Coping strategies and risk of cardiovascular disease incidence and mortality: the Japan Public Health Center-based prospective Study.

AIMS: Coping strategies may be significantly associated with health outcomes. This is the first study to investigate the association between baseline coping strategies and cardiovascular disease (CVD) incidence and mortality in a general population cohort. METHODS AND RESULTS: The Japan Public Health Center-based prospective Study asked questions on coping in its third follow-up survey (2000-04). Analyses on CVD incidence and mortality included 57 017 subjects aged 50-79 without a history of CVD and who provided complete answers on approach- and avoidance-oriented coping behaviours and strategies. Cox regression models, adjusted for confounders, were used to determine hazard ratios (HRs) according to coping style. Mean follow-up time was 7.9 years for incidence and 8.0 years for mortality.The premorbid use of an approach-oriented coping strategy was inversely associated with incidence of stroke (HR = 0.85; 95% CI, 0.73-1.00) and CVD mortality (HR = 0.74; 95% CI, 0.55-0.99). Stroke subtype analyses revealed an inverse association between the approach-oriented coping strategy and incidence of ischaemic stroke (HR = 0.79; 95% CI, 0.64-0.98) and a positive association between the combined coping strategy and incidence of intra-parenchymal haemorrhage (HR = 2.03; 95% CI, 1.01-4.10). Utilizing an avoidance coping strategy was associated with increased mortality from ischaemic heart disease (IHD) only in hypertensive individuals (HR = 3.46; 95% CI, 1.07-11.18). The coping behaviours fantasizing and positive reappraisal were associated with increased risk of CVD incidence (HR = 1.24; 95% CI, 1.03-1.50) and reduced risk of IHD mortality (HR = 0.63; 95% CI, 0.40-0.99), respectively. CONCLUSION: An approach-oriented coping strategy, i.e. proactively dealing with sources of stress, may be associated with significantly reduced stroke incidence and CVD mortality in a Japanese population-based cohort.

[Thoracoscopic pericardial resections for malignant pericardial effusions].

We have performed 5 thoracoscopic pericardial resections for malignant pericardial effusions. An initial trocar was placed in the seventh or eighth intercostal space posterior to the midaxillary line. Two additional trocars were placed, usually in the sixth intercostals spaces in the anterior axillary and posterior axillary lines. Using an endoscopic grasping instrument and scissors through the working ports, a pericardial resection was performed. All patients were successfully managed by thoracoscopic pericardial resections. Two of the 5 patients had associated malignant pleural effusions that were able to be managed at the same time by thoracoscopy. The average chest tube duration was 1.8 days. There has been no reaccumulation of pericardial effusions in all patients at an average follow-up of 5 months. The thoracoscopic approach could be minimally invasive and the procedure of choice in performing pericardial resections in selected patients with malignant pericardial effusions who are expected to have a reasonable life expectancy.

[Thoracoscopic surgery for metastatic lung tumors: computed tomography-guided localization with use of a needle with a suture].

When a metastatic lung tumor is found to be deep to the visceral surface of the pleura, or when it is found to be a small lesion, it may important to help identify the lesion by preoperative methods in order to localize it at the time of thoracoscopic operation. We performed computed tomography-guided localization of metastatic lung tumors with use of a needle with a suture in 11 cases prior to thoracoscopic resection. Placement of the needle, immediately before moving to the operation room were successfully performed in all patients. It took from 16 to 25 minutes (20.3 minutes on average). Complications included minimal pneumothorax in 8 patients, mild airway bleeding in 2, and penetration through the middle lobe to the lower lobe of the right lung in 1. However, treatment was not necessary in any of the patients. Thoracoscopic resections were successfully achieved in all patients. Our technique may be a simpler technique and advantageous for identification of small lesions and lesions deep to the visceral surface of the pleura during the thoracoscopic operation for metastatic lung tumors.

[Initial use of the newly developed voice-controlled robot system for a solitary pulmonary arterio-venous malformation].

We herein report an initial experience of thoracoscopic surgery for a solitary arterior-venous malformation (PAVM) with the AESOP 3000 HR voice-controlled robot to hold a thoracoscope. A 52-year-old woman was hospitalized due to a transient loss of consciousness. A brain magnetic resonance image and electroencephalogram (EEG) were normal. A chest computed tomogram indicated a suspicion of PAVM. The definite diagnosis of the PAVM was made by the 3-dimensional computed tomogram and pulmonary angiography. Thoracoscopic operation with the voice-controlled robot (AESOP 3000 HR) was conducted. The operating staffs were able to assemble the AESOP 3000 HR robotic system safely and quickly without difficulty. The robot functioned without problems throughout the procedure. No complications or events related or unrelated to the maneuvers of the robot during the operation were noted. The procedure of the pulmonary resection with the voice-controlled robot was successfully preformed by a single surgeon. The operating time was 110 minutes, and the volume of the intraoperative bleeding was 10 g. The postoperative course was uneventful. The use of the AESOP 3000 HR robot may be more convenient and friendly in thoracoscopic procedure.

[Thoracoscopic major lung resection using a newly developed instrument retraction system and a voice-controlled robot].

We report a case of thoracoscopic major lung resection using a newly-developed instrument retraction system and a voice-controlled robot for lung cancer in a 72-year-old woman. The patient was referred to our department for further examination of an abnormal shadow on chest x-ray. A chest computed tomographic scan indicated a suspicion of malignancy. Bronchoscopic brush cytology revealed a lung cancer. Thoracoscopic middle lobectomy of the right lung with dissection of the mediastinal lymphnodes was successfully performed without a human assistance with no complications. The postoperative course was uneventful. Thoracoscopic major lung resection using an instrument retraction system and a voice-controlled robot may be feasible in selected cases.

[A voice-controlled robot assisted thoracoscopic surgery for pulmonary tumor].

We herein report a case of voice-controlled robot assisted thoracoscopic surgery for a right apical tumor in a 55-year-old male. The patient was referred to our hospital for further examination of an abnormal shadow on chest X-ray. A chest computed tomographic scan indicated a suspicion of malignancy. Thoracoscopic surgery using a voice-controlled robot was conducted. The thoracoscope connected with the robotic arm was inserted through the trocar. In all maneuvers (forward and backward, right and left, up and down, insertion and extraction), the robotic arm moved appropriately immediately after the voice commands were issued, and favorable operative fields were obtained. Thoracoscopic partial resection of the involved lung was successfully performed with no complications. The operative time was 140 min. The postoperative course was uneventful. Voice-controlled robotic technology innovations may become the operating surgeon's third arm in the future. They will be further used not only in laparoscopic but also in thoracoscopic surgical procedures. Regular use will lead to greater skill in thoracoscopic application with the advent of new robotically assisted endoscopic surgery.

[Thoracoscopic surgery using voice controlled robot for spontaneous pneumothorax].

We investigated the feasibility and applicability of using voice controlled robot-assisted thoracoscopic surgery for spontaneous pneumothorax. Eleven patients with spontaneous pneumothorax were involved in this study. Five patients were treated by voice controlled robot-assisted thoracoscopic procedure and 6 by historical human-assisted thoracoscopic procedure. All procedures were successfully completed without complications. The number of times the thoracoscope required cleaning per 60-minute interval for cases involving voice controlled robot-assisted surgery were 1.4 compared to 8 per 60-minute interval for comparable cases when the robot was not used. Operative times, the amount of analgesics, the duration of indwelling chest tube, the number of recurrences after operation during thoracoscopic procedures were not statistically different. We found that use of voice-controlled robot as surgical assistant during thoracoscopic surgery for spontaneous pneumothorax is feasible.