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Tsuburai T, Tanaka S, Komase Y, Oyama B, Muraoka H, Shinozaki Y, Nishiyama K, Shibuya JU, Nishi Y, Numata Y, Hida N, Mineshita M, Inoue T. Changes in fractional exhaled nitric oxide, forced expiratory volume in one second, and forced oscillation technique parameters over three years in adults with bronchial asthma managed under Yokohama Seibu Hospital's coordinated care system. BMC Pulm Med 2024; 24:214. [PMID: 38698432 PMCID: PMC11064294 DOI: 10.1186/s12890-024-03040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND In western Yokohama, our hospital and primary care clinics manage adults with asthma via a coordinated care system. We investigated the changes in the fractional expired nitric oxide (FeNO), forced expiratory volume in 1 second (FEV1), and forced oscillation technique (FOT) parameters over 3 years in a cohort of patients in our collaborative system. METHODS From 288 adults with well controlled asthma managed under the Yokohama Seibu Hospital coordinated care system between January 2009 and May 2018, we selected 99 subjects to undergo spirometry, FeNO and FOT testing over 3 years and analyzed the changes in these parameters. RESULTS Of the 99 patients enrolled, 17 (17.2%) experienced at least one exacerbation (insufficiently controlled (IC)), whereas, 82 (82.8%) remained in well controlled during the 3-year study period. Of well-controlled patients, 54 patients (54.5%) met the criteria for clinical remission under treatment (CR); the remaining 28 patients did not meet the CR criteria (WC). There were no differences in FeNO, FEV1, or FOT parameters at baseline among the IC, WC, and CR groups. The levels of FEV1 decreased gradually, whereas the levels of FeNO decreased significantly over 3 years. The levels of percent predicted FEV1 (%FEV1) significantly increased. We also observed significant improvement in FOT parameters; reactance at 5 Hz (R5), resonant frequency (Fres), and integral of reactance up to the resonant frequency (AX). The CR group demonstrated significant relationships between the change in FeNO and the change in FEV1 and between the change in FEV1 and the change in FOT parameters. No significant correlations emerged in the IC or WC group. CONCLUSION The decrease in FeNO and increase in %FEV1, we observed in all study participants suggest that the coordinated care system model benefits patients with asthma. Although it is difficult to predict at baseline which patients will experience an exacerbation, monitoring changes in FeNO and FEV1 is useful in managing patients with asthma. Furthermore, monitoring changes in R5, Fres, and AX via forced oscillation technique testing is useful for detecting airflow limitation.
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Affiliation(s)
- Takahiro Tsuburai
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan.
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Satoshi Tanaka
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuko Komase
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
| | - Baku Oyama
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiromi Muraoka
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yusuke Shinozaki
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuhiro Nishiyama
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junko Ueno Shibuya
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro Nishi
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yu Numata
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoya Hida
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
| | - Masamichi Mineshita
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Kamata H, Takamatsu K, Fukunaga K, Chubachi S, Nakagawara K, Namkoong H, Terai H, Tanaka K, Sato S, Hagiwara E, Takei R, Kondoh Y, Takazono T, Hashimoto M, Tasaka S, Ohrui T, Tanino Y, Mineshita M, Komase Y, Miyazaki K, Nishikawa M, Ando A, Kita H, Ichihara E, Ohshimo S, Murata Y, Ishida M, Kobayashi S, Uchida T, Tateno H, Ikari J, Terashima T, Kozu Y, Tateishi T, Shinkai M, Sagara H, To Y, Ito Y, Yamamoto M, Yamamoto Y, Kita T, Ito Y, Tomii K, Fujita Y, Funaki Y, Yatera K, Yamasue M, Komiya K, Kozawa S, Manabe H, Hozumi H, Horiguchi T, Kitajima T, Nakano Y, Nagaoka T, Hojo M, Ebihara A, Kobayashi M, Takayama K, Jinta T, Sawai T, Fukuda Y, Kaneko T, Chin K, Ogura T, Mukae H, Ishii M, Yokoyama A. Pulmonary function and chest CT abnormalities 3 months after discharge from COVID-19, 2020-2021: A nation-wide multicenter prospective cohort study from the Japanese respiratory society. Respir Investig 2024; 62:572-579. [PMID: 38669898 DOI: 10.1016/j.resinv.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/07/2024] [Accepted: 02/17/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND No comprehensive analysis of the pulmonary sequelae of coronavirus disease 2019 (COVID-19) in Japan based on respiratory function tests and chest computed tomography (CT) has been reported. We evaluated post-COVID-19 conditions, especially focusing on pulmonary sequelae assessed by pulmonary function tests and chest CT. METHODS For this prospective cohort study, we enrolled 1069 patients who presented pneumonia at the time of admission in 55 hospitals from February 2020 to September 2021. Disease severity was classified as moderateⅠ, moderate II, and severe, defined primarily according to the degree of respiratory failure. The data on post-COVID-19 conditions over 12 months, pulmonary function, and chest CT findings at 3 months were evaluated in this study. Additionally, the impact of COVID-19 severity on pulmonary sequelae, such as impaired diffusion capacity, restrictive pattern, and CT abnormalities, was also evaluated. RESULTS The most frequently reported post-COVID-19 conditions at 3 months after COVID-19 were muscle weakness, dyspnea, and fatigue (48.4%, 29.0%, and 24.7%, respectively). The frequency of symptoms gradually decreased over subsequent months. In pulmonary function tests at 3 months, the incidence of impaired diffusion capacity and restrictive pattern increased depending on disease severity. There also were differences in the presence of chest CT abnormalities at the 3 months, which was markedly correlated with the severity. CONCLUSION We reported a comprehensive analysis of post-COVID-19 condition, pulmonary function, and chest CT abnormalities in Japanese patients with COVID-19. The findings of this study will serve as valuable reference data for future post-COVID-19 condition research in Japan.
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Affiliation(s)
- Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazufumi Takamatsu
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Katsushi Tanaka
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawaharacho, Sakyo-ku, 606-8507, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan
| | - Reoto Takei
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwakecho, Seto, Aichi, 489-8642, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwakecho, Seto, Aichi, 489-8642, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Midori Hashimoto
- Department of Respiratory Medicine, NTT-East Corporation Sapporo Medical Center, South 1, West 15, Chuo-ku, Sapporo, 060-0061, Japan
| | - Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
| | - Takashi Ohrui
- Division of Respiratory Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yuko Komase
- Department of Respiratory Internal Medicine, St. Marianna University School of Medicine, Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan
| | - Kazuhito Miyazaki
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawanishimachi, Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan
| | - Masanori Nishikawa
- Department of Respiratory Medicine, Fujisawa City Hospital, 2-6-1 Fujisawa, Kanagawa, 251-8550, Japan
| | - Akira Ando
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hideo Kita
- Department of Respiratory Medicine, Takatsuki Red Cross Hospital, 1-1-1 Abuno, Takatsuki, Osaka, 569-1045, Japan
| | - Eiki Ichihara
- Center for Clinical Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-0037, Japan
| | - Yoriyuki Murata
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Masayuki Ishida
- Department of Respiratory Medicine, Chikamori Hospital, 1-1-6 Okawasuji, Kochi, 780-8522, Japan
| | - Seiichi Kobayashi
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki, Miyagi, 986-8522, Japan
| | - Takahiro Uchida
- Department of Respiratory Medicine, Saitama Medical University Hospital, 38 Morohongo, Irumagun Moroyamamachi, Saitama, 350-0495, Japan
| | - Hiroki Tateno
- Department of Pulmonary Medicine, Saitama City Hospital, 2460, Oazamimuro, Midori-ku, Saitama, 336-8522, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan
| | - Yutaka Kozu
- Department of Internal Medicine, Division of Respiratory Medicine, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masaharu Shinkai
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo, 140-8522, Japan
| | - Hironori Sagara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Yasuo To
- Department of Pulmonary Medicine, International University of Health and Welfare School of Medicine, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Yoko Ito
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masaki Yamamoto
- Respiratory Disease Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152, Japan
| | - Toshiyuki Kita
- The Department of Respiratory Medicine, NHO Kanazawa Medical Center, 1-1 Shimoishibikimachi, Kanazawa, Ishikawa, 920-8650, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Mizuhochokawasumi, Mizuho-ku, Nagoya, 467-8602, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yoshihiro Funaki
- Division of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807- 8556, Japan
| | - Mari Yamasue
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Hasamamachiidaigaoka, Yufu, Oita, 879-5503, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Hasamamachiidaigaoka, Yufu, Oita, 879-5503, Japan
| | - Satoko Kozawa
- Center for Asbestos-Related Diseases, Yokohama Rosai Hospital, 3211, Kozukuecho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Hideaki Manabe
- Department of Respiratory Medicine, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara, Kanagawa, 252-5188, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3125, Japan
| | - Tomoya Horiguchi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Kutsukakechodengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Takamasa Kitajima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Yasushi Nakano
- Department of Respiratory Medicine, Kawasaki Municipal Ida Hospital, 2-27-1 Ida, Nakahara-ku, Kawasaki, Kanagawa, 211-0035, Japan
| | - Tetsutaro Nagaoka
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Akinori Ebihara
- Department of Respiratory Medicine, Tokai University Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Masayoshi Kobayashi
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Koji Takayama
- Department of Respiratory Medicine, Musashino Red Cross Hospital, 1-26-1 Kyonancho, Musashino, Tokyo, 180-0023, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Toyomitsu Sawai
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchimachi, Nagasaki, 850-0842, Japan
| | - Yuichi Fukuda
- Department of Respiratory Medicine, Sasebo City General Hospital, 9-3 Hirasecho, Sasebo, Nagasaki, 857-8511, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan; Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Oko-cho, Kohasu, Nankoku, Kochi, 783-8505, Japan
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Nishiyama K, Baba T, Oda T, Sekine A, Niwa T, Yamada S, Kaburaki S, Nagasawa R, Okudela K, Takemura T, Iwasawa T, Mineshita M, Ogura T. Bilateral Pneumothorax after a Transbronchial Lung Cryobiopsy for Interstitial Lung Disease. Intern Med 2024; 63:839-842. [PMID: 37532548 PMCID: PMC11009005 DOI: 10.2169/internalmedicine.2149-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
We herein report a case of bilateral pneumothorax after a unilateral transbronchial lung cryobiopsy (TBLC). A 73-year-old man with no history of cardiothoracic surgery underwent a TBLC for the reevaluation of interstitial lung disease. Five hours later, he developed bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema. He underwent bilateral chest drainage and was discharged 18 days later. The lung biopsy specimens obtained from the TBLC contained visceral pleura and bronchial cartilage, suggesting bronchial injury as the cause of the bilateral pneumothorax.
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Affiliation(s)
- Kazuhiro Nishiyama
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Niwa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Sho Yamada
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Shota Kaburaki
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Ryo Nagasawa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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4
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Morikawa K, Numata Y, Shinozaki Y, Kaneko S, Matsushima A, Nishida M, Kida H, Handa H, Nishine H, Mineshita M. High efficacy of brigatinib for brain metastases in ALK fusion gene-positive non-small cell lung cancer: A case series. Thorac Cancer 2024; 15:496-499. [PMID: 38158887 PMCID: PMC10883856 DOI: 10.1111/1759-7714.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024] Open
Abstract
Anaplastic lymphoma kinase (ALK) fusion gene-positive lung cancer often shows brain metastasis at initial diagnosis or during the course of treatment. However, molecular-targeted drugs are known to pass through the blood-brain barrier and present positive effects for central nervous system lesions. There are few reports suggesting how effective molecular-targeted drug therapy alone is for brain metastasis lesions of ALK fusion-positive lung cancer, especially after the first use of ALK-tyrosine kinase inhibitor (TKI) or for bulky brain metastases. A patient in his mid-fifties with stage IV pleural dissemination developed brain metastases after 10 years of crizotinib use, but showed a complete response after switching to brigatinib. Moreover, a patient in her early sixties with stage III recurrent large brain metastases 5 years after chemoradiation therapy experienced dramatic tumor shrinkage with brigatinib. In each case of ALK fusion gene-positive lung cancer with brain metastases, brigatinib showed a high efficacy and was well-tolerated after previous ALK-TKI and for bulky lesions.
