[Show abstract][Hide abstract] ABSTRACT: Background
Treatment protocols (including those for thoracic surgery) tend to be customized for individual hospitals. Procedural standardization is required to improve surgical tasks and patient outcomes. This study aimed to evaluate the effects of an initiative to standardize surgical tasks for efficient and safe performance.
Hospitals associated with the Division of Chest Surgery of the Kyoto Prefectural University of Medicine held joint meetings involving their thoracic surgeons and operating room nurses between February 2011 and November 2012 to standardize surgical tasks. Operation times and blood loss were compared before and after standardization.
The implementation rate of standardized surgical tasks was 97%. The pre-operative (from entry to the operating room until commencement of surgery) and post-operative (from conclusion of surgery until departure from the operating room) times were significantly decreased after the standardization. When compared according to operative group (all thoracic surgery, lung lobectomy, and partial lung resection), operation times were shorter for all three groups; in addition, the amount of blood loss was lower in all three groups after standardization. A post-standardization survey showed improved morale among the meeting participants.
Interdisciplinary standardization of surgical tasks across institutions improved thoracic surgery tasks and surgical outcomes.
Full-text · Article · Mar 2015 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Chondromyxoid fibroma (CMF) is a rare, benign cartilaginous tumor, comprising less than 1% of primary bone tumors, and usually occurs in the metaphysis of a long tubular bone around the knee. We report a rare case of CMF of the rib. The patient was a 25-year-old man who visited the hospital for left upper back pain. Roentgenography revealed an 8-cm mass in the left upper lung field; computed tomography revealed a large multicystic tumor with aneurysmal bone cyst (ABC)-like features in the posterior mediastinum. ABCs are also a rare benign tumor representing 2.5% of primary bone tumors, and most of ABCs are located in the metaphysis of long bones and vertebrae. To the best of my knowledge, there is no report of CMF with secondary ABC of the rib. We performed total resection of the tumor. Complete tumor resection may be the best treatment option for a cure.
[Show abstract][Hide abstract] ABSTRACT: In order to clarify the mechanisms of resistance to paclitaxel in lung cancer, three human lung cancer cell lines which exhibit different sensitivity to paclitaxel were investigated from the following viewpoints: overexpression of ATP-binding cassette, sub-family B, member 1 (ABCB1), mutations on paclitaxel binding site of β-tubulin genes, quantity of polymerized tubulin and the intracellular localization of paclitaxel. ABCB1 expression was evaluated by real-time RT-PCR. No correlations were noted between the ABCB1 expression in the sensitive and resistant cell lines at the mRNA level. No mutations on the paclitaxel binding site of the β-tubulin genes were detected in either the resistant or sensitive cells. Live cell images obtained by confocal laser microscopy revealed that the resistant cell line, RERF-LC-KJ, had more accumulation of Oregon Green® 488 conjugated paclitaxel in the lysosomal and extra-lysosomal compartments of cytoplasm than other cell lines. The results obtained in this study indicated that the changes in the subcellular localization could contribute to the production of paclitaxel resistance in lung cancer cell lines. Further studies should be conducted to elucidate the molecular mechanisms that differentiate the intracellular localization of paclitaxel.
Full-text · Article · Dec 2011 · International Journal of Oncology
[Show abstract][Hide abstract] ABSTRACT: Video-assisted thoracoscopic surgery (VATS) is a widely used technique where operating surgeons alternate between direct vision through minithoracotomy and monitor-aided vision as required. We analyzed surgeons' line of sight to assess their proficiency at using an optical tracking system with a multifaceted marker device.
An infrared optical tracking system was developed that is capable of integrating information from a multifaceted marker device and analyzing three-dimensional (3D) dynamic movements including flexion and rotation. Using this system, we analyzed multiple aspects of surgeons' head poses, thereby indirectly identifying their visual line of sight. A multifaceted device comprising 4 surfaces and 4 markers was constructed and attached to surgeons' heads. The surgeons' head motions were tracked using this multifaceted device and videotaped their face while they performed wedge resection. Both data sets were compared.
The system could document 98.5% of surgeons' head motions, with a high correlation ( = 0.935) between data acquired using the multifaceted device and video analysis. An inverse correlation was observed between tumor size and the monitor-viewing time ratio by surgeons in pulmonary wedge resection (R(2) = 0.728).
An optical tracking system with a multifaceted device was able to measure 3D dynamic movements of thoracic surgeons. The associated problems of reflection angle and marker shielding were solved. The utility of this device for analyzing surgeons' visual line of sight during VATS was established.
