Shunta Ishihara

Intuitive Touch Panel Navigation System through Kyoto Digital Sosui Network

We have developed multi-touch panel robotic arm control system for thoracoscopic surgery. Our multi-touch panel navigation system consists of green laser guide maker, robotic arms with four spindles, multi-touch panel monitor, and PCs for control regulation. The multi-touch panel monitor recognized the finger-touch; thereby the tip of the robot arm is controlled just on the green maker. For estimation in remote control use, the PC for the robot control was placed in Kyoto Prefectural University of Medicine, which was connected through the Kyoto Digital Sosui Network, a gigabit Ethernet with layer-2 security. Another computer for the remote control of the PC for the robot control was placed in Yamashiro Public Hospital, 35 kilometers south of Kyoto city, through the same gigabit Ethernet. Using virtual network computing (VNC), which is a graphical desktop sharing system to control another computer, we demonstrated a remote control of the robot and collected the packets to examine the traffic bandwidth. The robot was successfully controlled in remote conditions. The throughput of the Ethernet was 16.4 ±3.6 Mbps in the remote control of the robot using VNC. The round-trip time was 19.9 ± 0.39 msec, while 8000 bytes data was sent by using ping command. We demonstrated an intuitive touch panel navigation system, which a surgical robot stopped an arterial bleeding in an animal model. The robot system was successfully controlled through a gigabit Ethernet between two distant hospitals.

Significance of PD-L1 expression in pulmonary metastases from head and neck squamous cell carcinoma

BACKGROUND The mechanism by which tumors escape the immune system has been actively investigated and is partly explained by the programmed death-1 (PD-1) and its ligand (PD-L1) pathway. This study is aimed at clarifying the prognostic significance of PD-L1 expression in patients with surgically resected pulmonary metastases of head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS A retrospective review was conducted of 26 HNSCC patients who underwent complete resection of pulmonary metastases. PD-L1 expression in both the primary and metastatic tumors was evaluated using immunohistochemistry (anti-PD-L1 antibody, clone SP263). High PD-L1 expression was defined as ≥50% of tumor cells with positive staining. Survival and prognostic impacts following pulmonary metastasectomy were analyzed based on the PD-L1 expression level. RESULTS The patients included 23 men and 3 women, with a median age of 65 years. Six (23%) of the pulmonary metastatic cases showed high PD-L1 expression, while their corresponding primary lesions had low PD-L1 expression. The 5-year overall survival rate after pulmonary metastasectomy was 57.6% in all cases. The 5-year overall survival rates were 72.5% and 16.7% in the low and high PD-L1 groups, respectively (p < 0.001). Multivariate analysis demonstrated that high PD-L1 expression and older age (>65 years) correlated independently with a shorter overall survival (p < 0.001). CONCLUSIONS High PD-L1 expression in pulmonary metastases could be an independent predictor of poor outcome in HNSCC patients undergoing pulmonary metastasectomy. This is the first report evaluating the prognostic implication of PD-L1 expression in metastatic HNSCC.

Intractable pneumothorax due to rupture of subpleural rheumatoid nodules: a case report

BackgroundIn rare cases, rheumatoid pleural nodules can rupture into the pleural cavity to cause pneumothorax or empyema. We report successful surgical treatment of a patient with an intractable secondary pneumothorax due to rupture of a subpleural rheumatoid nodule into the pleural cavity.Case presentationA 75-year-old man with a medical history of rheumatoid arthritis, acute coronary syndrome, and diabetes was admitted to our hospital because of left chest pain and dyspnea. A chest X-ray and chest computed tomography (CT) scan showed a left pneumothorax and several small subpleural nodules with cavitation. Repeated pleurodesis via a chest tube failed to improve the pneumothorax, so we decided to perform thoracoscopic surgery. Air leakage was detected in the left upper lobe where the subpleural nodule was visible on chest CT. Resection of the lesion successfully resulted in resolution of the air leakage. The final pathological diagnosis of the subpleural nodule was a pulmonary rheumatoid nodule. The patient has had no evidence of recurrence of pneumothorax after surgery.ConclusionsWe obtained a final pathological diagnosis of a rheumatoid nodule that caused an intractable pneumothorax. Pneumothorax associated with rupture of rheumatoid nodules in the subpleural cavitary is difficult to treat with thoracoscopic surgery as a second-line treatment.

Three-dimensional kinematic analysis of active cervical spine motion by using a multifaceted marker device

Assessing cervical range of motion (CROM) is an important part of the clinical evaluation of patients with conditions such as whiplash syndrome. This study aimed to develop a convenient and accurate system involving multifaceted marker device (MMD)-based assessment of 3-dimensional (3D) dynamic coupled CROM and joint angular velocity. We used an infrared optical tracking system and our newly developed MMD that solved problems such as marker shielding and reflection angle associated with the optical tracking devices and enabled sequential and accurate analysis of the 3D dynamic movement of the polyaxial joint and other structurally complicated joints. The study included 30 asymptomatic young male volunteers (age, 22-27 years). The MMD consisted of 5 surfaces and 5 markers and was attached to the participants forehead. We measured active CROM (axial rotation, flexion/extension, and lateral bending) and joint angular velocity by the MMD. The MMD was easy to use, safe for patients and operators, could be constructed economically, and generated accurate data such as dynamic coupled CROM and angular velocity.