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Affiliation(s)
- Kei Morikawa
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Yu Numata
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Yusuke Shinozaki
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Shotaro Kaneko
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Aya Matsushima
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Makoto Nishida
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Hirotaka Kida
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Hiroki Nishine
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
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Hirai T, Asano K, Ito I, Miyazaki Y, Sugiura H, Agirbasli M, Kobayashi S, Kobayashi M, Shimada D, Natsume I, Kawasaki T, Ohba T, Tajiri S, Sakamaki F, Mineshita M, Takihara T, Sekiya K, Tomii K, Tomioka H, Kita H, Nishizaka Y, Fukui M, Miyata T, Harigae H. A randomized double-blind placebo-controlled trial of an inhibitor of plasminogen activator inhibitor-1 (TM5614) in mild to moderate COVID-19. Sci Rep 2024; 14:165. [PMID: 38168544 PMCID: PMC10761996 DOI: 10.1038/s41598-023-50445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
An inhibitor of plasminogen activator inhibitor (PAI)-1, TM5614, inhibited thrombosis, inflammation, and fibrosis in several experimental mouse models. To evaluate the efficacy and safety of TM5614 in human COVID-19 pneumonia, phase IIa and IIb trials were conducted. In an open-label, single-arm trial, 26 Japanese COVID-19 patients with mild to moderate pneumonia were treated with 120-180 mg of TM5614 daily, and all were discharged without any notable side effects. Then, a randomized, double-blind, placebo-controlled trial was conducted in Japanese COVID-19 patients with mild to moderate pneumonia. The number of study participants was set to be 50 in each arm. Even after extension of the enrollment period, the number of study participants did not reach the initially intended sample size, and 75 patients were enrolled in the study. The total oxygenation scale from Day 1 to Day 14 as the primary endpoint was 1.5 in the TM5614 group vs 4.0 in the placebo group (p = 0.22), and the number of days of oxygen administration required as the secondary endpoint was 2.0 days in the TM5614 group vs 3.5 days in the placebo group (p = 0.34). Further studies will be necessary to verify the efficacy of PAI-1 inhibition for the treatment of COVID-19 pneumonia.Clinical trial registration: Two studies were conducted: a prospective, multicenter, open-label phase II study at https://jrct.niph.go.jp (jRCT2021200018) (First registration date 18/08/2020) and a prospective, multicenter, randomized, double-blind, placebo-controlled, phase II study at https://jrct.niph.go.jp (jRCT2021210006) (First registration date 28/05/2021).
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Affiliation(s)
- Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan.
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Isao Ito
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mehmet Agirbasli
- Department of Cardiology, Istanbul Medeniyet University Hospital TR, Istanbul, Turkey
| | - Seiichi Kobayashi
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Makoto Kobayashi
- Department of Respiratory Medicine, Osaki Citizen Hospital, Osaki, Japan
| | - Daishi Shimada
- Department of Infectious Disease Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ichiro Natsume
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Tsutomu Kawasaki
- Department of Respiratory Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Takehiko Ohba
- Department of Respiratory Medicine, Ome Municipal General Hospital, Ome, Japan
| | - Sakurako Tajiri
- Department of Respiratory Medicine, Tokai University Oiso Hospital, Oiso, Japan
| | - Fumio Sakamaki
- Department of Respiratory Medicine, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Masamichi Mineshita
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahisa Takihara
- Department of Respiratory Medicine, Ebina General Hospital, Ebina, Japan
| | - Kiyoshi Sekiya
- Department of Allergy and Respiratory Medicine, National Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiromi Tomioka
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Hideo Kita
- Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Yasuo Nishizaka
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Osaka, Japan
| | - Motonari Fukui
- Department of Respiratory Medicine, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Toshio Miyata
- Department of Molecular Medicine and Therapy, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan.
| | - Hideo Harigae
- Department of Hematology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Mineshita M, Nishine H, Handa H, Kida H, Inoue T. A Quantitative Computed Tomography Analysis of Fissure Integrity and Emphysema Destruction in Japanese Patients with Severe Chronic Obstructive Pulmonary Disease. Intern Med 2024:2250-23. [PMID: 38171859 DOI: 10.2169/internalmedicine.2250-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Objective Bronchoscopic lung volume reduction (BLVR) using a one-way endobronchial valve (EBV) can provide clinically meaningful benefits to chronic obstructive pulmonary disease (COPD) patients. Although the Japanese Pharmaceuticals and Medical Devices Agency approved EBVs in November 2022, information regarding the number of Japanese patients with severe COPD eligible for BLVR treatment is still lacking. We therefore screened computed tomography (CT) images of patients with severe COPD using a quantitative CT (QCT) analysis to estimate the proportion of candidates eligible for BLVR treatment with an EBV. Methods CT scans of COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 3 and 4 were retrospectively analyzed using QCT to evaluate fissure integrity and tissue destruction. The difference in volume-weighted percentage was measured using the density scores of the target lobe and ipsilateral non-target lobe at -910 Hounsfield units. The target lobe was defined as the most affected lobe, with an emphysema destruction score of >50% for each patient. Results High-resolution CT scans of 32 patients (GOLD 3=19, GOLD 4=13) were analyzed. The target lobe could not be identified in 1 patient, whereas the target lobes for 8 patients were not surrounded by fissures with ≥80% completeness. Conversely, in 13 patients, the target lobes were surrounded by fissures with >95% completeness. The remaining 10 patients had fissure completeness between 80% and 95% at the target lobes and were considered candidates for collateral ventilation assessment. Conclusion A QCT analysis showed that 23 of 32 patients with severe COPD could be considered for a thorough examination of BLVR treatment with EBV.
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Affiliation(s)
- Masamichi Mineshita
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | - Hiroki Nishine
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | - Hiroshi Handa
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | - Hirotaka Kida
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | - Takeo Inoue
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
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Takahashi H, Nagamatsu H, Yamada Y, Toba N, Toyama-Kousaka M, Ota S, Morikawa M, Shinoda M, Takano S, Fukasawa S, Park K, Yano T, Mineshita M, Shinkai M. Surveillance of seasonal influenza viruses during the COVID-19 pandemic in Tokyo, Japan, 2018-2023, a single-center study. Influenza Other Respir Viruses 2024; 18:e13248. [PMID: 38188373 PMCID: PMC10767599 DOI: 10.1111/irv.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction COVID-19 pandemic led to significant reductions in influenza detection worldwide, fueling debates on whether influenza truly ceased circulating in communities. The number of influenza cases decreased significantly in Japan, raising concerns about the potential risk of decreased immunity to influenza in the population. Our single-center study aimed to investigate influenza trends before and during the COVID-19 pandemic in Tokyo, Japan. Materials and Methods This cross-sectional study included patients of all ages who visited Tokyo Shinagawa Hospital between April 1, 2018, and March 31, 2023. Influenza and COVID-19 tests were conducted using Quick Navi-Flu2 and polymerase chain reaction (PCR). We analyzed data from before and during the COVID-19 epidemic, based on patient background, hospitalization, and deaths, collected from medical records. Results A total of 12 577 influenza tests were conducted, with approximately 100 tests consistently performed each month even in the influenza off-season. Throughout the observation period, 962 positive cases were identified. However, no cases were observed for 27 months between March 2020 and November 2022. Influenza A cases were reobserved in December 2022, followed by influenza B cases in March 2023, similar to the influenza incidence reports from Tokyo. The positivity rate during the 2022-2023 winter season was lower than before the COVID-19 epidemic and decreased in elderly patients, with no hospitalizations or deaths observed. Conclusion This single-center study provided actual trend data for influenza patients before and during COVID-19 outbreaks in Tokyo, which could offer insights into the potential impact and likelihood of influenza virus infection in Japan.
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Affiliation(s)
- Hidenori Takahashi
- Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan
- Department of Infection Control Tokyo Shinagawa Hospital Tokyo Japan
- Department of Respiratory Medicine St. Marianna University School of Medicine Kawasaki Japan
| | - Hiroki Nagamatsu
- Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan
| | - Yuka Yamada
- Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan
| | - Naoya Toba
- Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan
| | | | - Shinichiro Ota
- Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan
| | - Miwa Morikawa
- Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan
| | - Masahiro Shinoda
- Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan
| | - Syunsuke Takano
- Department of Infection Control Tokyo Shinagawa Hospital Tokyo Japan
| | - Suzuko Fukasawa
- Department of Infection Control Tokyo Shinagawa Hospital Tokyo Japan
| | - Kaeyoung Park
- Department of Infection Control Tokyo Shinagawa Hospital Tokyo Japan
| | - Takahiko Yano
- Department of Infection Control Tokyo Shinagawa Hospital Tokyo Japan
| | - Masamichi Mineshita
- Department of Respiratory Medicine St. Marianna University School of Medicine Kawasaki Japan
| | - Masaharu Shinkai
- Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan
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8
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Handa H, Tsuruoka H, Kinoshita K, Mineshita M. Dupilumab in a patient with severe asthma and glucocorticoid hypersensitivity: a case report. J Int Med Res 2023; 51:3000605231193922. [PMID: 37607026 PMCID: PMC10467398 DOI: 10.1177/03000605231193922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Recently, several biologics have been approved for the treatment of severe asthma. Dupilumab, a biologic used to treat severe asthma, is a monoclonal antibody targeting interleukin-4 and interleukin-13. In the present case, inhaled corticosteroid-induced glucocorticoid hypersensitivity was suspected, and the administration of omalizumab and mepolizumab had no beneficial effects. Subsequently, we switched to dupilumab therapy, which produced better effectiveness. Therefore, when a biologic agent proves ineffective, changing to another suitable biologic agent should be considered.
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Affiliation(s)
- Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hajime Tsuruoka
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Kinoshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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9
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Morikawa K, Kinoshita K, Matsuzawa S, Kida H, Handa H, Inoue T, Nakamura S, Sato Y, Mineshita M. EML4-ALK Gene Mutation Detected with New NGS Lung Cancer Panel CDx Using Sputum Cytology in a Case of Advanced NSCLC. Diagnostics (Basel) 2023; 13:2327. [PMID: 37510070 PMCID: PMC10378045 DOI: 10.3390/diagnostics13142327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
The detection of driver gene mutations has become essential for lung cancer; however, insufficient sample sizes make gene panel tests difficult to use. We previously reported that the lung cancer compact panel TM (LCCP) could detect EGFR and MET gene mutations with sputum cytology. To date, the detection of gene mutation using RNA from sputum samples is considered practically difficult. We report a case in which the EML4-ALK fusion gene was successfully detected from a sputum sample using the LCCP that was just released in Japan as a new next-generation sequencing lung cancer panel, CDx.
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Affiliation(s)
- Kei Morikawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Kohei Kinoshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Shin Matsuzawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Hirotaka Kida
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Takeo Inoue
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | | | | | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
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10
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Handa H, Ooka S, Shimizu J, Suzuki N, Mineshita M. Evaluation of airway involvement and treatment in patients with relapsing polychondritis. Sci Rep 2023; 13:8307. [PMID: 37221366 DOI: 10.1038/s41598-023-35616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/21/2023] [Indexed: 05/25/2023] Open
Abstract
Airway involvement in relapsing polychondritis (RP) can be debilitating and life threatening, often requiring interventional procedures. If standard therapies including systemic corticosteroid and immunosuppressive agents are ineffective, airway stenting is often required. Recently, biologics have been reported to be effective for RP, and the early administration of biologics may avoid airway stenting. To evaluate survival rates and treatment approaches, medical records of RP patients with airway involvement were reviewed. These cases were divided into the following groups: with and without malacia, stenting and non-stenting, and with and without biologics. Kaplan-Meier was used to calculate survival rates and log rank tests were used to analyze biologics groups. A total of 77 patients were enrolled. Airway stenting was performed in 13 patients, all of which developed airway malacia. The stenting group had significantly lower survival rates than the non-stenting group (p < 0.001). Stent-related complications were granulation tissue (85%) and mucostasis (69%). In the non-stenting group, a lower mortality rate was observed. A significantly higher survival rate was seen in patients administered biologics than without (p = 0.014). The early administration of biologics shows promise in preventing severe airway disorders that require airway stenting.
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Affiliation(s)
- Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki City, Kanagawa, Japan.
| | - Seido Ooka
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki City, Kanagawa, Japan
| | - Jun Shimizu
- Department of Immunology and Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Noboru Suzuki
- Department of Immunology and Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki City, Kanagawa, Japan
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11
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Kumagai K, Tsuruoka H, Morikawa K, Handa H, Mineshita M. Pre-treatment bronchoscopic evaluation in a case of relapsing polychondrits. BMC Pulm Med 2023; 23:108. [PMID: 37013530 PMCID: PMC10069111 DOI: 10.1186/s12890-023-02400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Relapsing polychondritis (RP) is a chronic and recurrent inflammatory disease of the cartilage tissues in the body. The cause of RP is unknown, and since it is a rare disease with symptoms that affect multiple organs, diagnosis is often delayed. CASE PRESENTATION A 62-year-old woman with no smoking history visited our institution complaining of fever, cough, and dyspnoea. Chest CT showed a stenosis from the left main bronchus to the left lower lobe branch. Bronchoscopy visualised intense erythema and oedema at the left main bronchus, with airway narrowing. Biopsy of the ear revealed degenerative vitreous cartilage and fibrous connective tissue with a mild inflammatory cell infiltrate. She was subsequently diagnosed with RP and administered systemic corticosteroid therapy. Her symptoms improved rapidly, and post-treatment bronchoscopy revealed that although mild erythema of the airway epithelium remained, oedema markedly improved, and the airway stenosis was resolved. CONCLUSIONS We report a case where pre-treatment bronchoscopy was able to visually confirm RP at the acute stage. Since RP is difficult to diagnose, severe airway narrowing can occur prior to diagnosis. Therefore, to determine the stage of the disease, it is helpful to perform bronchoscopic observation before treatment. However, bronchoscopic observation before treatment should be performed by experienced bronchoscopists due to the risk of airway obstruction.
