Prognostic Impact of Preoperative Assessment of Muscle Mass and Strength in Surgically Resected Lung Cancer.

BACKGROUND/AIM: The association between resected non-small cell lung cancer (NSCLC) and long-term outcomes of muscle mass depletion and muscle weakness has also not been well documented. This study evaluated whether muscle mass depletion assessed by bioelectrical impedance analysis (BIA) and low muscle strength assessed by the peak expiratory flow rate as a percentage of predicted value (%PEFR) were associated with surgical outcomes in patients with resected NSCLC. PATIENTS AND METHODS: This retrospective study included 219 patients with resected NSCLC between 2016 and 2021. The cutoff value for muscle mass depletion was according to guidelines, for low muscle strength, we defined by receiver operating characteristics analysis for recurrence-free survival (RFS). Survival analysis was performed, and postoperative outcomes were compared. RESULTS: A total of 76 patients (34.7%) had muscle mass depletion, and 114 patients (52.1%) had low muscle strength. Muscle mass depletion and low muscle strength were independent poor prognostic factors for overall survival [hazard ratio (HR)=2.631, p=0.003; HR=1.983, p=0.044] and RFS (HR=3.120, p<0.001; HR=1.857, p=0.028) in multivariate analysis. Postoperative complication was associated with low muscle strength (p=0.009). Postoperative recurrence was associated with muscle mass depletion (p=0.03). CONCLUSION: Preoperative muscle mass depletion assessed by BIA and low muscle strength determined by %PEFR are worse prognostic factors after surgical resection for NSCLC. Our results may provide some important information for preoperative management.

Effect of Postoperative Muscle Loss After Resection of Non-small Cell Lung Cancer on Surgical Outcomes.

BACKGROUND/AIM: Preoperative depletion of psoas muscle mass index (PMI) in lung cancer patients is an unfavorable prognostic factor. The relationship between post-surgical changes in PMI and survival is not clear. Therefore, we conducted a retrospective study to clarify the prognostic significance of preoperative and postoperative PMI changes. PATIENTS AND METHODS: We retrospectively reviewed lung cancer patients, who underwent curative surgical resection with lymph node dissection and computed tomography (CT) approximately six months post-surgery between 2010 and 2019. Pre- and postoperative PMI was measured from CT images at the third lumbar vertebra level. A sex-dependent PMI change ratio (postoperative PMI/preoperative PMI) was used to divide patients into two groups: high PMI loss (67 patients, ≤25th lower quartile) and low PMI loss/PMI increase (204 patients, >25th lower quartile), and clinicopathological features were compared. RESULTS: Age ≥70 years, elevated preoperative carcinoembryonic antigen levels, advanced pathological stage, lymphatic permeation, vascular invasion, performance of adjuvant platinum-doublet chemotherapy, low body mass index, and postoperative recurrence were significantly higher in the high PMI loss group. Logistic regression analysis found that Charlson comorbidity index, low body mass index, advanced pathological stage, and postoperative recurrence were associated with high PMI loss. The five-year postoperative overall survival rate was 50% in the high PMI loss group and 79% in the low PMI loss/PMI increase group (p<0.001). High PMI loss was also an unfavorable factor in a multivariable Cox's proportional hazard model (p=0.002). CONCLUSION: Postoperative muscle loss was an independent prognostic factor for poorer overall survival regardless of preoperative sarcopenia, in non-small cell lung cancer.

Sarcopenia in Resected NSCLC: Effect on Postoperative Outcomes.

INTRODUCTION: Skeletal muscle depletion, referred to as sarcopenia, has recently been identified as a risk factor for poor outcomes in various malignancies. However, the prognostic significance of sarcopenia in patients with NSCLC after surgery has not been adequately determined. This study investigated the impact of sarcopenia in patients undergoing pulmonary resection for lung cancer. METHODS: This retrospective study consisted of 328 patients with pathologically confirmed NSCLC who underwent curative resection between January 2005 and April 2017. Preoperative computed tomography imaging at the third lumbar vertebrae level was assessed to measure the psoas muscle mass index (PMI, cm2/m2). Sarcopenia was defined as a cutoff value of PMI less than 6.36 cm2/m2 for males and 3.92 cm2/m2 for females, based on PMI values from "healthy" subjects. RESULTS: The median patient age was 71 years and 59% were male. Sarcopenia was present in 183 (55.8%) and was significantly related with increasing age (p < 0.001), being male (p < 0.001), smoking habit (p < 0.001), lower body mass index (p < 0.001), and postoperative major complication (Clavien-Dindo grade ≥3, p = 0.036). The prevalence of sarcopenia was higher in men than in women, and the prevalence increased with age in men, whereas the prevalence did not increase in females older than 70 years. The 5-year survival rate was 61% in patients with sarcopenia and 91% in those without. Multivariate analysis revealed that sarcopenia was an independent unfavorable prognostic factor (p = 0.019). CONCLUSIONS: Sarcopenia as determined using preoperative computed tomography could be used to predict postoperative major complication and prognosis in patients with resected NSCLC. Our results may provide some important information for preoperative management.

