Comparison of CO-RADS Scores Based on Visual and Artificial Intelligence Assessments in a Non-Endemic Area.

In this study, we first developed an artificial intelligence (AI)-based algorithm for classifying chest computed tomography (CT) images using the coronavirus disease 2019 Reporting and Data System (CO-RADS). Subsequently, we evaluated its accuracy by comparing the calculated scores with those assigned by radiologists with varying levels of experience. This study included patients with suspected SARS-CoV-2 infection who underwent chest CT imaging between February and October 2020 in Japan, a non-endemic area. For each chest CT, the CO-RADS scores, determined by consensus among three experienced chest radiologists, were used as the gold standard. Images from 412 patients were used to train the model, whereas images from 83 patients were tested to obtain AI-based CO-RADS scores for each image. Six independent raters (one medical student, two residents, and three board-certified radiologists) evaluated the test images. Intraclass correlation coefficients (ICC) and weighted kappa values were calculated to determine the inter-rater agreement with the gold standard. The mean ICC and weighted kappa were 0.754 and 0.752 for the medical student and residents (taken together), 0.851 and 0.850 for the diagnostic radiologists, and 0.913 and 0.912 for AI, respectively. The CO-RADS scores calculated using our AI-based algorithm were comparable to those assigned by radiologists, indicating the accuracy and high reproducibility of our model. Our study findings would enable accurate reading, particularly in areas where radiologists are unavailable, and contribute to improvements in patient management and workflow.

Extraction of nobiletin from Citrus Unshiu peels by supercritical fluid and its CRE-mediated transcriptional activity.

BACKGROUND: Polymethoxyflavone (PMF) is one of bioactive compounds in Citrus Unshiu and included mainly in the peels rather than the fruits, seeds and leaves. HYPOTHESIS/PURPOSE: Supercritical CO2 extraction is one candidate for selective extraction of polymethoxyflavone and in this study, supercritical CO2 extraction with/without ethanol entrainer from Citrus Unshiu peels was examined at a temperature of 333K and a pressure of 30MPa. METHODS: CRE (cyclic AMP response element)-mediated transcriptional assay was examined by using the extracts from supercritical fluid extraction. RESULTS: The results showed that extracts including nobiletin increased with increasing ethanol concentration in supercritical CO2 and the elapsed extraction time. Extracts at ethanol concentration of 5 mol% showed high CRE-mediated transcription activity. This can be caused by activity of the extract including nobiletin in addition to the other methoxylated flavonoid species such as tangeretin. Extracts at ethanol concentration of 50% showed the highest CRE-mediated transcription activity, which can be attributed to flavonoid glycoside such as hesperidin. From our investigations, flavonoid glycoside can be one of promoters of CRE-mediated transcription activity.

Long-term effects of gastrectomy in patients with spirometry-defined COPD and patients at risk of COPD: a case-control study.

OBJECTIVE: Comorbidities are characteristic of COPD. However, little is known about the secondary manifestations of COPD in the gastrointestinal tract. Therefore, we aimed to explore the long-term effects of gastrectomy in patients with spirometry-defined COPD or those at risk of COPD. PARTICIPANTS: Subjects included 87 patients either with COPD or at risk of COPD (symptomatic) who underwent gastrectomy between December 2003 and October 2013 (group A), and 174 patients either with COPD or at risk of COPD, matched by age (±5 years), sex, and forced expiratory volume in 1 second (FEV1) as percentage of predicted (FEV1% predicted) (±5%) (group B). METHODS: All patients underwent routine blood chemistry and pulmonary function tests, arterial blood gas analysis, 6-minute walk test (6MWT), high-resolution chest computed tomography scans, and nutritional assessments. RESULTS: The mean duration postgastrectomy was 18.3±15.4 years. The mean FEV1 and FEV1% predicted were 2.07±0.76 L and 74.6±24.5%, respectively. Univariate analysis indicated that group A patients had significantly lower body mass index, fat-free mass index, and serum hemoglobin and albumin concentration (all P=0.00), and walked a significantly shorter distance in the 6MWT (P<0.05). Multivariate linear regression analysis for the distance in the 6MWT indicated that increased residual volume (RV) to total lung capacity (TLC) as percentage of predicted (%RV/TLC) alone was an independent and significant predictor of reduced distances in the 6MWT. CONCLUSION: We concluded that nutritional insufficiency in patients with COPD (or those at risk of COPD) who previously underwent gastrectomy might lead to hyperinflation and consequently, decreased exercise capacity.