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Affiliation(s)
- Kosumi Kumagai
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Hajime Tsuruoka
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan.
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12
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Nishiyama K, Morikawa K, Shinozaki Y, Ueno J, Tanaka S, Tsuruoka H, Azagami S, Ishida A, Yanagisawa N, Akashi YJ, Mineshita M. Case report: Electrocardiographic changes in pembrolizumab-induced fatal myocarditis. Front Immunol 2023; 14:1078838. [PMID: 36875060 PMCID: PMC9980342 DOI: 10.3389/fimmu.2023.1078838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Immune checkpoint inhibitor (ICI)-induced myocarditis is rare but fatal. Because of the rapid course of ICI-induced myocarditis, understanding of clinical course is only possible through information from case reports. We report a case of pembrolizumab-induced myocarditis in which we were able to document the course of electrocardiographic changes from onset to death. A 58-year-old woman with stage IV lung adenocarcinoma, who had completed her first cycle of pembrolizumab, carboplatin, and pemetrexed, was admitted with pericardial effusion. She underwent pericardiocentesis after admission. A second cycle of chemotherapy was administered 3 weeks after the first cycle. Twenty-two days after admission, she developed a mild sore throat and tested positive for SARS-CoV-2 antigen. She was diagnosed with mild coronavirus disease 2019 (COVID-19), isolated, and treated with sotrovimab. Thirty-two days after admission, an electrocardiogram showed monomorphic ventricular tachycardia (VT). Suspecting myocarditis caused by pembrolizumab, the patient was started on daily methylprednisolone after coronary angiography and endocardial biopsy. Eight days after the start of methylprednisolone administration, she was considered to have passed the acute stage. However, four days later, R-on-T phenomenon triggered polymorphic VT and she died. The impact of viral infections such as COVID-19 on patients be treated with immune checkpoint inhibitors is still unknown and we need to be careful with systemic management after viral infections.
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Affiliation(s)
- Kazuhiro Nishiyama
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yusuke Shinozaki
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Junko Ueno
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Satoshi Tanaka
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hajime Tsuruoka
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shinya Azagami
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Atsuko Ishida
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Nobuyuki Yanagisawa
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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13
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Morikawa K, Handa H, Ueno J, Tsuruoka H, Inoue T, Shimada N, Koike J, Nakamura S, Sato Y, Mineshita M. RET fusion mutation detected by re-biopsy 7 years after initial cytotoxic chemotherapy: A case report. Front Oncol 2022; 12:1019932. [DOI: 10.3389/fonc.2022.1019932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Personalized medicine using molecular-targeted drugs to achieve better therapeutic response and long-term prognosis is common practice for lung cancer treatment. However, in cases before gene batch tests were available, medical treatment continued without the detection of rare mutations. We report a sixty-seven-old year man diagnosed with adenocarcinoma T1cN3M1a, stage IVA. Initial screening performed 7 years earlier using EGFR mutation and ALK immunohistochemical tests were negative. Although first-line cytotoxic combination chemotherapy was remarkably effective, a gradual regression of the primary lesion was noted. After a recent bronchoscopic re-biopsy, RET fusion was detected by gene panel test. In addition, we were able to confirm RET from FFPE specimens obtained from 7-year-old pleural effusion cell blocks. Subsequent administration of the molecular-targeted drug selpercatinib, was highly effective for the primary lesion and all metastatic lesions including brain metastases. We describe a case of RET fusion-positive lung cancer where molecular targeted therapy and cytotoxic drug showed a drastic response and long-term therapy was well maintained. Next generation sequencing was able to correctly diagnose RET fusion mutation using re-biopsy specimen after going undiagnosed for 7 years.
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14
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Suzuki S, Imamura M, Mouri M, Tsuchida T, Tomita H, Matsuoka S, Takita M, Kakinuma K, Kawasaki T, Sakurai K, Yamazaki K, Kurokawa MS, Kunishima H, Matsuda T, Mineshita M, Takemura H, Fujitani S, Ooka S, Sugihara T, Kato T, Kawahata K. Serum gasdermin D levels are associated with the chest computed tomography findings and severity of COVID-19. Respir Investig 2022; 60:750-761. [PMID: 35934631 PMCID: PMC9273659 DOI: 10.1016/j.resinv.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/27/2022] [Accepted: 06/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of programmed cell death, especially pyroptosis and apoptosis, in unfavorable immune responses in COVID-19 remains to be elucidated. METHODS We conducted a cross-sectional analysis to investigate the association between the serum gasdermin D (GSDMD) levels, a pyroptotic marker, and caspase-cleaved cytokeratin 18 fragment (M30), an apoptotic marker, and the clinical status and abnormal chest computed tomography (CT) findings in patients with COVID-19. RESULTS In this study, 46 patients diagnosed with COVID-19 were divided into the following three groups according to the disease severity: mild to moderate group (n = 10), severe group (n = 14), and critical group (n = 22). The serum GSDMD levels were higher in the critical group than in the mild to moderate group (P = 0.016). In contrast, serum M30 levels were lower in the critical group than in the severe group (P = 0.048). Patients who required mechanical ventilation or died had higher serum GSDMD levels than those who did not (P = 0.007). Area of consolidation only and of ground glass opacity plus consolidation positively correlated with serum GSDMD levels (r = 0.56, P < 0.001 and r = 0.53, P < 0.001, respectively). CONCLUSION Higher serum GSDMD levels are associated with critical respiratory status and the consolidation area on chest CT in patients with COVID-19, suggesting that excessive activation of pyroptosis may affect the clinical manifestations in patients with COVID-19.
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Affiliation(s)
- Shotaro Suzuki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Mitsuru Imamura
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Corresponding author. Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University, School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan. Fax: +81-44-977-8593
| | - Mariko Mouri
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tomoya Tsuchida
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hayato Tomita
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shin Matsuoka
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Mumon Takita
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kazutaka Kakinuma
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tatsuya Kawasaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Keiichi Sakurai
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kazuko Yamazaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Manae S. Kurokawa
- Disease Biomarker Analysis and Molecular Regulation, St. Marianna University Graduate School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takahide Matsuda
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masamichi Mineshita
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiromu Takemura
- Department of Microbiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Seido Ooka
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takahiko Sugihara
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tomohiro Kato
- Clinical Proteomics and Molecular Medicine, St. Marianna University Graduate School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kimito Kawahata
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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15
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Handa H, Tsuruoka H, Matsuzawa S, Azagami S, Mineshita M. Temporary stenting in a case of bronchomalacia due to relapsing polychondritis. Respirol Case Rep 2022; 10:e01060. [PMID: 36312219 PMCID: PMC9606138 DOI: 10.1002/rcr2.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022] Open
Abstract
Airway involvement in relapsing polychondritis (RP) can often be debilitating and life threatening. Interventional procedures such as stenting can be useful to improve airway stenosis. This case was diagnosed with RP with a circumferential obstruction at the left main bronchus. We determined that a silicone airway stent would be placed. The silicone stent was removed after 22 months due to granulation tissue. After stent removal, bronchoscopic findings revealed a collapsing left main bronchus during exhalation, but airway patency was maintained during inhalation without any respiratory symptoms. In this case, bronchomalacia remained after stent removal. However, since there were no severe respiratory symptoms, we decided that stent replacement was unnecessary. In general, it is difficult to remove airway stents in severe tracheobronchomalacia; however, temporary stenting might be a useful procedure in cases with unilateral main bronchial stenosis.
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Affiliation(s)
- Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Hajime Tsuruoka
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Shin Matsuzawa
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Shinya Azagami
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
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16
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Nishioka Y, Toyoda Y, Egashira R, Johkoh T, Terasaki Y, Hebisawa A, Abe K, Baba T, Fujikura Y, Fujita E, Hamada N, Handa T, Hasegawa Y, Hidaka K, Hisada T, Hisata S, Honjo C, Ichikado K, Inoue Y, Izumi S, Kato M, Kishimoto T, Okamoto M, Miki K, Mineshita M, Nakamura Y, Sakamoto S, Sano M, Tsukada Y, Yamasue M, Bando Y, Homma S, Hagiwara K, Suda T, Inase N. Nationwide retrospective observational study of idiopathic dendriform pulmonary ossification: clinical features with a progressive phenotype. BMJ Open Respir Res 2022; 9:9/1/e001337. [PMID: 36162917 PMCID: PMC9516172 DOI: 10.1136/bmjresp-2022-001337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Diffuse pulmonary ossification is a specific lung condition that is accompanied by underlying diseases. However, idiopathic dendriform pulmonary ossification (IDPO) is extremely rare, and the clinical features remain unclear. In this study, we aimed to report the clinical characteristics of IDPO. METHODS We conducted a nationwide survey of patients with IDPO from 2017 to 2019 in Japan and evaluated the clinical, radiological, and histopathological findings of patients diagnosed with IDPO. RESULTS Twenty-two cases of IDPO were identified. Most subjects (82%) were male, aged 22-56 years (mean (SD), 37.9 (9.1)) at diagnosis. Nearly 80% of the subjects were asymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted <80% at diagnosis. The typical radiological features of high-resolution CT (HRCT) are calcified branching structures that are predominantly distributed in the lower lung fields without any other conspicuous finding. Histopathological analysis also showed dendriform ossified lesions from the intraluminal areas to interstitial areas. Notably, during the follow-up period of 20 years, disease progression was found in 88% on HRCT and more than 50% on pulmonary function tests (FVC and/or forced expiratory volume in 1 s). Two cases with rapid decline of 10% /year in %FVC predicted were observed.)) at diagnosis. Nearly 80% of the subjects were asymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted <80% at diagnosis. The typical radiological features of high-resolution CT (HRCT) are calcified branching structures that are predominantly distributed in the lower lung fields without any other conspicuous finding. Histopathological analysis also showed dendriform ossified lesions from the intraluminal areas to interstitial areas. Notably, during the follow-up period of 20 years, disease progression was found in 88% on HRCT and more than 50% on pulmonary function tests (FVC and/or forced expiratory volume in 1 s). Two cases with rapid decline of 10% /year in %FVC predicted were observed. CONCLUSIONS IDPO develops at a young age with gradually progressive phenotype. Further research and long-term (>20 years) follow-up are required to clarify the pathogenesis and clinical findings in IDPO.