No preview · Article · Apr 2011 · International Journal of Computer Assisted Radiology and Surgery
[Show abstract][Hide abstract] ABSTRACT: A target of NESH-SH3/Abi3bp (TARSH) was originally identified as an SH3 domain-binding molecule of the NESH-SH3/Abi3 protein that is involved in Rac-dependent actin polymerization. In recent studies, TARSH gene expression was dramatically induced in mouse embryonic fibroblasts (MEFs) replicative senescence and suppressed in human lung carcinoma specimens and thyroid carcinomas. However, the molecular mechanism underlying the regulation of TARSH in tumorigenesis remains unclear. Here, we address a p53-dependent apoptosis function of the mouse TARSH gene using RNAi-mediated suppression of endogenous TARSH expression. Our results will be useful in the discovery of a novel therapeutic target in lung carcinoma.
Preview · Article · Sep 2009 · Nagoya journal of medical science
[Show abstract][Hide abstract] ABSTRACT: A novel target of NESH-SH3 (TARSH) was identified as a cellular senescence related gene in mouse embryonic fibroblasts (MEFs) replicative senescence, the expression of which has been suppressed in primary clinical lung cancer specimens. However, the molecular mechanism underlying the regulation of TARSH involved in pulmonary tumorigenesis remains unclear. Here we demonstrate that the reduction of TARSH gene expression by short hairpin RNA (shRNA) system robustly inhibited the MEFs proliferation with increase in senescence-associated beta-galactosidase (SA-beta-gal) activity. Using p53-/- MEFs, we further suggest that this growth arrest by loss of TARSH is evoked by p53-dependent p21(Cip1) accumulation. Moreover, we also reveal that TARSH reduction induces multicentrosome in MEFs, which is linked in chromosome instability and tumor development. These results suggest that TARSH plays an important role in proliferation of replicative senescence and may serve as a trigger of tumor development.
No preview · Article · Apr 2009 · Biochemical and Biophysical Research Communications
[Show abstract][Hide abstract] ABSTRACT: Sufficient lighting is sometimes required when surgeons watch the mediastinum through the 7x7cm thoracic window in video-assisted thoracoscopic (VATS) lobectomy. It is thus important to develop the "ultimately localized solid-statelighting" because the distance between the window and the surface of the lung is as short as 4-5 cm. Our new idea was to place the module composed of red, green and blue light emitting diodes (RGB LEDs) at the tip of the retractor. Compared to a conventional endoscopic lighting consisting of halogen lamp, this method has lead to the bright and shadowless illumination within the entire thoracic cavity since the white RGB LEDs are emitted unidirectionally from the cylinder-shaped camera component, moving the shadows from the surgical instruments to the side of the incision. It also should be noted that we found an effective principle for controlling the color rendering of each biomaterial through the synthesis of LED lighting spectra, by which the visual performance of surgeons can be coordinated. Therefore, we believe that "medical RGB LEDs" will contribute to the safe operation, and will be developed to a standard lighting system in clinical settings with bright surgical fields in the near future.
No preview · Article · Feb 2008 · Proceedings of SPIE - The International Society for Optical Engineering
[Show abstract][Hide abstract] ABSTRACT: We report a case of cardiac angiosarcoma of the right atrium. A 20-year-old woman was admitted to the Kyoto Prefectural University of Medicine with severe chest pain and dyspnea. A cardiac tumor was diagnosed by computed tomography (CT), echocardiography, and cinecardiography. The tumor marker CA125 was 293 U/ml (normal : <35 U/ml). Therefore a CT-guided transthoracic needle biopsy under CT fluoroscopic guidance for definitive diagnosis was performed after obtaining the patient's informed consent. Pathohistologically, the tumor was diagnosed as a cardiac angiosarcoma. The use of an intravenous infusion of contrast material contributed greatly to clear visualization of the tumor margin and cardiac lumen and assisted in easily and correctly advancing the needle toward the tumor. Moreover, tumor marker CA125 was a good indicator of therapeutic efficacy.
No preview · Article · Jan 2008 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: In order to detect and track a small magnet embedded in the vicinity of a target tumor during surgery, we have developed a magnetic navigation system based on three-dimensional measurements with micro-fluxgate magnetic sensors. In this paper, we present an image overlay method for superimposing the embedded magnetic marker through a bronchoscope. To evaluate the performance of the proposed system and its applicability in clinical use, we set up an in vivo experiment, in which surgeons used this system to perform thoracoscopic surgery on a pig with transbronchial marking and oblique-viewing, and we succeeded in a partial resection of the pig lung including the target area. Next, we tried a wedge resection for a lung tumor in a clinical case. We successfully performed the partial resection of the lung including the target area, which corresponded to the tumor lesion, under the guidance of the magnetic navigation system.
