Background: Uniportal thoracoscopic surgery has gained popularity as a minimally invasive approach for anatomical lung resection. While outcomes from high-volume centers have been reported, evidence describing nationwide real-world practice across institutions with varying experience is scarce. This study aimed to evaluate the current status and perioperative outcomes of uniportal thoracoscopic anatomical pulmonary resections in Japan. Methods: We conducted a multicenter retrospective study under the Japanese Uniportal Video-assisted Thoracoscopic Surgery Interest Group. Patients with primary lung cancer who underwent uniportal thoracoscopic lobectomy or segmentectomy in Japan between April 2018 and March 2023 were included. Clinical information was collected from participating institutions, and patient characteristics, operative variables, and perioperative outcomes were evaluated. The primary outcome was the incidence of procedurerelated complications, with secondary outcomes including operative time and other perioperative parameters. Results: A total of 3,546 patients were analyzed, comprising 2,780 lobectomies and 766 segmentectomies. The proportion of segmentectomies gradually increased during the study period. In the lobectomy group, the median operative time was 170 min, with prolonged air leak in 7.6% and significant vessel injury in 3.4%. In the segmentectomy group, the median operative time was 154 min, with prolonged air leak in 4.6% and significant vessel injury in 3.5%. Thirty-day mortality was 0.3% in both groups, and conversion to multiport or thoracotomy occurred in 1.8-3.6% of cases. Conclusions: This nationwide analysis indicates that uniportal thoracoscopic anatomical pulmonary resection is performed safely in Japan, with perioperative outcomes comparable to those reported internationally. Although operative times were slightly longer than those in single-institution series, complication rates remained low, indicating that uniportal thoracoscopic anatomical pulmonary resection is being conducted with acceptable perioperative outcomes in real-world practice.
OBJECTIVES:Lymphovascular invasion (LVI) is an established adverse prognostic factor in urothelial carcinoma; however, prior studies have rarely distinguished lymphatic vessel invasion (LymVI) from blood vessel invasion (BVI). We investigated the prevalence and prognostic significance of LymVI and BVI in upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNUx), and assessed their associations with clinicopathological characteristics and metastatic patterns. METHODS:We retrospectively analyzed 455 patients who underwent RNUx at Jikei University Hospital and six affiliated centers between 2012 and 2021. LVI subtype was assessed using hematoxylin-eosin staining, supplemented by D2-40, CD31, and Elastica van Gieson staining when required. Patients were categorized into four groups: no LVI, LymVI only, BVI only, and combined LymVI+BVI. Outcomes included non-urothelial tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier methods and Cox regression analyses were used to evaluate prognostic associations. RESULTS:LVI subtypes were distributed as follows: no LVI (65.1%), LymVI only (9.9%), BVI only (7.7%), and combined LymVI+BVI (17.4%). Higher pathological T and N stages were observed progressively across these groups (P < 0.001). BVI only and combined LymVI+BVI were independent predictors of inferior NUTRFS (HR 4.52 and 5.01), OS (HR 2.46 and 2.73), and CSS (HR 2.85 and 4.06), whereas isolated LymVI did not significantly affect outcomes. Hematogenous metastases to the lung, liver, and bone were significantly more frequent in patients with BVI or combined LVI. CONCLUSIONS:Distinguishing BVI from LymVI provides refined prognostic stratification in UTUC. BVI, alone or combined with LymVI, is strongly associated with adverse survival and increased hematogenous dissemination, while isolated LymVI has limited prognostic impact. Routine pathological subclassification of vascular invasion may improve postoperative risk assessment and guide adjuvant treatment decisions.