The negative impact of insulin therapy for acute hyperglycemia secondary to glucose load on plasma amino acid profiles in a rat model of sepsis.

BACKGROUND: In critical illnesses, insulin therapy under overfed conditions with an excessive glucose infusion may cause metabolic disturbances in skeletal muscle mainly through muscle cell glucose uptake and the inhibition of physiological protein breakdown. The aim of this study was to examine the potential negative aspects of insulin therapy in a rat model of sepsis. MATERIALS AND METHODS: Male Sprague-Dawley rats underwent cecal ligation and puncture (CLP) or sham surgery. A pre-established continuous intravenous glucose infusion was initiated immediately after surgery. Rats with sepsis were divided into four groups (n = 7 in each group) based on target blood glucose (BG) levels: a no glucose (NG) group (100-150 mg/dl), moderate glucose (MG) group (200-300 mg/dl), high glucose (HG) group (>300 mg/dl), and the hyperinsulinemia (HI) group, which received the same glucose infusion as the HG group with the insulin infusion (200-300 mg/dl). The sham group underwent sham surgery and received the same glucose infusion as the HG group. All rats were sacrificed 9 h after surgery, and blood samples were collected to measure plasma amino acid (AA) profiles. To examine survival rates in the 48 h following CLP, the HG, MG, and HI groups were newly prepared according to the aforementioned experimental design. RESULTS: Plasma levels of the branched-chain AAs, glutamine, arginine, citrulline, and alanine among the septic groups slightly and inversely decreased with the amount of glucose infused, and HI had significantly lower values (p < 0.01). A strong correlation was observed among the AAs. Plasma 3-methylhistidine concentrations were the highest in the HI group. The survival rate of the HI group was greater than that of the HG, but did not reach the level of the MG group. CONCLUSION: In critical illnesses, insulin therapy under overfed conditions may impair the physiological supply of AAs and conditionally essential AA starvation, such as glutamine and arginine, and may have an adverse impact on the prognosis of patients.

A case of intestinal obstruction caused by prominent kyphosis resulting in compression of the intestine by the costal arch.

An 85-year-old woman with no history of abdominal surgery complained of abdominal pain and vomiting and was referred to us with a diagnosis of intestinal obstruction a few days later. Upon admission to our facility, she presented with marked abdominal swelling and prominent kyphosis. Because of the kyphosis, most of the dilated bowel was compressing her thoracic cavity. No obvious strangulation or free air was observed via abdominal computed tomography imaging. We attempted decompression using a nasogastric tube, but the symptoms persisted. Surgery was performed 2 days after admission. The origin of the obstruction was a compression of the ileocecal region by the costal arch. The bowel was discolored, and thus surgically excised. There were no major postsurgical complications other than a mild wound infection. Until now, there have been no reports of advanced kyphosis inducing ileus, but there are concerns of an increase in similar cases as society continues to age.

The manner of the inflammation-boosting effect caused by acute hyperglycemia secondary to overfeeding and the effects of insulin therapy in a rat model of sepsis.