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Affiliation(s)
- Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yuko Toyoda
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Akira Hebisawa
- Department of Clinical Pathology, Asahi General Hospital, Chiba, Japan
| | - Kinya Abe
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Etsuo Fujita
- Department of Respiratory Medicine, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan
| | - Naoki Hamada
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Koko Hidaka
- Department of Respiratory Medicine, National Hospital Organization Kokura Medical Center, Kitakyushu, Fukuoka, Japan
| | - Takeshi Hisada
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Meabashi, Gunma, Japan
| | - Shu Hisata
- Division of Pulmonary Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Chisato Honjo
- Department of Respiratory Medicine, University of Fukui Hospital, Fukui, Japan
| | - Kazuya Ichikado
- Department of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Motoyasu Kato
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St.Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Susumu Sakamoto
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Masaaki Sano
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshikazu Tsukada
- Department of Respiratory Medicine, Soka Municipal Hospital, Soka, Saitama, Japan
| | - Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yoshimi Bando
- Division of Pathology, Tokushima University Hospital, Tokushima, Japan
| | - Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Diseases Research, School of Medicine, Toho University, Tokyo, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naohiko Inase
- Hiratsuka Kyosai Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Hiratsuka, Kanagawa, Japan
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17
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Morikawa K, Kida H, Handa H, Inoue T, Mineshita M. EP11.01-010 A Prospective Validation Study of Lung Cancer Gene Panel Testing Using Cytological Specimens. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Morikawa K, Kida H, Handa H, Inoue T, Saji H, Koike J, Nakamura S, Sato Y, Ueda Y, Suzuki F, Matoba R, Mineshita M. A Prospective Validation Study of Lung Cancer Gene Panel Testing Using Cytological Specimens. Cancers (Basel) 2022; 14:cancers14153784. [PMID: 35954448 PMCID: PMC9367394 DOI: 10.3390/cancers14153784] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary The gold standard for genetic panel test samples is considered to be tissue specimens. However, in clinical practice, tissue specimens are often unavailable. Therefore, using an amplicon-based high-sensitivity next-generation sequencing panel test capable of measuring eight druggable genes, we enrolled patients who underwent diagnostic procedures to evaluate analysis accuracy, nucleic acid yield, and quality using cytological specimens. Cytological specimens were suitable for both nucleic acid yield and specimen quality due to the ease of collection and processing. Cytological sample analysis detected gene mutations in 68.7% of lung adenocarcinomas, and these samples were consistent with companion diagnostic tests 99.5% of the time. Moreover, the allele frequency of gene mutations in cytological specimens showed a high correlation with tissue specimens. This is the first study to prospectively evaluate the feasibility of a lung cancer gene panel test using cytological specimens. Abstract Background: Genetic panel tests require sufficient tissue samples, and therefore, cannot always be performed. Although collecting cytological specimens is easier than tissue collection, there are no validation studies on the diagnostic accuracy of lung cancer gene panel tests using cytology samples. Methods: Using an amplicon-based high-sensitivity next-generation sequencing panel test capable of measuring eight druggable genes, we prospectively enrolled consecutive patients who underwent diagnostic procedures. We evaluated the analysis accuracy rate, nucleic acid yield, and the quality of cytological specimens under brushing, needle aspiration, and pleural effusion. We then compared these specimens with collected tissue samples. Results: In 163 prospectively enrolled cases, nucleic acid extraction and analysis accuracy was 100% in cases diagnosed with adenocarcinoma. Gene mutations were found in 68.7% of cases with 99.5% (95% CI: 98.2–99.9) concordance to companion diagnostics. The median DNA/RNA yield and DNA/RNA integrity number were 475/321 ng and 7.9/5.7, respectively. The correlation coefficient of the gene allele ratio in 64 cases compared with tissue samples was 0.711. Conclusion: The success of gene analysis using cytological specimens was high, and the yield and quality of the extracted nucleic acid were sufficient for panel analysis. Moreover, the allele frequency of gene mutations in cytological specimens showed high correlations with tissue specimens.
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Affiliation(s)
- Kei Morikawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
- Correspondence: ; Tel.: +81-44-977-8111; Fax: +81-44-976-5792
| | - Hirotaka Kida
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
| | - Takeo Inoue
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan;
| | - Junki Koike
- Department of Pathological Diagnosis, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan;
| | - Seiji Nakamura
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Yoshiharu Sato
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Yumi Ueda
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Fumihiko Suzuki
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Ryo Matoba
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
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19
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Oki M, Handa H, Saka H, Kogure Y, Niwa H, Yamada A, Torii A, Ando M, Mineshita M. Changes in Pulmonary Function Test Results and Respiratory Symptoms before and after Airway Stent Removal. Respiration 2022; 101:925-930. [PMID: 35878595 DOI: 10.1159/000525783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Airway stenting is a useful form of palliation for patients with airway stenosis/fistulas; the stent can be removed after addressing the cause of the airway disorder. Patients with airway stents often complain of coughing and difficulty with expectoration, so the use of such stents can negatively affect pulmonary function and worsen symptoms. OBJECTIVES The aim of this study was to compare pulmonary function and respiratory symptoms before and after stent removal. METHODS Patients who would later undergo simple airway stent removal were prospectively recruited in two institutions. All stents were removed using both rigid and flexible bronchoscopes with patients under general anesthesia. Pulmonary function tests were performed before stent removal and at 1 and 4 weeks after stent removal. All patients self-reported their respiratory symptoms using a 100-mm visual analog scale (VAS). RESULTS Of the 31 patients enrolled, 28 (23 with malignant stenoses, 3 with benign stenoses, and 2 with fistulas [21 silicone and 7 metallic stents]) were included in analyses. Pulmonary function measurements before stent removal and at 1 and 4 weeks after stent removal were as follows: vital capacity, 3.00, 3.04, and 3.08 L (p = 0.387); forced expiratory volume in 1 s, 1.96, 1.96, and 2.12 L (p = 0.034); and peak expiratory flow, 3.60, 4.28, and 5.06 L/s, respectively (p < 0.001). Symptoms (cough, sputum production, difficulty with expectoration, and dyspnea) evaluated using the VAS improved significantly after stent removal. No complications were encountered during removal. CONCLUSION Removal of unnecessary airway stents improves pulmonary function and respiratory symptoms. Any stent that is no longer functioning should be removed.
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Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Yoshihito Kogure
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hideyuki Niwa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Arisa Yamada
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Atsushi Torii
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine St. Marianna University School of Medicine, Kawasaki, Japan
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20
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Morikawa K, Kinoshita K, Kida H, Inoue T, Mineshita M. Preliminary Results of NGS Gene Panel Test Using NSCLC Sputum Cytology and Therapeutic Effect Using Corresponding Molecular-Targeted Drugs. Genes (Basel) 2022; 13:genes13050812. [PMID: 35627198 PMCID: PMC9141607 DOI: 10.3390/genes13050812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/04/2022] Open
Abstract
As more molecular-targeted drugs for advanced non-small cell lung cancer are brought to market, batch tests for the identification of gene mutations are needed at initial diagnosis. However, since current gene panel tests require a sufficient amount of tissue sample, there are many instances where panel tests cannot be performed. Therefore, we have developed a highly sensitive next generation sequencing (NGS) panel test to facilitate cytological specimens. Herein, we describe three cases positive for epidermal growth factor receptor (EGFR) exon 19 deletion, MET exon 14 skipping, and KRAS G12A using NGS analysis from sputum. In each case, genetic information was consistent with companion diagnostic analysis obtained from tissue samples collected under bronchoscopy. In cases of EGFR and MET mutations, the corresponding tyrosine kinase inhibitors were highly effective. This is the first report to demonstrate that a novel panel test could detect gene mutations in sputum samples in clinical practice and compare the gene allele ratio with the sample directly collected from the lesion.
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Affiliation(s)
- Kei Morikawa
- Correspondence: ; Tel.: +81-44-977-8111; Fax: +81-44-976-5792
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21
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Nishi Y, Handa H, Tsuruoka H, Inoue T, Naruki S, Abe T, Mineshita M. Successful Treatment with Radiation Therapy in an Older Patient with Endobronchial Schwannoma. Case Rep Oncol 2022; 15:212-217. [PMID: 35431859 PMCID: PMC8958606 DOI: 10.1159/000522408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022] Open
Abstract
Bronchial schwannoma is extremely rare, accounting for a small percentage of benign bronchial tumors, with no determined standardized treatment. An 89-year-old woman with a persistent cough underwent CT scan which revealed a tracheal tumor. A diagnosis of endobronchial schwannoma was confirmed based on tissue obtained by high-frequency snare polypectomy. A hybrid stent was implanted in the trachea due to tumor regrowth; however, stent migration occurred, and it was removed after 1 month. Subsequently, radiation therapy was performed, and airway patency was well maintained for over 3 years. In general, surgical resection is recommended for endobronchial schwannoma; however, due to the age of this patient, resection was deemed invasive. Therefore, radiation therapy was administered as an alternative treatment.
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Affiliation(s)
- Yoshihiro Nishi
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- *Hiroshi Handa,
| | - Hajime Tsuruoka
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Saeko Naruki
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tatsuyuki Abe
- Department of Radiation Oncology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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22
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Otsubo K, Sakai H, Kimura H, Miyazawa T, Marushima H, Kojima K, Furuya N, Mineshita M, Chosokabe M, Koike J, Saji H. Thoracic mesenchymal malignant tumors and programed cell death ligand-1 status: Clinicopathologic and prognostic analysis of eight pulmonary sarcomatoid carcinomas and eight malignant mesotheliomas. Thorac Cancer 2021; 12:3169-3176. [PMID: 34655161 PMCID: PMC8636199 DOI: 10.1111/1759-7714.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The current study aimed to evaluate the significance of clinicopathological factors, particularly the immunohistochemistry of programed cell death ligand-1 (PD-L1), in eight cases each of pulmonary sarcomatoid carcinoma (PSC) and malignant pleural mesothelioma (MPM) at our hospital. METHODS From January 2004 to December 2020, a total of 16 consecutive patients (eight with PSC and eight with MPM diagnosed via surgical resection or biopsy) were included in this study. After retrospectively reviewing the patient characteristics, the associations between PD-L1 status and age, sex, stage, histological type, and prognosis were investigated. RESULTS PD-L1-positive staining was observed in four (50%) PSC cases and one (12.5%) MPM case. Among the four PD-L1-positive PSC cases, two showed high PD-L1 expression in the vimentin-positive sarcomatoid compartment. Moreover, among those with PSC, two survived for about 10 years, whereas the others died within 5 years. No clear correlation was found between PD-L1 expression and prognosis. Among the patients with MPM, four survived for more than 2 years, with the longest being 9 years. Among MPM cases who received nivolumab, one patient with positive PD-L1 staining in the sarcomatoid survived, whereas the other with negative PD-L1 staining did not. CONCLUSION The present study showed that sarcomatoid carcinoma had a higher PD-L1 expression compared to non-small-cell lung cancer and that both PSC and MPM tended to exhibit PD-L1 positivity in the sarcomatoid compartment. Moreover, while immune checkpoint inhibitors may somewhat prolong the prognosis of both tumors, further studies with a larger cohort are necessary to confirm our results.
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Affiliation(s)
- Kanji Otsubo
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Hiroki Sakai
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Hiroyuki Kimura
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Tomoyuki Miyazawa
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Hideki Marushima
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Koji Kojima
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Motohiro Chosokabe
- Department of PathologySt. Marianna University School of MedicineKawasakiJapan
| | - Junki Koike
- Department of PathologySt. Marianna University School of MedicineKawasakiJapan
| | - Hisashi Saji
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
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Miyazawa T, Morikawa K, Otsubo K, Sakai H, Kimura H, Chosokabe M, Furuya N, Marushima H, Kojima K, Mineshita M, Koike J, Saji H. Solid histological component of adenocarcinoma might play an important role in PD-L1 expression of lung adenocarcinoma. Thorac Cancer 2021; 13:24-30. [PMID: 34811933 PMCID: PMC8720631 DOI: 10.1111/1759-7714.14209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In this study we aimed to clarify the PD-L1 positive expression in lung adenocarcinoma, including various adenocarcinoma subtypes paying particular attention to its component. METHODS A total of 307 lung adenocarcinoma patients who underwent lobectomy or segmentectomy, as well as systematic lymph node dissection (ND2a), from February 2008 to March 2020 at our hospital, were enrolled into the study. A final diagnosis of adenocarcinoma was obtained from the resected lung specimens of all 307 patients to determine the histological type, adenocarcinoma subtype, and component of adenocarcinoma by ethics of 5%. PD-L1 was immunohistochemically stained using the murine monoclonal antibody clone 22C3. RESULTS When PD-L1 expression-positive was defined by tumor proportion score (TPS) ≥1%, the positive cases were 6/33 in adenocarcinoma (Ad) in situ (AIS), 2/26 in minimally invasive Ad (MIA), 12/60 in lepidic predominant Ad (LPA), 44/91 in papillary predominant Ad (PPA), 24/49 in acinar predominant Ad (APA), 23/28 in solid predominant Ad (SPA), 4/7 in micropapillary predominant Ad (MPA), and 0/13 in invasive mucinous Ad (IMA). In the high proportion group (APA, PPA, SPA, and MPA) of PD-L1 expression, SPA was the only subtype which was statistically significant when both PD-L1 expression-positive was defined by TPS ≥ 1% (p < 0.0001) and TPS ≧ 50% (p < 0.0001). We then considered the solid component. We investigated 279 cases of the other subtype group excluding SPA. The group containing a solid component (≥5%) tended to be PD-L1 expression-positive both when defined by TPS ≥1% (p < 0.0001) and TPS ≧50% (p = 0.0049). CONCLUSIONS The PD-L1 expression tended to be positive when a solid component was confirmed (≥5%) in specimens of lung adenocarcinoma patients.