No preview · Article · Jan 2008 · IEEJ Transactions on Sensors and Micromachines
[Show abstract][Hide abstract] ABSTRACT: TARSH/Abi3bp was originally isolated as a novel target of NESH-SH3 by a two-hybrid yeast system. We have already identified murine TARSH (mTARSH) as a cellular senescence-related gene because of its robust induction in the early phase of mouse embryonic fibroblast cellular senescence. We have also revealed that the expression of this gene was dramatically reduced in human lung cancer cell lines and primary lung tumor, while it was predominantly expressed in normal conditions. This evidence suggests that TARSH is involved in both stress-induced senescence and prevention of cancer development; however, little is known about its molecular mechanisms. To reveal the further physiological function of this molecule, we established rat anti-TARSH monoclonal antibodies (MAb). Recombinant His-tagged partial mouse TARSH protein was expressed in Escherichia coli, affinity purified and used as an antigen to immunize rats. Hybridomas were screened by enzyme-linked immunosorbent assay, and we generated six stable hybridoma cell lines that produced antibody against murine TARSH protein, including three clones that represented cross-reactivity with human TARSH. We determined their isotypes and further examined capabilities or limitations in immunoblotting, immunoprecipitation, and immunofluorescence microscopy, realizing the most suitable antibody for each application. These MAbs should therefore be very useful tools for the study of TARSH expression and for following biological function in cellular senescence and tumor suppression.
No preview · Article · Jan 2008 · Hybridoma (2005)
[Show abstract][Hide abstract] ABSTRACT: We report the first case of a malignant mesothelioma expressing not only granulocyte-colony stimulating factor (G-CSF), but also its receptor. A 59-year-old male carpenter underwent a panpleuropneumonectomy, but the tumor relapsed and spread rapidly, accompanied by leukocytosis. The white blood cell count reached 147,000/mm3 (96.2% neutrophils), and the concentration of serum G-CSF was 77 pg/mL. An autopsy demonstrated that some of the tumor cells produced G-CSF, but more tumor cells and endothelial cells in the tumor expressed G-CSF receptor. It was hypothesized that an autocrine loop involving G-CSF and the G-CSF receptor greatly accelerated the tumor growth.
No preview · Article · Dec 2006 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Use of a central venous catheter (CVC) may be complicated by a catheter fracture, causing an embolism. Pinch-off syndrome is a recognized complication that develops from the use of implantable subclavian venous access devices. Although rare, as it occurs in only 0.8% of the reported cases, the condition can appear as a complication secondary to the insertion of a CVC. We experienced a case of CVC division in a 26-year-old male who had a CVC implanted through the subclavian vein. We failed in our attempt to remove the catheter fragment using video-assisted thoracoscopic surgery (VATS). If no complication occur over a long-term, it is highly possible that the catheter fragment will become adhered to the vessel wall. Therefore, it may not be necessary to remove the fragment in those cases.
No preview · Article · Jul 2006 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: We have previously identified mouse Tarsh as one of the cellular senescence-related genes and showed the loss of expression of TARSH mRNA in four human lung cancer cell lines. TARSH is a presumptive signal transduction molecule interacting with NESH, which is implicated to have some roles in lung cancer metastasis.
The amplification of complete ORF-encoding TARSH cDNA was done with reverse transcription-PCR. Northern blotting was carried out using TARSH cDNA probes. To clarify the relationship between TARSH and lung cancer, we quantified TARSH mRNA expression in 15 human lung cancer cell lines and 32 primary non-small cell lung cancers.
We first determined the complete ORF-encoding cDNA sequence which is expressed in the human lung. On the Northern hybridization analysis, TARSH was strongly expressed in the human lung. The expression of TARSH mRNA is remarkably downregulated in all the lung cancer cell lines examined. Furthermore, TARSH expression was significantly low in all of the tumor specimens when compared to the expression in corresponding non-neoplastic lung tissue specimens.
The cancer-associated transcriptional inactivation of TARSH suggests that TARSH could be used as a biomarker for lung cancer development as well as a molecular adjunct for lung carcinogenesis in human.
No preview · Article · Feb 2006 · Journal of Cancer Research and Clinical Oncology