BACKGROUND: The aim of the study was to investigate both the inflammation-boosting effect and the metabolic stress induced by acute hyperglycemia secondary to overfeeding with excessive glucose infusion and the effects of insulin therapy on those events in a rat model of sepsis. MATERIALS AND METHODS: Sprague-Dawley rats underwent cecal ligation and puncture (CLP) or sham operation. Preestablished continuous intravenous glucose infusion was initiated immediately after surgery. First, rats with CLP-inducing sepsis were divided into three groups on the basis of the target blood glucose (BG) levels: high glucose (HG) group (overfed, >300 mg/dL), moderate glucose group (moderate hyperglycemia, 200-300 mg/dL), and no glucose group (100-150 mg/dL). The sham group received the same glucose infusion as that of the HG group. BG and plasma interleukin (IL) 6 levels were monitored over time. All rats were sacrificed 9 h after surgery to evaluate lung histology and measure hepatic total glutathione and malondialdehyde contents. Based on the results, the high glucose and insulin (HI) group was added to septic groups as a model of insulin therapy, in which insulin with the same HG dose as that in the HG group was administered to maintain moderate hyperglycemia. RESULTS: BG level in all groups remained in the preestablished target range throughout the experiment. Plasma IL-6 level in all septic groups increased in a time-dependent manner, whereas that in the sham group with moderate hyperglycemia hardly increased. Nine hours after CLP, plasma IL-6 level in the HG group rose to 7407.5 ± 1987.3 pg/mL, which was three times higher than that in the other septic groups. There was no significant difference among moderate glucose, no glucose, and HI groups, in which BG level remained constant at <300 mg/dL. The HG group showed the worst consequences of lung injury and oxidative stress in the liver, which were completely stable in HI group. CONCLUSIONS: Acute severe hyperglycemia in critical illness might excessively boost the existing systemic inflammatory response in a threshold-based manner. Insulin therapy under overfeeding could strongly inhibit such a boosting effect and oxidative stress in the liver.

A new mother-child play activity program to decrease parenting stress and improve child cognitive abilities: a cluster randomized controlled trial.

BACKGROUND: We propose a new play activity intervention program for mothers and children. Our interdisciplinary program integrates four fields of child-related sciences: neuroscience, preschool pedagogy, developmental psychology, and child and maternal psychiatry. To determine the effect of this intervention on child and mother psychosocial problems related to parenting stress and on the children's cognitive abilities, we performed a cluster randomized controlled trial. METHODOLOGY/PRINCIPAL FINDINGS: Participants were 238 pairs of mothers and typically developing preschool children (ages 4-6 years old) from Wakakusa kindergarten in Japan. The pairs were asked to play at home for about 10 min a day, 5 days a week for 3 months. Participants were randomly assigned to the intervention or control group by class unit. The Parenting Stress Index (PSI) (for mothers), the Goodenough Draw-a-Man intelligence test (DAM), and the new S-S intelligence test (NS-SIT) (for children) were administered prior to and 3 months after the intervention period. Pre-post changes in test scores were compared between the groups using a linear mixed-effects model analysis. The primary outcomes were the Total score on the child domain of the PSI (for child psychosocial problems related to parenting stress), Total score on the parent domain of the PSI (for maternal psychosocial problems related to parenting stress), and the score on the DAM (for child cognitive abilities). The results of the PSI suggested that the program may reduce parenting stress. The results of the cognitive tests suggested that the program may improve the children's fluid intelligence, working memory, and processing speed. CONCLUSIONS/SIGNIFICANCE: Our intervention program may ameliorate the children's psychosocial problems related to parenting stress and increase their cognitive abilities. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000002265.

Effects of platelet-rich plasma on intestinal anastomotic healing in rats: PRP concentration is a key factor.

BACKGROUND: Few studies have examined the effects of platelet-rich plasma (PRP) on intestinal anastomotic healing. The applied preparation methods and PRP concentrations used in the few studies that have been carried out varied markedly. Therefore, the positive effects of PRP on the anastomotic healing process remain unclear. The aim of this study is to examine the effects of different concentrations of PRP on intestinal anastomotic healing. MATERIAL AND METHODS: From SD rat blood, three different concentrations of plasma were prepared: high-concentrated PRP (H-PRP: platelet count 5 × 10(6)/mm(3)), low-concentrated PRP (L-PRP: 2 × 10(6)/mm(3)), and platelet-poor plasma (PPP). Male SD rats underwent proximal jejunal anastomosis and central venous catheterization. Rats were divided into four groups (n = 12 for each group): control, PPP, L-PRP, and H-PRP groups. Two types of PRP and PPP (0.21 mL) were applied to each anastomosis line, with the exception of the control group. Total parenteral nutrition (TPN) solutions were administered (151 kcal/kg/d). Five days after surgery, anastomotic bursting pressure (ABP) in situ and hydroxyproline concentration (HYP) in anastomotic tissue were evaluated. RESULTS: The ABP values of control, PPP, L-PRP, and H-PRP groups were 171 ± 20, 174 ± 23, 189 ± 17, and 148 ± 25 mmHg, respectively. The HYP values of each group were 516 ± 130, 495 ± 123, 629 ± 120, and 407 ± 143 µg/g dry tissue. Compared with the other groups, the L-PRP group exhibited a significant increase in both ABP and HYP, while the H-PRP group exhibited a significant decrease in these two variables. As a result, L-PRP was considered to promote anastomotic wound healing, but H-PRP was considered to inhibit it. There was no significant difference between the PPP group and the control group. CONCLUSIONS: PRP concentration plays a crucial role in the efficacy of PRP. PRP might exert positive effects on intestinal anastomotic healing in a dose-dependent manner up to a certain level, but adverse effects occur when it is highly concentrated. The essential PRP action appears to be driven by the platelets themselves.