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Affiliation(s)
- Tomoyuki Miyazawa
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kanji Otsubo
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Sakai
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Kimura
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Motohiro Chosokabe
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hideki Marushima
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Koji Kojima
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junki Koike
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
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Mineshita M, Morikawa K, Furuya N, Kida H, Nishine H, Handa H, Inoue T. Flexible bronchoscopy for lung cancer diagnosis in patients aged ≥85 years. Geriatr Gerontol Int 2021; 22:32-35. [PMID: 34786808 DOI: 10.1111/ggi.14313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/15/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
AIM Flexible bronchoscopy (FB) is a common modality for the diagnosis of lung cancer. Recently, the number of older patients with lung cancer is increasing, and FB is being utilized more for these patients. METHODS FB carried out in patients aged ≥85 years at St. Marianna University Hospital, Kawasaki, Japan, were reviewed. The indication of FB was decided on a case-by-case basis, taking into consideration the condition of the patient, which included mental status and accessibility of the lesion. Outcomes included complications, diagnostic yields, treatment options and survival after FB evaluation. RESULTS From April 2015 to March 2019, 1604 diagnostic FBs were carried out. A total of 28 were carried out for the diagnosis of lung cancer (19 transbronchial lung biopsy, 9 transbronchial needle aspiration) in patients aged ≥85 years. Although there were three complications reported (pneumonia, fever, asthma exacerbation), they were successfully treated. A total of 19 cases were diagnosed with malignancy; five were treated with stereotactic body radiation therapy, five were prescribed targeted therapy, two underwent surgery and one was treated by cytotoxic monotherapy. Six patients were not included for active treatment. A total of 12 patients who received active treatment for lung cancer reported a 2-year survival rate of >60%. CONCLUSIONS FB for lung cancer diagnosis in patients aged ≥85 years were carried out with acceptable safety and diagnostic yield. Considering the development of less invasive therapeutic measures for lung cancer, FB is safe and valuable in individuals aged ≥85 years suspected of lung cancer with therapeutic indications. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Masamichi Mineshita
- Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Morikawa
- Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Furuya
- Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirotaka Kida
- Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Nishine
- Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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25
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Morikawa K, Iinuma M, Shinozaki Y, Nishine H, Inoue T, Mineshita M. A case of advanced adenocarcinoma genetically confirmed with EGFR/BRAF co-mutation in both primary and metastatic lesions. Ther Adv Med Oncol 2021; 13:17588359211053420. [PMID: 34707694 PMCID: PMC8544759 DOI: 10.1177/17588359211053420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
Driver mutations in lung cancer have been generally considered mutually exclusive; however, multiple gene screenings have recently become mainstream. Therefore, it is not uncommon to identify two or more mutations at first diagnosis, making it difficult to determine which tyrosine kinase inhibitor to administer. A 69-year-old woman complaining of back pain was diagnosed with adenocarcinoma T4N3M1c, stage IVB. Although PCR mutation test detected exon21 L858R point mutation by bronchoscopic sample, the therapeutic effect of afatinib was poor. Subsequently, next-generation sequencing (NGS) panel test of a metastasized bone specimen confirmed BRAF V600E. Furthermore, high sensitivity NGS panel system found the gene mutation allele frequency was higher for BRAF V600E than EGFR exon21 L858R for both primary lung tissue and the metastasized specimen. Subsequent BRAF/MEK inhibitor administration showed a remarkable treatment effect. When two or more driver mutations are detected in lung cancer, confirming the allelic frequency of the mutant gene might be useful in selecting more effective agents for front-line treatment.
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Affiliation(s)
- Kei Morikawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan
| | - Masahiro Iinuma
- Department of Orthopedic Surgeon, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yusuke Shinozaki
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Nishine
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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26
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Kida H, Muraoka H, Morikawa K, Inoue T, Mineshita M. Pleurodesis After Bronchial Occlusion for Inoperable Secondary Spontaneous Pneumothorax. J Bronchology Interv Pulmonol 2021; 28:290-295. [PMID: 34191760 DOI: 10.1097/lbr.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In many cases of secondary spontaneous pneumothorax (SSP), surgery is not feasible. Furthermore, in cases with a collapsed lung or numerous air leaks, pleurodesis is ineffective, and treatment options are severely limited. For these cases, bronchial occlusion might be the only effective treatment, despite the low success rate. If, however, bronchial occlusion can expand the lung and reduce air leakage, it can positively amplify later effects on pleurodesis, resulting in a powerful treatment. We reviewed the clinical data of patients who underwent bronchial occlusion with endobronchial Watanabe spigot (BO-EWS) and pleurodesis to investigate the usefulness of bronchial occlusion therapy in inoperable SSP patients. MATERIALS AND METHODS This single-center, retrospective study reviewed 36 cases of inoperable SSP patients who underwent pleurodesis after BO-EWS from April 2007 to October 2018. Twenty cases were allocated to the air leak analysis group, and 16 cases were included in the pneumothorax volume analysis group. The Robert David Cerfolio classification and the Collins method were used to evaluate air leak and pneumothorax volume, respectively. RESULTS Pneumothorax volumes decreased significantly after BO-EWS from 29.1%±17.3% to 12.1%±8.8%, while the air leak score decreased from 2.9±1.4 to 1.2±1.0. The success rate for chest tube removals in cases that underwent pleurodesis after BO-EWS was 85.0% (17/20). CONCLUSIONS This study demonstrated the synergistic effectiveness of BO-EWS and the usefulness of pleurodesis treatment in inoperable SSP patients with lung collapse or numerous air leaks. We believe that this treatment will benefit patients with inoperable SSP which, until now, has had few treatment options.
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Affiliation(s)
- Hirotaka Kida
- Department of Internal Medicine, Division of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki
| | - Hiromi Muraoka
- Department of Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Kei Morikawa
- Department of Internal Medicine, Division of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki
| | - Takeo Inoue
- Department of Internal Medicine, Division of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki
| | - Masamichi Mineshita
- Department of Internal Medicine, Division of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki
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27
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Koda E, Nishine H, Saiki Y, Tsunoda A, Usuba A, Furuya N, Mineshita M. Untreated Squamous Cell Lung Carcinoma May Contribute to the Occurrence of Hemophagocytic Syndrome. Intern Med 2021; 60:2997-3002. [PMID: 33775994 PMCID: PMC8502648 DOI: 10.2169/internalmedicine.5892-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
A 44-year-old man presented at our hospital to be evaluated for persistent fever and dyspnea. A chest computed tomography (CT) scan showed diffuse ground glass shadows and a left hilar tumor shadow. Upon further examination, he was found to have leukopenia, thrombocytopenia, and elevated lactate dehydrogenase and ferritin levels. He was diagnosed with both squamous cell lung carcinoma by a transbronchial lung biopsy and hemophagocytic syndrome by a bone marrow biopsy. After receiving treatment with dexamethasone and etoposide, the blood test abnormalities and performance status improved. Chemotherapy for lung cancer was initiated. He had a partial response after first-line chemotherapy and thereafter underwent left upper sleeve lobectomy.
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Affiliation(s)
- Eriko Koda
- Division of Respiratory Disease, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Hiroki Nishine
- Division of Respiratory Disease, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yusuke Saiki
- Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Akihito Tsunoda
- Division of Respiratory Disease, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Ayano Usuba
- Division of Respiratory Disease, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Naoki Furuya
- Division of Respiratory Disease, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Masamichi Mineshita
- Division of Respiratory Disease, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
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28
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Miyazawa T, Otsubo K, Sakai H, Kimura H, Chosokabe M, Morikawa K, Furuya N, Marushima H, Kojima K, Mineshita M, Koike J, Saji H. Combining PD-L1 Expression and Standardized Uptake Values in FDG-PET/CT Can Predict Prognosis in Patients With Resectable Non-Small-Cell Lung Cancer. Cancer Control 2021; 28:10732748211038314. [PMID: 34384268 PMCID: PMC8369954 DOI: 10.1177/10732748211038314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to determine the relationship of programmed death-ligand 1 (PD-L1) expression and standardized uptake values in fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) with prognosis in non–small-cell lung cancer (NSCLC). Methods We retrospectively analyzed 328 NSCLC patients who underwent lobectomy/segmentectomy with lymph node dissection. PD-L1 expression was detected by immunohistochemically stained using the murine monoclonal antibody clone 22C3. The preoperative maximum standardized uptake value (SUVmax) of FDG-PET/CT at the primary lesion; pathological factors including histological type, microscopic lymphatic, venous, and pleural invasion; and lymph node metastases in resected specimens was determined. Significant prognostic clinicopathologic factors were analyzed by univariate and multivariate analyses. Results PD-L1 expression was higher in men, smokers, squamous cell carcinoma, advanced pathologic stages, positive venous invasion, positive pleural invasion, and high preoperative SUVmax (≥3). Postoperative survival analysis showed that both PD-L1 expression and preoperative SUVmax were significantly negative prognostic factors in univariate analysis for overall survival (OS) (P = 0.0123 and P < 0.0001) and relapse-free survival (RFS) (P = 0.0012 and P < 0.0001). Kaplan–Meier survival curves showed that the OS and RFS were the best in patients with negative PD-L1 expression and SUVmax < 3, intermediate in patients with positive PD-L1 expression and SUVmax < 3 and those with negative PD-L1 expression and SUVmax ≥ 3, and poor in patients with positive PD-L1 expression and SUVmax ≥ 3. Conclusion Combining PD-L1 expression and preoperative FDG-PET/CT SUVmax in primary tumor might help in accurate prediction of postoperative prognosis in NSCLC patients.
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Affiliation(s)
- Tomoyuki Miyazawa
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Kanji Otsubo
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Sakai
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Kimura
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Motohiro Chosokabe
- Pathology, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Hideki Marushima
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Koji Kojima
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Junki Koike
- Pathology, 12927St Marianna University School of Medicine, Kawasaki, Japan
| | - Hisashi Saji
- Departments of Chest Surgery, 12927St Marianna University School of Medicine, Kawasaki, Japan
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29
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Morikawa K, Kida H, Handa H, Inoue T, Mineshita M. Evaluation of Droplet Countermeasures by Particle Visualization System in Simulated Bronchoscopy. Am J Respir Crit Care Med 2021; 204:599-602. [PMID: 34170782 PMCID: PMC8491252 DOI: 10.1164/rccm.202009-3430im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kei Morikawa
- St. Marianna University School of Medicine, Division of Respiratory Diseases, Kawasaki, Japan;
| | - Hirotaka Kida
- St. Marianna University School of Medicine, Division of Respiratory and Infectious Diseases, Department of Internal Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- St. Marianna University School of Medicine, Division of Respiratory and Infectious Diseases, Department of Internal Medicine, Kawasaki, Japan
| | - Takeo Inoue
- St. Marianna University School of Medicine, Division of Respiratory and Infectious Diseases, Department of Internal Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- St. Marianna University School of Medicine, Division of Respiratory and Infectious Diseases, Kawasaki, Japan
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30
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Ikeda S, Misumi T, Izumi S, Sakamoto K, Nishimura N, Ro S, Fukunaga K, Okamori S, Tachikawa N, Miyata N, Shinkai M, Shinoda M, Miyazaki Y, Iijima Y, Izumo T, Inomata M, Okamoto M, Yamaguchi T, Iwabuchi K, Masuda M, Takoi H, Oyamada Y, Fujitani S, Mineshita M, Ishii H, Nakagawa A, Yamaguchi N, Hibino M, Tsushima K, Nagai T, Ishikawa S, Ishikawa N, Kondoh Y, Yamazaki Y, Gocho K, Nishizawa T, Tsuzuku A, Yagi K, Shindo Y, Takeda Y, Yamanaka T, Ogura T. Corticosteroids for hospitalized patients with mild to critically-ill COVID-19: a multicenter, retrospective, propensity score-matched study. Sci Rep 2021; 11:10727. [PMID: 34021229 PMCID: PMC8140087 DOI: 10.1038/s41598-021-90246-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/26/2021] [Indexed: 12/20/2022] Open
Abstract
Corticosteroids use in coronavirus disease 2019 (COVID-19) is controversial, especially in mild to severe patients who do not require invasive/noninvasive ventilation. Moreover, many factors remain unclear regarding the appropriate use of corticosteroids for COVID-19. In this context, this multicenter, retrospective, propensity score-matched study was launched to evaluate the efficacy of systemic corticosteroid administration for hospitalized patients with COVID-19 ranging in the degree of severity from mild to critically-ill disease. This multicenter, retrospective study enrolled consecutive hospitalized COVID-19 patients diagnosed January-April 2020 across 30 institutions in Japan. Clinical outcomes were compared for COVID-19 patients who received or did not receive corticosteroids, after adjusting for propensity scores. The primary endpoint was the odds ratio (OR) for improvement on a 7-point ordinal score on Day 15. Of 1092 COVID-19 patients analyzed, 118 patients were assigned to either the corticosteroid and non-corticosteroid group, after propensity score matching. At baseline, most patients did not require invasive/noninvasive ventilation (85.6% corticosteroid group vs. 89.8% non-corticosteroid group). The odds of improvement in a 7-point ordinal score on Day 15 was significantly lower for the corticosteroid versus non-corticosteroid group (OR, 0.611; 95% confidence interval [CI], 0.388-0.962; p = 0.034). The time to improvement in radiological findings was significantly shorter in the corticosteroid versus non-corticosteroid group (hazard ratio [HR], 1.758; 95% CI, 1.323-2.337; p < 0.001), regardless of baseline clinical status. The duration of invasive mechanical ventilation was shorter in corticosteroid versus non-corticosteroid group (HR, 1.466; 95% CI, 0.841-2.554; p = 0.177). Of the 106 patients who received methylprednisolone, the duration of invasive mechanical ventilation was significantly shorter in the pulse/semi-pulse versus standard dose group (HR, 2.831; 95% CI, 1.347-5.950; p = 0.006). In conclusion, corticosteroids for hospitalized patients with COVID-19 did not improve clinical status on Day 15, but reduced the time to improvement in radiological findings for all patients regardless of disease severity and also reduced the duration of invasive mechanical ventilation in patients who required intubation.Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry on April 21, 2020 (ID: UMIN000040211).