Effects of the oriental herbal medicine Bofu-tsusho-san in obesity hypertension: a multicenter, randomized, parallel-group controlled trial (ATH-D-14-01021.R2).

OBJECTIVE: There is no clinical evidence that supports the benefit of integrative medicine, defined as combination therapy of oriental and western medicine, on obesity-related hypertension. This study evaluates the efficacy of Bofu-tsusho-san (BOF), an oriental herbal medicine, on the ambulatory blood pressure (BP) profile in hypertensive patients with obesity. METHODS: The study design was a multicenter, randomized, open-label, parallel-group controlled trial in 107 hypertensive patients with obesity. Participants were randomly assigned to receive either the conventional control therapy or BOF add-on therapy. In both groups antihypertensive therapy was aimed at achieving the target clinic BP. The primary outcome was change in the ambulatory BP profile from baseline to 24 weeks after randomization. RESULTS: Daytime systolic BP variability, an important parameter of ambulatory BP profile, was decreased in the BOF group, and the difference in the changes in daytime systolic BP variability was significant between the BOF and control group (Control vs BOF; the change from baseline in daytime systolic BP variability, 1.0±3.3 vs -1.0±3.3%; p=0.006). CONCLUSION: The BOF add-on therapy effectively improved the ambulatory BP variability. This is the first report suggesting that an integrative medicine approach may exert favorable effects on obesity-related hypertension compared with conventional pharmaceutical treatment. CLINICAL TRIAL REGISTRATION: UMIN000003878.

Alternating chemotherapy with amrubicin plus cisplatin and weekly administration of irinotecan plus cisplatin for extensive-stage small cell lung cancer.

BACKGROUND: A phase II study was conducted in order to determine the tumor efficacy and tolerance of alternating chemotherapy for extensive-stage small cell lung cancer (ED-SCLC). PATIENTS AND METHODS: Twenty patients with previously-untreated ED-SCLC were enrolled in the study. At least four courses of chemotherapy consisting of alternation of two drug combinations were given: alternating cycles of amrubicin and cisplatin with weekly administration of irinotecan and cisplatin at 3- or 4-week intervals. RESULTS: The overall response rate was 85.0% (17/20). The median duration of overall survival and progression-free survival were 359 days and 227 days, respectively. Hematological toxicity was the main adverse event. Grade 3 or 4 neutropenia, thrombocytopenia and anemia were observed in 20 (100%), 4 (20%) and 6 (30%) patients, respectively. With regard to non-hematological adverse events, grade 3 or 4 anorexia, diarrhea, febrile neutropenia and infection were observed in 5 (25%), 2 (10%), 2 (10%) and 2 (10%) patients, respectively. No treatment-related death occurred during either regimen. CONCLUSION: The novel alternating non-cross-resistant chemotherapy was probably active against ED-SCLC and had acceptable toxicities. Further evaluation of this treatment for ED-SCLC in randomized phase III trials is warranted.

Rheumatoid pleural effusion presenting as pseudochylothorax in a patient without previous diagnosis of rheumatoid arthritis.

