscopic wedge resection under fluoroscopic guidance is a one-stop solution for intraoperative marking and resection of small peripheral pulmonary lesions in any operating room.journal articl
Feasibility of robot-assisted surgery for defining circumferential resection margins for rectal cancer : a retrospective study
Get PDFBackground: Local recurrence is a major problem after surgery for rectal cancer. Precision of the circumferential resection margin (CRM) has been shown to be an independent predictor of local recurrence. The purpose of this study is to evaluate the usefulness of robotic surgery for defining the CRM.
Methods: A retrospective cohort study of patients with rectal cancer who underwent radical surgery at Tokushima University Hospital from January 2012 to April 2023 was included in this study to evaluate risk factors for CRM involvement. Short-term outcomes, including CRM rates, as well as long-term outcomes, were compared between patients who had undergone robot-assisted versus laparoscopic surgery following propensity score analysis.
Results: A total of 223 patients were analyzed in this study. Multivariate analysis demonstrated that lymph node metastasis was the most significant predictive factor for CRM involvement (p = 0.030), and that robot-assisted surgery tended to lead to less CRM involvement (p = 0.085). The CRM involvement rate for robotic and laparoscopic surgery before propensity score matching was 4.7% and 11.7%, respectively. Following propensity score matching, the CRM involvement rate for robotic surgery was 4.5% versus 11.4% for laparoscopic surgery. Disease-free survival (DFS) and overall survival (OS) rates for patients who had undergone robot-assisted and laparoscopic surgery were not significantly different before or after matching (DFS before matching: p = 0.876, DFS after matching: p = 0.805, OS before matching: p = 0.511, OS after matching: p = 0.458).
Conclusion: Robot-assisted surgery may be useful in defining the CRM for rectal cancer.journal articl