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Affiliation(s)
- Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0051, Japan.
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Keita Sakamoto
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Shosei Ro
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Natsuo Tachikawa
- Department of Infectious Disease, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawanishimachi, Kanagawa-ku, Yokohama-city, Kanagawa, 221-0855, Japan
| | - Nobuyuki Miyata
- Department of Infectious Disease, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawanishimachi, Kanagawa-ku, Yokohama-city, Kanagawa, 221-0855, Japan
| | - Masaharu Shinkai
- Department of Internal Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo, 140-8522, Japan
| | - Masahiro Shinoda
- Department of Internal Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo, 140-8522, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yuki Iijima
- Department of Respiratory Medicine, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, shibuya-ku, Tokyo, 150-8935, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, shibuya-ku, Tokyo, 150-8935, Japan
| | - Masaki Okamoto
- Department of Respirology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Chigyohama, Chuo-ku, Fukuoka, 810-0065, Japan
| | - Tomoyoshi Yamaguchi
- Department of Respiratory Medicine, Tokyo Rinkai Hospital, 1-4-2 Rinkai-Cho, Edogawa-ku, Tokyo, 123-0086, Japan
| | - Keisuke Iwabuchi
- Department of General Medicine, Kanagawa Prefectural Ashigarakami Hospital, 866-1 Matsuda-Soryo, Matsuda-machi, Ashigarakami, Kanagawa, 258-0003, Japan
| | - Makoto Masuda
- Department of Respiratory Medicine, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa-city, Kanagawa, 251-8550, Japan
| | - Hiroyuki Takoi
- Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yoshitaka Oyamada
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1Meguro-ku, HigashigaokaTokyo, 152-8902, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-city, Kanagawa, 216-8511, Japan
| | - Masamichi Mineshita
- Department of Internal Medicine, Division of Respiratory Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-city, Kanagawa, 216-8511, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-city, Tokyo, 181-8611, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Hospital Organization Kobe City Medical Center General Hospital, 2-1-1, Minatojima Minamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Nobuhiro Yamaguchi
- Department of Respiratory Medicine, Yokosuka City Hospital, 1-3-2 Nagasaka, Yokosuka-city, Kanagawa, 240-0195, Japan
| | - Makoto Hibino
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, 1-5-1 Tsujido Kandai, Fujisawa-city, Kanagawa, 251-0041, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, International University of Health and Welfare School of Medicine, 4-3 Kozunomori, Narita-city, Chiba, 286-8686, Japan
| | - Tatsuya Nagai
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu-Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu-city, Chiba, 279-0001, Japan
| | - Satoru Ishikawa
- Department of Respiratory Medicine, Funabashi Central Hospital, 6 -13-10 Kaijin, Funabashi-city, Chiba, 273-8556, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima-city, Hiroshima, 734-8530, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Yoshitaka Yamazaki
- Center of Infectious Diseases, Nagano Prefectural Shinshu Medical Center, 1332 Suzaka, Suzaka-city, Nagano, 382-8577, Japan
| | - Kyoko Gocho
- Department of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama-city, Kanagawa, 230-0012, Japan
| | - Tomotaka Nishizawa
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Akifumi Tsuzuku
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu-city, Gifu, 500-8717, Japan
| | - Kazuma Yagi
- Department of Pulmpnary Medicine, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, Kanagawa, 220-8521, Japan
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-city, Aichi, 466-8550, Japan
| | - Yuriko Takeda
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0051, Japan.
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Morikawa K, Izawa N, Kida H, Handa H, Inoue T, Mineshita M. Detection of a pinhole-sized bronchoesophageal fistula under bronchoscopic autofluorescence imaging. Thorac Cancer 2021; 12:2043-2045. [PMID: 34002538 PMCID: PMC8258352 DOI: 10.1111/1759-7714.14008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
Autofluorescence imaging (AFI) is a technique for detecting early‐stage lung cancer by amplifying the difference in autofluorescence of the bronchial mucosa. However, there are few reports detailing its other applications. Here, we report the case of a 54‐year‐old woman with stage IVa esophageal cancer who completed chemoradiation therapy, but developed a bronchoesophageal fistula at the left main bronchus and underwent fasting treatment. Computed tomography confirmed that the fistula had closed; however, she subsequently developed aspiration pneumonia and underwent bronchoscopy for confirmation. Although it was difficult to identify the site of the pinhole bronchoesophageal fistula under white light, AFI could easily identify the fistula and digestive mucus in light magenta. AFI may therefore be worth considering for the detection of pinhole bronchoesophageal fistulas.
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Affiliation(s)
- Kei Morikawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirotaka Kida
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Sakaguchi T, Ito K, Furuya N, Morikawa K, Fujiwara K, Nishii Y, Inoue T, Hataji O, Mineshita M. Assessment of chemotherapy regimens on radiation pneumonitis in patients with unresectable stage III non-small-cell lung cancer after definitive chemoradiotherapy. Thorac Cancer 2021; 12:2024-2030. [PMID: 34002492 PMCID: PMC8258360 DOI: 10.1111/1759-7714.14005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background Consolidation therapy with durvalumab after concurrent chemoradiotherapy has been reported to significantly prolong progression‐free survival and overall survival in patients with stage III unresectable non‐small cell lung cancer (NSCLC). However, which chemotherapy regimen should be selected for consolidation therapy with durvalumab is currently unknown. Methods We retrospectively reviewed consecutive patients with unresectable stage III NSCLC who received concurrent definitive chemoradiotherapy with platinum‐based chemotherapy. We reviewed the timing and severity of radiation pneumonitis by assessing chemotherapy regimens and histology. Results A total of 103 patients were identified. Fourteen patients (13.6%) developed grade 2 or greater radiation pneumonitis within 42 days after chemoradiotherapy. No adenocarcinoma patients treated with a regimen of cisplatin plus pemetrexed developed grade 2 or greater radiation pneumonitis within 42 days; however, 20% of patients who were treated with carboplatin plus paclitaxel developed grade 2 or greater radiation pneumonitis. Furthermore, the objective response rates and disease control rates of cisplatin plus pemetrexed were equal to or greater than those of carboplatin plus paclitaxel in adenocarcinoma patients. Conclusion Cisplatin plus pemetrexed regimen may be a preferable option to consider for subsequent consolidation therapy with durvalumab in patients with unresectable stage III adenocarcinoma.
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Affiliation(s)
- Tadashi Sakaguchi
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.,Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Kentaro Ito
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kentaro Fujiwara
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Yoichi Nishii
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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33
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Nishine H, Hiramoto T, Handa H, Inoue T, Wakahara K, Saka H, Miyazawa T, Mineshita M. Assessment of Extensive Airway Obstruction Using Point-by-Point Lateral Pressure Measurements during Bronchoscopy. Respiration 2021; 100:611-617. [PMID: 33946078 DOI: 10.1159/000515442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The positioning of the stent at the flow-limiting segment is crucial for patients with extensive airway obstruction to relieve dyspnea. However, CT and flow-volume curves cannot detect the area of maximal obstruction. OBJECTIVES The aim of this study is to physiologically evaluate extensive airway obstruction during interventional bronchoscopy. METHODS We prospectively measured point-by-point lateral airway pressure (Plat) at multiple points from the lower lobe bronchus to the upper trachea using a double-lumen catheter in 5 patients. The site of maximal obstruction was evaluated continuously to measure point-by-point Plat at multiple points when the airway catheter was withdrawn from the lower lobe bronchus to the upper trachea. RESULTS Remarkable pressure differences occurred at the site of maximal obstruction assessed by point-by-point Plat measurements. After initial stenting in 1 case, migration of the maximal obstruction to a nonstented segment of the weakened airway was seen with extensive stenosis from the trachea to the bronchi. In the second case, in addition to radiological analysis, point-by-point Plat measurements could identify the location of the maximal obstruction which contributed to dyspnea. CONCLUSIONS Point-by-point Plat measurement could be used to detect the site of maximal obstruction physiologically. Furthermore, Plat measurement could assess the need for additional procedures in real time in patients with extensive airway obstruction.
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Affiliation(s)
- Hiroki Nishine
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takehiko Hiramoto
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keiko Wakahara
- Division of Respirology, Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan
| | - Hideo Saka
- Departments of Respiratory Medicine and Medical Oncology, National Organization Nagoya Medical Center, Nagoya, Japan
| | - Teruomi Miyazawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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34
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Handa H, Azagami S, Mineshita M. Natural closing of a tracheal tear caused by intubation in a patient with relapsing polychondritis. Respirol Case Rep 2021; 9:e00721. [PMID: 33664957 PMCID: PMC7900709 DOI: 10.1002/rcr2.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/05/2021] [Accepted: 02/03/2021] [Indexed: 12/03/2022] Open
Abstract
Relapsing polychondritis (RP) often develops into severe tracheobronchial stenosis with malacia. Although tracheal tears rarely occur by intubation, treatment decisions for tears can be difficult due to airway inflammation in RP patients. In this case, due to advanced age and immunosuppressive treatment, we decided against invasive surgery.
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Affiliation(s)
- Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Shinya Azagami
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
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35
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Tsuchida T, Nitahara Y, Suzuki S, Komase Y, Candray K, Kido Y, Nakagama Y, Yamasaki Y, Imamura M, Kawahata K, Kunishima H, Fujitani S, Mineshita M, Matsuda T. Back to normal; serological testing for COVID-19 diagnosis unveils missed infections. J Med Virol 2021; 93:4549-4552. [PMID: 33739483 PMCID: PMC8250857 DOI: 10.1002/jmv.26949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022]
Abstract
Background The gold standard for coronavirus disease (COVID‐19) diagnosis has been the detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA by nucleic acid amplification testing (NAAT). On the other hand, serological testing for COVID‐19 may offer advantages in detecting possibly overlooked infections by NAAT. Methods To evaluate seroconversion of NAAT‐negative pneumonia patients, immunoglobulin M (IgM) and IgG targeting the spike protein of SARS‐CoV‐2 were semiquantified by an immunofluorescence assay. Seroconversion was confirmed by another serological method, targeting the nucleocapsid protein. Results Eight suspected but unconfirmed COVID‐19 pneumonia patients (median age, 39 years; range, 21–55) were included. The median period between symptom onset and NAAT sample collection was 6 days (2–27 days). None of them had tested positive for SARS‐CoV‐2 by NAAT. In contrast, all eight patients revealed seropositivity with the two serological methods, indicating actual seroconversion against SARS‐CoV‐2. The median period between onset and blood sampling was 26.5 days (7–51 days). Conclusion Eight patients with COVID‐19 pneumonia, initially tested negative for SARS‐CoV‐2 by NAAT, were finally confirmed of the diagnosis by serological testing. To cover the whole spectrum of this heterogenous infectious disease, serology testing should be implemented to the multitiered diagnostic algorithm for COVID‐19.