BACKGROUND: Rheumatoid pleurisy rarely occurs before a diagnosis of rheumatoid arthritis (RA). It is the second leading cause of pseudochylothorax, but there are few reports of RA-associated pseudochylothorax. CASE: A 50-year-old man presented to our hospital with an undiagnosed exudative pleural effusion. In order to obtain a definitive diagnosis, we performed medical thoracoscopy under local anesthesia. The pleural effusion was turbid and was identified as a pseudochylothorax. The parietal pleura was white and slightly thickened with numerous scattered small granules and the pleural biopsy showed an infiltration of inflammatory cells including lymphocytes and plasma cells with a lack of normal mesothelial cells, findings that were highly consistent with rheumatoid pleurisy. Additional laboratory data revealed elevated levels of CCP antibody and rheumatoid factor. During an outpatient visit about 30 days after discharge, the patient complained of polyarthralgia and was diagnosed with RA, resulting in a definitive diagnosis of the pleural effusion as rheumatoid pleurisy. CONCLUSION: We encountered a rare case of a rheumatoid pleural effusion without other symptoms of arthritis, which was identified as a pseudochylothorax by medical thoracoscopy.

Combination chemotherapy of alternating etoposide and carboplatin with weekly administration of irinotecan and cisplatin in extensive-stage small-cell lung cancer.

BACKGROUND: A phase II study was conducted to determine the tumor efficacy and tolerance of alternating chemotherapy in extensive-stage small-cell lung cancer (ED-SCLC). PATIENTS AND METHODS: Thirty-six patients with previously untreated ED-SCLC were enrolled in the study. At least four courses of chemotherapy consisting of alternation of two drug combinations were given: alternating cycles of etoposide and carboplatin (EC) with weekly administration of irinotecan and cisplatin (IP) at 3- or 4-week intervals. RESULTS: The overall response rate was 81.8%. The median duration of survival and progression-free survival were 314 days and 144 days, respectively. Hematological toxicity was the main adverse event. Grade 3 or 4 neutropenia, thrombocytopenia and anemia were observed in 69.2, 25.6 and 23.1% of the patients, respectively. Severe diarrhea (10.8%) was remarkable during the IP regimen. CONCLUSION: This novel alternating chemotherapy for patients with ED-SCLC showed moderate tumor efficacy and an acceptable safety profile.

Clinical characteristics of healthcare-associated pneumonia in a public hospital in a metropolitan area of Japan.

Healthcare-associated pneumonia (HCAP) is a new category that is essential in the present aging society. Knowing the different characteristics and outcomes between patients with HCAP and community-acquired pneumonia (CAP) would help physicians manage and treat HCAP patients. Although HCAP is thought to be heterogeneous in regions, there are no reports from a metropolitan area in Japan. We retrospectively reviewed the clinical findings of all consecutive pneumonia patients who required hospitalized care in our hospital between April 2006 and March 2010. There were 184 (35.0%) patients with HCAP and 342 (65.0%) patients with CAP. Previous hospitalization within 90 days of the infection was the most common criterion for HCAP (63.0%). HCAP patients were significantly older than CAP patients (82.5 vs. 70.0 years, P < 0.001). The percentage of patients with poor functional status was higher in HCAP than CAP (64.0% vs. 26.6%, P < 0.001). Hospital mortality was significantly higher in HCAP patients than in CAP patients (15.8% vs. 5.0%, P < 0.001). Low levels of serum albumin (odds ratio, 0.126; 95% CI, 0.025-0.640; P = 0.012) and high scores in the ADROP (age, dehydration, respiratory failure, orientation, and blood pressure) system (odds ratio, 2.846; 95% CI, 1.449-5.587; P = 0.002) were the risk factors for HCAP mortality. In conclusion, patients with HCAP have different epidemiological characteristics compared with those with CAP in a metropolitan area of Japan. Outcomes and risk factors for mortality of patients with HCAP included poor nutritional status and high severity scores on the pneumonia severity scoring system.

Severe COPD is correlated with mild radiation pneumonitis following stereotactic body radiotherapy.