Plugging a molecular wire into photosystem I: reconstitution of the photoelectric conversion system on a gold electrode.

Plug and play: Photoinduced electron transfer occurs from photoexcited P700 in photosystem I (PSI) to a gold surface (see picture). A novel molecular connector system is used, in which an artificial molecular wire, which is assembled on the gold surface, was plugged into PSI by reconstitution. Analysis of the photoelectron transfer kinetics proved both the output of electrons from PSI and the effectiveness of the molecular wire.

Bio-photosensor: Cyanobacterial photosystem I coupled with transistor via molecular wire.

We report on the first successful output of electrons directly from photosystem I (PSI) of thermophilic cyanobacteria to the gate of a field-effect transistor (FET) by bypassing electron flow via a newly designed molecular wire, i.e., artificial vitamin K(1), and a gold nanoparticle; in short, this newly manufactured photosensor employs a bio-functional unit as the core of the device. Photo-electrons generated by the irradiation of molecular complexes composed of reconstituted PSI on the gate were found to control the FET. This PSI-bio-photosensor can be used to interpret gradation in images. This PSI-FET system is moreover sufficiently stable for use exceeding a period of 1 year.

[Inter-laboratory validation studies of biological method for determination of tetracyclines in royal jelly].

Inter-laboratory validation studies were conducted in 5 laboratories to validate the biological method for determination of tetracyclines in royal jelly. Oxytetracycline spiked at the levels of 0.2 and 1.0 ppm was analyzed. Mean recoveries were 88 and 90%, reproducibility relative standard deviations (RSD(R)) were 13.7 and 7.8%, and HORRAT(R) values were 0.7 and 0.5. Samples containing residues at the levels of 0.25 and 0.80 ppm were analyzed. Mean recoveries were 73 and 77%, RSD(R) were 12.6 and 10.5%, and HORRAT(R) values were 0.6 and 0.6. The determination limit was 0.1 ppm (oxytetracycline, tetracycline) and 0.02 ppm (chlortetracycline). These results show that this method has good performance.

[Inter-laboratory validation studies of biological method for determination of streptomycin in royal jelly].

Inter-laboratory validation studies were conducted in 6 laboratories to validate the biological method for determination of streptomycin in royal jelly. Streptomycin spiked at the level of 0.2 and 1.0 ppm was analyzed. Mean recoveries were 89 and 96%, reproducibility relative standard deviations (RSD(R)) were 15.0 and 14.0%, HORRAT(R) values were 0.7 and 0.9. Samples containing residues at the levels of 0.25 and 0.80 ppm were analyzed. Mean recoveries were 113 and 99%, RSD(R) were 15.0 and 10.4%, and HORRAT(R) values were 0.8 and 0.6. The determination limit was 0.1 ppm. These results show that this method has good performance.

[Inter-laboratory validation studies of analytical method for determination of chloramphenicol in royal jelly].

Inter-laboratory validation studies were conducted in 6 laboratories to validate the analytical method for determination of chloramphenicol in royal jelly. Chloramphenicol spiked at the levels of 0.1 and 0.5 ppm was analyzed. Mean recoveries were 89 and 89%, reproducibility relative standard deviations (RSD(R)) were 10.5 and 6.8%, HORRAT(R) values were 0.5 and 0.4. Samples containing residues at the levels of 0.25 and 0.80 ppm were analyzed. Mean recoveries were 89 and 84%, RSD(R) were 9.8 and 12.3%, and HORRAT(R) values were 0.5 and 0.7. The determination limit was 0.05 ppm. These results show that this method has good performance.