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Affiliation(s)
- Tomoya Tsuchida
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuko Nitahara
- Department of Parasitology and Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shotaro Suzuki
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuko Komase
- Department of Respiratory Internal Medicine, St. Marianna University School of Medicine, Yokohama-City Seibu Hospital, Yokohama, Japan
| | - Katherine Candray
- Department of Parasitology and Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasutoshi Kido
- Department of Parasitology and Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yu Nakagama
- Department of Parasitology and Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yukitaka Yamasaki
- Department of Infectious Diseases, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mitsuru Imamura
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kimito Kawahata
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahide Matsuda
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Furuya N, Kakinuma K, Morikawa K, Inoue T, Mineshita M. P14.05 The Relationship Between Genomic Alterations and the Efficacy of Immune Check Point Inhibitor for KRAS Mutated Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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37
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Tsuruoka H, Handa H, Yamashiro T, Nishine H, Inoue T, Mineshita M. Correlation between Computed Tomographic Analysis and Pulmonary Function Measurements in Patients with Relapsing Polychondritis. Respiration 2021; 100:109-115. [PMID: 33477148 DOI: 10.1159/000511437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Relapsing polychondritis (RP) is a rare systemic disease of unknown origin, with cartilaginous involvement in multiple organs. Airway involvement is the most important prognostic factor in RP. OBJECTIVES Spirometric measurements and minimum tracheal cross-sectional area (mtCSA) have been reported as useful to assess the degree of airway stenosis. Because the length and severity of tracheal involvement in RP can vary, mtCSA might not provide enough information to assess tracheal abnormalities. We introduced tracheal volume (TrV) as a new method to evaluate correlations between chest computed tomography (CT) measurements and pulmonary function tests, including impulse oscillometry (IOS). METHOD We analyzed chest CT images, spirometry, and IOS collected at our institution from April 2004 to March 2019. We calculated correlations between chest CT measurements using software (TrV, TrV/tracheal length [TrV/TL], and mtCSA) and pulmonary function parameters. RESULTS Twenty-five of 73 clinically diagnosed patients with RP were included. Spirometric findings showed moderate airway obstruction. Peak flow (PEF) was strongly correlated with mtCSA, TrV, and TrV/TL (ρ = 0.74, p < 0.001). FEV1 was significantly correlated with mtCSA (ρ = 0.56, p = 0.004), TrV (ρ = 0.52, p = 0.007), and TrV/TL (ρ = 0.53, p = 0.006). Whereas respiratory resistance at 5 Hz (R5) and 20 Hz (R20) and resonant frequencies (RFs) were significantly correlated with TrV (ρ = -0.46, p = 0.021; ρ = -0.46, p = 0.046; and ρ = -0.42, p = 0.037, respectively), IOS parameters and mtCSA were not. CONCLUSIONS In patients with RP, TrV and mtCSA were strongly correlated with spirometric measurements. Respiratory resistances assessed by IOS correlated only with TrV. This suggests TrV assessment reflects pulmonary function in patients with RP more appropriately than mtCSA.
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Affiliation(s)
- Hajime Tsuruoka
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Radiology, Yokohama City University, Yokohama, Japan
| | - Hiroki Nishine
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan,
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Abstract
An 83-years-old woman diagnosed with advanced Epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma was administered afatinib as a first-line treatment. On Day 17, the patient presented with grade 3 diarrhea and a blood test analysis showed an increased inflammatory response. Afatinib treatment was discontinued on the same day. On Day 26, the patient displayed blepharedema and multiple irregular erythema covering her entire body. Drug-induced hypersensitivity syndrome (DIHS) was suspected, and the systemic administration of 30 mg/day prednisolone was administered. The symptoms subsided thereafter. A blood test analysis 3 weeks after onset revealed a reactivation of Human herpesvirus 6 (HHV-6) and a diagnosis of DIHS due to afatinib therapy was confirmed.
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Affiliation(s)
- Baku Oyama
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | - Kei Morikawa
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | | | - Akihito Tsunoda
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | - Hirotaka Kida
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | - Takeo Inoue
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
| | - Masamichi Mineshita
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Japan
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39
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Koda E, Yamashiro T, Onoe R, Handa H, Azagami S, Matsushita S, Tomita H, Inoue T, Mineshita M. CT texture analysis of mediastinal lymphadenopathy: Combining with US-based elastographic parameter and discrimination between sarcoidosis and lymph node metastasis from small cell lung cancer. PLoS One 2020; 15:e0243181. [PMID: 33264372 PMCID: PMC7710054 DOI: 10.1371/journal.pone.0243181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To investigate the potential of computed tomography (CT)-based texture analysis and elastographic data provided by endobronchial ultrasonography (EBUS) for differentiating the mediastinal lymphadenopathy by sarcoidosis and small cell lung cancer (SCLC) metastasis. Methods Sixteen patients with sarcoidosis and 14 with SCLC were enrolled. On CT images showing the largest mediastinal lymph node, a fixed region of interest was drawn on the node, and texture features were automatically measured. Among the 30 patients, 19 (12 sarcoidosis and 7 SCLC) underwent endobronchial ultrasound transbronchial needle aspiration, and the fat-to-lesion strain ratio (FLR) was recorded. Texture features and FLRs were compared between the 2 patient groups. Logistic regression analysis was performed to evaluate the diagnostic accuracy of these measurements. Results Of the 31 texture features, the differences between 11 texture features of CT ROIs in the patients with sarcoidosis versus patients with SCLC were significant. Among them, the grey-level run length matrix with high gray-level run emphasis (GLRLM-HGRE) showed the greatest difference (P<0.01). Differences between FLRs were significant (P<0.05). Logistic regression analysis together with receiver operating characteristic curve analysis demonstrated that the FLR combined with the GLRLM-HGRE showed a high diagnostic accuracy (100% sensitivity, 92% specificity, 0.988 area under the curve) for discriminating between sarcoidosis and SCLC. Conclusion Texture analysis, particularly combined with the FLR, is useful for discriminating between mediastinal lymphadenopathy caused by sarcoidosis from that caused by metastasis from SCLC.
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Affiliation(s)
- Eriko Koda
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of Diagnostic Radiology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Rintaro Onoe
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shinya Azagami
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shoichiro Matsushita
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hayato Tomita
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- * E-mail:
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40
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Furuya N, Matsumoto S, Kakinuma K, Morikawa K, Inoue T, Saji H, Goto K, Mineshita M. Suitability of transbronchial brushing cytology specimens for next-generation sequencing in peripheral lung cancer. Cancer Sci 2020; 112:380-387. [PMID: 33124129 PMCID: PMC7780058 DOI: 10.1111/cas.14714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 02/01/2023] Open
Abstract
Next‐generation sequencing (NGS) enables the diagnosis of large numbers of gene aberrations during one examination, and precision medicine has been developed for patients with advanced non–small cell lung cancer (NSCLC). However, peripheral lung lesions account for the majority of advanced lung cancers, especially lung adenocarcinoma. In these cases, it is difficult to obtain tissue samples which contain sufficient tumor cells by transbronchial biopsy (TBB) with forceps. Even when the target lesions are quite small, bronchial brushing can obtain enough tumor cells by endobronchial ultrasonography using guide sheath (EBUS‐GS). In this study, we investigate the suitability of bronchial brushing cytology specimens obtained by EBUS‐GS‐TBB to evaluate the correlation between the success rate of NGS and extracted DNA/RNA yields according to biopsy method. We prospectively collected 222 tumor samples obtained from patients with advanced lung cancer. All patients were enrolled in a prospective nationwide genomic screening project for lung cancer (LC‐SCRUM‐Japan/Asia). Genomic data were obtained from the clinico‐genomic database of LC‐SCRUM‐Japan/Asia. The extraction yields of DNA/RNA from samples obtained by EBUS‐GS‐TBB were relatively low compared with tissue samples. The success rate of DNA sequencing for EBUS‐GS‐TBB was 97.9%, with no significant differences between biopsy methods. The success rate of RNA sequencing for EBUS‐GS‐TBB was 80.4%, which was relatively low compared with surgical biopsy samples (P = 0.069). However, some rare oncogenic driver aberrations were detected from these specimens. This study demonstrated that cytology samples obtained by transbronchial brushing with EBUS‐GS‐TBB were suitable for NGS analysis.
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Affiliation(s)
- Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shingo Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazutaka Kakinuma
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Sakaguchi T, Inoue T, Miyazawa T, Mineshita M. Comparison of the 22-gauge and 25-gauge needles for endobronchial ultrasound-guided transbronchial needle aspiration. Respir Investig 2020; 59:235-239. [PMID: 33187889 DOI: 10.1016/j.resinv.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive hilar mediastinal node sampling technique used for lung cancer staging and diagnosis of lesions. Besides the conventional 22-gauge (G) and 21G needles, a 25G needle is now available for this procedure. The objective of this study was to evaluate the efficacy of the 25G EBUS-TBNA needle. METHODS We retrospectively reviewed consecutive patients who underwent EBUS-TBNA using both 22G and 25G aspiration needles from January 2017 through December 2017 at St. Marianna University School of Medicine. We identified 10 patients and compared the diagnostic yield and the sample volume for each needle. RESULTS Six patients were diagnosed with lung cancer and four with sarcoidosis. Total diagnostic yield was 80% (8/10) for the 22G and 60% (6/10) for the 25G (P = 0.31). In patients with lung cancer, the diagnostic yield was 67% (4/6) for the 22G and 83% (5/6) for the 25G (P = 0.50). In patients with sarcoidosis, the diagnostic yield was 100% (4/4) for the 22G and 25% (1/4) for the 25G (P = 0.07). In patients with lung cancer, the median tissue area was comparable for each needle; however, in patients with sarcoidosis, the sample area was smaller for the 25G than for the 22G. We did not encounter any major complications or bleeding during EBUS-TBNA procedures. CONCLUSIONS Although histologic specimens obtained by the 25G needle are expected to be useful for the diagnosis of lung cancer, we found the 25G needle inadequate for diagnosing sarcoidosis due to insufficient sample size.
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Affiliation(s)
- Tadashi Sakaguchi
- St. Marianna University School of Medicine, Division of Respiratory Medicine, Kanagawa, Japan; Respiratory Center, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-0073, Japan.
| | - Takeo Inoue
- St. Marianna University School of Medicine, Division of Respiratory Medicine, Kanagawa, Japan
| | - Teruomi Miyazawa
- St. Marianna University School of Medicine, Division of Respiratory Medicine, Kanagawa, Japan
| | - Masamichi Mineshita
- St. Marianna University School of Medicine, Division of Respiratory Medicine, Kanagawa, Japan
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Furuya N, Kojima K, Marushima H, Kakinuma K, Tsunoda A, Koda E, Tsuruoka H, Nishida K, Inoue T, Saji H, Mineshita M. Successful treatment with nivolumab in a patient with lung adenocarcinoma complicated by pulmonary aspergilloma. Thorac Cancer 2020; 11:3391-3395. [PMID: 32941695 PMCID: PMC7605990 DOI: 10.1111/1759-7714.13662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are the key drugs used in patients with non‐small cell lung cancer (NSCLC). However, anti‐PD‐1 therapy might worsen chronic infection by reactivating the immune response to infectious diseases. Here, we describe a case of successful treatment with nivolumab in a patient with NSCLC complicated by pulmonary aspergilloma, which was safely treated by surgical resection before administration of nivolumab. In conclusion, to safely treat patients with locally limited chronic pulmonary aspergillosis (CPA), surgical resection should be considered before ICI therapy.
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Affiliation(s)
- Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Koji Kojima
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hideki Marushima
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazutaka Kakinuma
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Akihito Tsunoda
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Eriko Koda
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hajime Tsuruoka
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Nishida
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Takamoto H, Nishine H, Sato S, Sun G, Watanabe S, Seokjin K, Asai M, Mineshita M, Matsui T. Development and Clinical Application of a Novel Non-contact Early Airflow Limitation Screening System Using an Infrared Time-of-Flight Depth Image Sensor. Front Physiol 2020; 11:552942. [PMID: 33013479 PMCID: PMC7516262 DOI: 10.3389/fphys.2020.552942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
Obstructive pulmonary diseases, such as diffuse panbronchiolitis (DPB), asthma, chronic obstructive pulmonary disease (COPD), and asthma COPD overlap syndrome (ACOS) trigger a severe reaction at some situations. Detecting early airflow limitation caused by diseases above is critical to stop the progression. Thus, there is a need for tools to enable self-screening of early airflow limitation at home. Here, we developed a novel non-contact early airflow limitation screening system (EAFL-SS) that does not require calibration to the individual by a spirometer. The system is based on an infrared time-of-flight (ToF) depth image sensor, which is integrated into several smartphones for photography focusing or augmented reality. The EAFL-SS comprised an 850 nm infrared ToF depth image sensor (224 × 171 pixels) and custom-built data processing algorithms to visualize anterior-thorax three-dimensional motions in real-time. Multiple linear regression analysis was used to determine the amount of air compulsorily exhaled after maximal inspiration (referred to as the forced vital capacity, FVCEAFL–SS) from the ToF-derived anterior-thorax forced vital capacity (FVC), height, and body mass index as explanatory variables and spirometer-derived FVC as the objective variable. The non-contact measurement is automatically started when an examinee is sitting 35 cm away from the EAFL-SS. A clinical test was conducted with 32 COPD patients (27/5 M/F, 67–93 years) as typical airflow limitation cases recruited at St. Marianna University Hospital and 21 healthy volunteers (10/11 M/F, 23–79 years). The EAFL-SS was used to monitor the respiration of examinees during forced exhalation while sitting still, and a spirometer was used simultaneously as a reference. The forced expiratory volume in 1 s (FEV1%EAFL–SS) was evaluated as a percentage of the FVCEAFL–SS, where values less than 70% indicated suspected airflow limitation. Leave-one-out cross-validation analysis revealed that this system provided 81% sensitivity and 90% specificity. Further, the FEV1EAFL–SS values were closely correlated with that measured using a spirometer (r = 0.85, p < 0.0001). Hence, EAFL-SS appears promising for early airflow limitation screening at home.
