Ryo Takagi

Purpose Serum levels of cardiovascular markers, including brain natriuretic peptide (BNP), are associated with the prognosis of cancer patients. This study examined the relationship between the preoperative blood BNP level and the long-term prognosis after curative lung cancer resection. Methods Patients who underwent radical resection for lung cancer at our institution between January 2012 and June 2019 were divided into the high- (≥ 18.5 pg/ml) and low- (< 18.5 pg/ml) BNP groups. Kaplan–Meier curves were used to analyze the postoperative overall survival (OS) and relapse-free survival (RFS). The cumulative incidence function (CIF) was analyzed using the Gray’s test. Univariate and multivariate Cox proportional hazards models were used to identify independent predictors of the OS. Results The postoperative OS was significantly worse in the high-BNP group than in the low-BNP group (p = 0.03), but there was no statistically significant difference in the RFS (p = 0.09). A CIF analysis indicated that non-cancer-related deaths had a greater impact on the RFS than cancer recurrence. Blood BNP levels possibly affected the OS independently (hazard ratio, 1.50). Conclusions Preoperative BNP levels in patients with lung cancer may indicate a potentially compromised condition and can be associated with the postoperative OS. However, the link between the BNP level and lung cancer severity remains unclear.

Purpose To evaluate the inter- and intraobserver reproducibility of sublingual microcirculatory indices measured using the GlycoCheck system, including the perfused boundary region (PBR), vascular density (VD), and red blood cell filling (RBCF), in patients under general anesthesia without any motion artifacts. Methods Fifty patients who received general anesthesia for laparoscopic gastrointestinal surgery were included in this study. After the induction of general anesthesia, the leading observer and one of the five subobservers took two and one measurements of sublingual microcirculation with the GlycoCheck system, respectively. Inter- and intraobserver reproducibility was assessed using intraclass correlation coefficients (ICC). Interobserver reproducibility was calculated using the first measurements of the leading observer and subobservers, and intraobserver reproducibility was calculated using two consecutive measurements of the leading observer. Results The interobserver reproducibility of a single measurement was poor for all three parameters. The interobserver ICCs for PBR were 0.13 [95% CI: -0.15, 0.39], for VD was − 0.01 [95%CI: -0.29, 0.27], and for RBCF were 0.31 [95%CI: -0.45, 0.78]. The intraobserver ICCs for PBR was 0.32 [95% CI: 0.05, 0.55] for all 50 cases, 0.17 [95% CI: -0.25, 0.53] for the first 25 cases, and 0.46 [95% CI: 0.09, 0.72] for the second 25 cases. The Bland-Altman plots indicated that the measurement errors were random. Conclusion In patients under general anesthesia, single PBR, VD, and RBCF measurements using the GlycoCheck system showed poor interobserver reproducibility. Although the intraobserver reproducibility of PBR measurements was poor, improving measurement proficiency might improve reproducibility. Further research is required to establish measurement methods that achieve better reproducibility and adequate observer training.

Correlation between colorectal lesions and BLF methylation