BACKGROUND: The primary cause of COPD and lung cancer is smoking. Thus, patients with COPD frequently have lung cancer that often is inoperable. Stereotactic body radiation therapy (SBRT) is anticipated to be the standard of care for inoperable early stage non-small cell lung cancer. The most critical toxicity following SBRT is radiation pneumonitis (RP). We analyzed predictive factors for RP following SBRT and investigated the degree and occurrence of RP in patients with severe COPD. METHODS: We retrospectively evaluated 265 lung tumors treated with SBRT between 2005 and 2010 with a minimum follow-up of 6 months. Predictive factors for RP, including GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage and pack-years smoked, were evaluated by univariate and multivariate analyses. RP was graded according to the Common Terminology Criteria for Adverse Events version 3.0 scale. RESULTS: Median follow-up was 19.2 months (range, 6.0-72.0 months). RP grades of 0, 1, 2, 3, 4, and 5 occurred in 101, 102, 49, 12, 0, and one of these patients, respectively. Multivariate analysis revealed that high normal lung volume receiving ≥ 20 Gy, fewer pack-years smoked, and high total dose were significant predictive factors for RP ≥ grade 1, and high normal lung volume receiving 20 Gy, fewer pack-years smoked, and a history of lung resection were predictive for RP ≥ grade 2. RP in patients with more severe COPD was relatively milder than in patients with normal lung function and with mild COPD. Pack-year scales were significantly correlated with GOLD stage. CONCLUSIONS: RP following SBRT in patients with severe COPD was relatively mild. Heavy smoking was the strongest negative predictor for severe RP and was correlated with severe COPD. Further follow-up and quantitative analysis of lung function might be needed to ascertain longer tolerability to SBRT.

[Detection of pleural plaques on chest X-ray film by chest physicians].

With increasing awareness about health damage due to asbestos exposure, the number of people presenting with non-occupational exposure has increased remarkably. Consequently, chest physicians in general hospitals must read the chest X-ray films of patients with asbestos exposure. Can non-specialized chest physicians, who may have little experience of occupational medicine, diagnose pleural plaques accurately? The study subjects were 44 consecutive patients who were admitted to our hospital, under the Japanese medical health check system for workers employed in dangerous work. Their chest X-ray films were checked by 4 chest physicians, who were independently informed that the patients had a high suspicion of asbestos exposure. The detection rate of chest Xray for pleural plaques was compared with computed tomography (CT) results as the gold standard. The sensitivity was 0.818 and the specificity was 0.393. The sensitivity of the presence of pleural plaques was lower in anterior and posterior sites, and on the pleura adjacent to the mediastinum, pericardium and vertebral (0.429, 0.348, 0.217), while specificity was lower on lateral sites (0.610). Chest physicians in general hospitals must be trained in the manifestation of asbestos-related diseases.

[Pulmonary tumor thrombotic microangiopathy caused by signet ring cell carcinoma in gastric cancer].

This case involved a 38-year-old man who was referred to our hospital with general fatigue, appetite loss, weight loss, cough and exertional dyspnea. Within a couple of days, he was admitted due to advanced dyspnea and general fatigue. Severe hypoxemia was identified and acute right heart failure developed on admission. Treatment was initiated using oxygen, antibiotics and heparin sodium, but the patient died of sudden cardiopulmonary arrest 30 h after admission. Autopsy revealed advanced gastric cancer and widespread tumor embolism together with fibrocellular intimal proliferation and thrombus formation in the small arteries. Pulmonary tumor thrombotic microangiopathy (PTTM) with gastric cancer was diagnosed. PTTM is characterized by widespread fibrocellular intimal proliferation of the small pulmonary arteries and arterioles in patients with metastatic carcinoma. Microscopic pulmonary tumor emboli frequently occur in patients with malignant tumors, but very few cases of PTTM have been reported. PTTM should be considered in the differential diagnosis of acute dyspnea or pulmonary hypertension. In cases of acute cor pulmonal, the existence of malignant cells can be examined using pulmonary arterial wedge aspiration cytology where feasible, in addition to positron emission tomography with F-2-deoxy-2-fluoro-D-glucose, which can be used to investigate certain primary tumors and associated metastatic disease. The suitability of gastroendoscopy to screen for malignancies should be examined.