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Affiliation(s)
- Hiroki Takamoto
- Graduate School of Systems Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Hiroki Nishine
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shohei Sato
- Japan Research Institute, Huawei Technologies Japan KK, Kanagawa, Japan
| | - Guanghao Sun
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | | | - Kim Seokjin
- Graduate School of Systems Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Masahito Asai
- Graduate School of Systems Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Masamichi Mineshita
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takemi Matsui
- Graduate School of Systems Design, Tokyo Metropolitan University, Tokyo, Japan
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Morikawa K, Kida H, Handa H, Furuya N, Nishine H, Inoue T, Saji H, Koike J, Mineshita M. The efficacy of EBUS-guided cryobiopsy for peripheral pulmonary lesions. Lung Cancer 2020. [DOI: 10.1183/13993003.congress-2020.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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45
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Sakaguchi T, Furuya N, Ito K, Hida N, Morikawa K, Komase Y, Inoue T, Hataji O, Mineshita M. The efficacy and safety of ramucirumab plus docetaxel in older patients with advanced non-small cell lung cancer. Thorac Cancer 2020; 11:1559-1565. [PMID: 32291896 PMCID: PMC7262941 DOI: 10.1111/1759-7714.13429] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ramucirumab plus docetaxel (RAM+DOC) is expected to prolong survival in patients with advanced non-small cell lung cancer (NSCLC); however, the efficacy and safety for older patients remains unknown. The objective of this study was to evaluate the efficacy and safety of RAM+DOC in patients 75 years and older. METHODS We retrospectively reviewed consecutive patients with advanced NSCLC who had received RAM+DOC treatment at three institutions. We compared the efficacy and safety in patients 75 years and older to those under 75 years of age. RESULTS A total of 114 patients were identified. The median progression-free survival, time to treatment failure and overall survival was 3.6 (95% CI: 0.4-6.7), 3.1 (95% CI: 2.4-3.9) and 11.2 months (95% CI: 5.6-16.8) in the older group (N = 23), and 4.2 (95% CI: 3.3-5.0), 3.4 (95% CI: 3.3-5.0) and 12.2 months (95% CI: 9.1-15.4) in the younger group (N = 91), respectively. Survival curves were similar for each group, while the objective response rate was 30.4% (95% CI: 13.2-52.9%) in older patients and 35.2% (95% CI, 25.4-45.9%) for the younger group. A total of 22 older patients (95.7%) and 73 (80.2%) younger patients received primary prophylactic pegylated-granulocyte-colony stimulating factor (PEG-G-CSF). Four older patients (17.3%) and 14 younger patients (15.3%) discontinued RAM+DOC due to adverse events. CONCLUSIONS RAM+DOC is expected to be efficacious and tolerable in older patients when supported with prophylactic PEG-G-CSF therapy. KEY POINTS Significant findings of the study ・PFS, OS, and ORR in older patients were similar to those under 75 years of age. ・Safety of RAM+DOC was well tolerated in older patients with prophylactic PEG-G-CSF. ・Prophylactic PEG-G-CSF with RAM+DOC may contribute to better efficacy. What this study adds ・This study suggests that RAM+DOC with prophylactic PEG-G-CSF is expected to be a useful option in older patients with advanced NSCLC.
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Affiliation(s)
- Tadashi Sakaguchi
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kentaro Ito
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Naoya Hida
- Division of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuko Komase
- Division of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Furuya N, Ito K, Sakaguchi T, Hida N, Kakinuma K, Morikawa K, Inoue T, Komase Y, Hataji O, Mineshita M. The Impact of EGFR Mutation Status and Brain Metastasis for Non-Small Cell Lung Cancer Treated with Ramucirumab plus Docetaxel. Oncology 2020; 98:661-668. [PMID: 32464632 PMCID: PMC7592951 DOI: 10.1159/000507050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/05/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Currently, combination therapy of ramucirumab (RAM) + docetaxel (DOC) must play a more important role as a second-line treatment. Epithelial growth factor receptor (EGFR) mutation accounts for around 50% of oncogenic driver mutations in patients with advanced non-small cell lung cancer (NSCLC) in Asian subsets. The number of brain metastases (BM) is relatively higher in EGFR mutation-positive patients compared to EGFR wild-type patients. The objective of this study is to evaluate the efficacy of RAM + DOC focusing on EGFR mutation and BM. METHODS We retrospectively reviewed consecutive advanced NSCLC patients who received combination therapy of RAM + DOC at three institutions. A total of 112 patients with NSCLC were enrolled for efficacy analyses. We evaluated the efficacy of RAM + DOC for EGFR-mutated NSCLC with endpoints including progression-free survival (PFS), time to treatment failure (TTF) and overall survival. RESULTS Median PFS was 5.7 months for the EGFR mutant group compared with 3.6 months for the EGFR wild-type group (HR 0.53, 95% CI 0.32-0.87; p = 0.01). Median TTF was 5.1 months for the EGFR mutant group compared with 2.8 months for the EGFR wild-type group (HR 0.53, 95% CI 0.33-0.85; p = 0.007). Median PFS and TTF of the EGFR mutant group was significantly longer than median PFS and TTF of the EGFR wild-type group. The multivariate analysis identified EGFR mutation status as an independent favorable factor of PFS. In subset analyses of BM, median PFS of the EGFR mutant group (2.8 months) was significantly shorter than that of the EGFR wild-type group (5.1 months) (HR 7.27, 95% CI 1.78-29.68; p = 0.002). CONCLUSION This study revealed that EGFR mutation status and BM might be predictive or prognostic factors for PFS.
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Affiliation(s)
- Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan,
| | - Kentaro Ito
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Tadashi Sakaguchi
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Naoya Hida
- Division of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Kazutaka Kakinuma
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuko Komase
- Division of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Muraoka H, Tsuburai T, Komase Y, Ono A, Oyama B, Tsuruoka H, Usuba A, Hida N, Mineshita M. [CHARACTERISTICS OF ADULT ASTHMATICS COMPLICATED WITH PULMONARY THROMBOEMBOLISM IN YOKOHAMA CITY SEIBU HOSPITAL]. Arerugi 2020; 69:119-122. [PMID: 32188823 DOI: 10.15036/arerugi.69.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidences have shown that bronchial asthma (BA) enhances the risk of pulmonary thromboembolism (PTE). We previously reported the cases of adult BA patients complicated with PTE. (Aim) To clarify the risk factors of PTE in BA patients, we investigated about the characteristics and risk of contrast medium about patients coexisting asthma and PTE. METHODS We investigated adult asthmatics who visited our hospital and examined chest contrasted CT from January 2011 to 2018.March, retrospectively. RESULTS Fifty seven times examinations (33 asthmatics) were detected from 304 times of enhanced chest CT. We examined twenty times enhanced CT without premedication, but no subjects had side effect such as asthma attack. And also, we diagnosed 12 asthmatics as PTE from 33 patients. The subjects with PTE were high BMI (p=0.024) heavy weight (p=0.033), compared with asthmatics without PTE. There were no significant changes about lung function test, smoking history, sex and the levels of D-dimer among two groups. CONCLUSION Adult asthmatics with PTE were high BMI and heavy compared with those without PTE.
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Affiliation(s)
- Hiromi Muraoka
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital.,Department of Respiratory Medicine, St. Marianna University School of Medicine
| | - Takahiro Tsuburai
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Yuko Komase
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Ayami Ono
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Baku Oyama
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital.,Department of Respiratory Medicine, St. Marianna University School of Medicine
| | - Hajime Tsuruoka
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital.,Department of Respiratory Medicine, St. Marianna University School of Medicine
| | - Ayano Usuba
- Department of Respiratory Medicine, St. Marianna University School of Medicine
| | - Naoya Hida
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Masamichi Mineshita
- Department of Respiratory Medicine, St. Marianna University School of Medicine
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48
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Nishida K, Tsuburai T, Komase Y, Tsuruoka H, Oyama B, Muraoka H, Usuba AT, Hida N, Inoue T, Mineshita M. Relationships among bronchodilator reversibility, the fraction of exhaled nitric oxide, and the parameters of the forced oscillation technique in adult asthma treated with inhaled corticosteroids and long-acting β2 agonists combination. J Breath Res 2020; 14:026013. [PMID: 32120351 DOI: 10.1088/1752-7163/ab7b8c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In bronchial asthma, both airway inflammation and reversible airway narrowing require assessment and treatment. These two pathologies are treated primarily with inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA), respectively. Therefore, ICS-LABA combinations are widely used to treat asthma. Airway inflammation and reversible airway narrowing are assessed primarily with fraction of exhaled nitric oxide (FENO) and bronchodilator reversibility (BDR). The forced oscillation technique (FOT) has recently attracted attention as a method for assessing obstructive respiratory disturbance. However, little is known about the relationships among these assessments. Therefore, we investigated the relationships among BDR, FENO, and FOT during ICS-LABA combination therapy. The subjects comprised 87 patients (25 men and 62 women) with asthma undergoing ICS/LABA combination therapy from July to September 2017. We applied the FENO test, FOT, and BDR testing without the patients stopping their therapy. The rates of change in FEV1 (ΔFEV1%) was correlated with FENO (r = 0.278). Among the FOT parameters, X5 (r = -0.263), Fres (r = 0.292), and AX (r = 0.245) were significantly correlated with ΔFEV1%. FENO, Fres and %FEV1 at baseline in these stable asthmatics were significantly assosiated with ΔFEV1% independently of the effects of age, atopy and body mass index (BMI). These results suggest that FENO and the results of respiratory function testing and FOT reflect different aspects of asthma and should be combined and comprehensively evaluated.
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Affiliation(s)
- Kohei Nishida
- Department of Respiratory Medicine, St. Marianna University school of Medicine, Yokohama City Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa 241-0811, Japan. Department of Respiratory Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
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Morikawa K, Kida H, Handa H, Inoue T, Miyazawa T, Mineshita M. Drastic healing process after pembrolizumab monotherapy in a case of advanced squamous cell carcinoma with severe bronchial stenosis observed over a two-year period using continuous bronchoscopy: A case report. Thorac Cancer 2020; 11:1339-1343. [PMID: 32142590 PMCID: PMC7180542 DOI: 10.1111/1759-7714.13390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 12/26/2022] Open
Abstract
Programmed cell death-1 immune checkpoint inhibitor (ICI) antibody has proven to be effective in advanced non-small cell lung cancer (NSCLC) patients positive for programmed cell death-1 ligand-1. However, there are currently no reports which evaluate drug efficacy by continuous bronchoscopic observation. A 75-year-old man with complete right atelectasis was diagnosed with squamous cell carcinoma (SCC) of the right lower lobe (tumor proportion score: TPS 90%, cT4N3M0, stage 3C). For first-line chemotherapy, carboplatin and nab-paclitaxel were effective for the primary lesion and the right lung atelectasis improved. However, due to repeated febrile neutropenia with pneumonia, treatment was modified to pembrolizumab monotherapy. Bronchoscopic rebiopsy prior to second-line treatment revealed high TPS, with a severe stenosis in the right main bronchus. After three courses of pembrolizumab, the right main bronchus opened completely, and no signs of malignancy were observed. Bronchoscopic narrow-band and autofluorescence imaging also confirmed a complete endobronchial response. Subsequent bronchoscopic observation two years after the initial diagnosis showed a complete and continued response to treatment. ICIs can result in a drastic bronchoscopic response. In this case, the healing process was notable with minimal scarring, and resulted in continued locally bronchoscopic and complete pathological response to treatment compared to previous cytotoxic chemotherapy.
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Affiliation(s)
- Kei Morikawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirotaka Kida
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Teruomi Miyazawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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50
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Muraoka H, Tsuburai T, Komase Y, Ono A, Oyama B, Tsuruoka H, Usuba A, Hida N, Mineshita M. [Erratum : CHARACTERISTICS OF ADULT ASTHMATICS COMPLICATED WITH PULMONARY THROMBOEMBOLISM IN YOKOHAMA CITY SEIBU HOSPITAL [Japanese Journal of Allergology Vol.69 (2020) No.2 p.119-122]]. Arerugi 2020; 69:451. [PMID: 32684554 DOI: 10.15036/arerugi.69.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Hiromi Muraoka
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
- Department of Respiratory Medicine, St. Marianna University School of Medicine
| | - Takahiro Tsuburai
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Yuko Komase
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Ayami Ono
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Baku Oyama
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
- Department of Respiratory Medicine, St. Marianna University School of Medicine
| | - Hajime Tsuruoka
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
- Department of Respiratory Medicine, St. Marianna University School of Medicine
| | - Ayano Usuba
- Department of Respiratory Medicine, St. Marianna University School of Medicine
| | - Naoya Hida
- Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Masamichi Mineshita
- Department of Respiratory Medicine, St. Marianna University School of Medicine
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