Postoperative lower limb lymphedema is a common complication following pelvic or para-aortic lymphadenectomy for gynecologic cancers. Early detection of lymphatic dysfunction is crucial, but the temporal relationship between functional and structural changes remains unclear. This prospective observational study aimed to compare indocyanine green (ICG) lymphography and lymphatic ultrasound findings at multiple time points in the early postoperative phase. We enrolled 23 patients (46 lower limbs) who underwent pelvic and/or para-aortic lymphadenectomy for gynecologic malignancies. Each patient underwent ICG lymphography and lymphatic ultrasound preoperatively and at 1, 3, and 9 months postoperatively. ICG patterns were categorized as linear, splash, or stardust, while lymphatic vessel dilation ≥0.3 mm was defined as abnormal on ultrasound. At least one abnormal ICG finding was observed in 52.2% of limbs, and abnormal ultrasound findings were present in 65.2%. Among limb-timepoints with abnormal ICG findings, lymphatic dilation on ultrasound was observed in 32.6% overall, increasing to 52.6% at 9 months postoperatively, indicating increasing concordance between functional and structural abnormalities over time. Splash patterns on ICG were often not accompanied by lymphatic dilation, whereas stardust patterns were more likely to coincide with structural changes, especially at 9 months. Skin thickness increased significantly in the medial and lateral lower leg regions in limbs with stardust patterns. Our findings demonstrate a temporal dissociation between functional abnormalities detected by ICG and structural changes detected by ultrasound, suggesting that ICG lymphography may be more sensitive in the early phase. The combined use of both modalities may help capture the continuum from early functional disturbance to later structural remodeling and inform the optimal timing of intervention.
Introduction:Chronic pain exhibits significant interindividual variability, partly because of genetic factors. The dopaminergic system is implicated in pain modulation. Objectives:This study investigated the association between single-nucleotide polymorphisms (SNPs) in dopamine pathway genes and chronic pain susceptibility in a Japanese population. Methods:A case-control study compared 191 patients with chronic pain with 282 healthy controls in Japan. Genotype data from previous whole-genome studies were analyzed for SNPs within or flanking 8 candidate genes (tyrosine hydroxylase, solute carrier family 6 member 3 [SLC6A3], dopamine D1-D5 receptor genes, and catechol-O-methyltransferase), including the gene body and ±30 kb flanking regions. Association analyses used Pearson chi-squared tests and modified Poisson regression with Bonferroni correction. Results:After quality control, 184 SNPs were analyzed. A significant association was identified between the rs2963257 SNP flanking the SLC6A3 gene and chronic pain (genotypic P = 0.00026). This remained significant after Bonferroni correction. Analysis using a dominant model for the A allele (GA + AA vs GG) also showed a significant association (prevalence ratio = 2.11, 95% confidence interval = 1.23-3.61, P = 0.0017), indicating individuals carrying at least one A allele had a significantly higher prevalence of chronic pain vs those with the GG genotype. No other SNPs showed a significant association after multiple comparison correction. Conclusions:The SLC6A3 rs2963257 polymorphism is associated with chronic pain susceptibility in the Japanese population. Specifically, the A allele appears to increase susceptibility under a dominant model, suggesting the GG genotype may have a protective effect against chronic pain.
Background : Accurate absorbed dose-to-water determination in radiotherapy requires electrometers calibrated by a primary standards laboratory (PSL). Recent studies have suggested that electrometers of the same model may exhibit sufficiently similar sensitivity characteristics to allow the use of a common electrometer calibration coefficient for quality-control purposes. However, the effect of this approach on absorbed dose-to-water uncertainty has not been quantitatively evaluated. Purpose : To evaluate the uncertainty contribution associated with the use of a common electrometer calibration coefficient and to assess its influence on absorbed dose-to-water determination. Methods A multicenter study was conducted involving 12 radiotherapy facilities and 24 combinations of linear accelerators, ionization chambers, and electrometers. All electrometers possessed valid PSL-issued calibration coefficients. Absorbed dose-to-water values were calculated using both the PSL calibration coefficient ( k elec ) and a common electrometer coefficient ( k elec,user ). Dose monitor unit values and uncertainty budgets were compared for 6-MV and 10-MV photon beams. Uncertainty analysis was performed according to the Guide to the Expression of Uncertainty in Measurement (GUM). Results : Only small differences were observed between dose monitor unit values calculated using ( k elec ) and ( k elec,user ). The user-dependent uncertainty increased from 0.17% to 0.23% ( k = 1), corresponding to an increase of approximately 0.06 percentage points. However, this contribution remained substantially smaller than the dominant uncertainty sources in reference dosimetry. Consequently, the combined standard uncertainty and expanded uncertainty of absorbed dose-to-water determination remained unchanged. Conclusion : The uncertainty contribution associated with the common electrometer calibration coefficient was small and had no meaningful influence on the overall uncertainty budget of absorbed dose-to-water determination. These findings support the use of a common coefficient for electrometer sensitivity verification and quality-control applications within a given electrometer type. Although periodic PSL calibration remains essential for maintaining traceability, common-coefficient-based verification may provide a useful complementary approach for routine electrometer quality assurance.
