研究者詳細 - 芳川　豊史

論文 - 芳川　豊史

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Outcomes of combination therapy including rituximab for antibody-mediated rejection after lung transplantation. 査読有り

Keiji Yamanashi, Toyofumi Fengshi Chen-Yoshikawa, Masatsugu Hamaji, Kimiko Yurugi, Satona Tanaka, Yojiro Yutaka, Yoshito Yamada, Daisuke Nakajima, Akihiro Ohsumi, Hiroshi Date

General thoracic and cardiovascular surgery 68 巻 ( 2 ) 頁： 142 - 149 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: This study assessed the outcomes of combination therapy including rituximab for antibody-mediated rejection after lung transplantation. METHODS: Retrospective chart reviews were performed for all patients who received combination therapy including rituximab for post-lung transplantation antibody-mediated rejection between June 2008 and October 2018. RESULTS: Among the 196 consecutive patients undergoing lung transplantation during the study period, eight (4.1%) were eligible for this study. Two patients (25.0%) were classified as having clinically definite antibody-mediated rejection and six (75.0%) as having possible antibody-mediated rejection. Prior to treatment, four patients (50.0%) met the definition of chronic lung allograft dysfunction; seven of the eight patients (87.5%) remained alive at 6 months and four (50.0%) at 12 months after antibody-mediated rejection. All patients identified as having chronic lung allograft dysfunction, prior to the treatment, died of allograft failure, or underwent re-transplantation. Decreases in the mean fluorescence intensities of the major donor-specific antibodies were observed in three patients. One patient, diagnosed with clinical antibody-mediated rejection but without pre-treatment chronic lung allograft dysfunction, began treatment relatively soon after lung transplantation, and demonstrated improved respiratory function at the 3-year follow-up. CONCLUSIONS: Our experience suggests that multimodality therapy that includes rituximab is feasible and may prevent progression of antibody-mediated rejection after lung transplantation in selected patients.

DOI： 10.1007/s11748-019-01189-1

PubMed

術中CBCT画像を用いた虚脱肺の変形解析の試み

前川日南子, 中尾恵, 峯浦一貴, 芳川豊史, 松田哲也

電子情報通信学会技術報告 (MI) 119 巻 ( 399 ) 頁： 31 - 36 2020年1月

記述言語：日本語出版者・発行元：電子情報通信学会

肺は手術時に虚脱するため，肺内部に複数発生しうる微小結節の位置同定が望まれる．術中に撮像されたCone-beam CT(CBCT) 画像により，肺全体の虚脱変形を推定するモデルを構築できる可能性がある．本研究では手術室において含気状態と虚脱状態で撮像された Paired CBCT 画像の位置合わせを行い，術中気胸の変形解析を行った．部分観測された大きな回転を含むデータに対応した位置合わせの枠組みを提案した．撮像時に肺表面に設置されたクリップを利用し，8 症例に対して平均誤差 3.9mm の位置合わせが達成されることを確認した．解析の結果，変位には収縮に加えて回転や肺門からの距離の影響が大きいことが確認された．Since the lung deforms during surgery, it is important to obtain the location of the tumor. Deformation of the whole lung could be estimated using intraoperative Cone-beam CT(CBCT) images. In this study, we registered the paired intraoperative CBCT images in the inflated and deflated states, and analyzed their deformation. Experimental results showed that the proposed methods reduced the error of point-to-point correspondence. As a result of registration using clips placed on the lung surface during imaging, it was confirmed that an average error of 3.9 mm was achieved in 8 cases. The result of analysis showed that both rotation and contraction had large effects on displacement.

CiNii Research

Unexpected metastasis of intraductal papillary neoplasm of the bile duct without an invasive component to the brain and lungs: A case report. 国際誌

Nguyen Hai Nam, Kojiro Taura, Masashi Kanai, Keita Fukuyama, Norimitsu Uza, Hirona Maeda, Yojiro Yutaka, Toyofumi F Chen-Yoshikawa, Manabu Muto, Shinji Uemoto

World journal of gastroenterology 26 巻 ( 3 ) 頁： 366 - 374 2020年1月

記述言語：英語

BACKGROUND: Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct (IPNB), distant metastasis remains unexplained especially in cases of carcinoma in situ. In the present study, we report a rare and interesting case of IPNB without invasive components that later metastasized to lungs and brain. CASE SUMMARY: A 69-year-old male was referred to our hospital due to suspected cholangiocarcinoma. Laboratory tests on admission reported a mild elevation of alkaline phosphatase, γ-glutamyl transpeptidase, and total bilirubin in serum. Endoscopic retrograde cholangiography revealed a ﬁlling defect in the common bile duct (CBD) extending to the left hepatic duct. Peroral cholangioscopy delineated a tumor in the CBD that had a papillary pattern. Multidetector computed tomography and magnetic resonance cholangiopancreatography detected partial blockage ot interlude in the CBD leading to cholestasis without evidence of metastasis. Therefore, a diagnosis of IPNB cT1N0M0 was established. Left hepatectomy with bile duct reconstruction was performed. Pathological examination confirmed an intraepithelial neoplasia pattern without an invasive component and an R0 resection achievement. The patient was monitored carefully by regular examinations. However, at 32 mo after the operation, a 26 mm tumor in the lungs and a 12 mm lesion in the brain were detected following a suspicious elevated CA 19-9 level. Video-assisted thoracoscopic surgery of left upper lobectomy and stereotactic radiotherapy are indicated. In addition to histopathological results, a genomic profiling analysis using whole exome sequencing subsequently confirmed lung metastasis originating from bile duct cancer. CONCLUSION: This case highlights the important role of genomic profiling analysis using whole exome sequencing in identifying the origin of metastasis in patients with IPNB.

DOI： 10.3748/wjg.v26.i3.366

PubMed

Variations and surgical management of pulmonary vein in living-donor lobectomy. 査読有り国際誌

Hidenao Kayawake, Toyofumi Fengshi Chen-Yoshikawa, Satona Tanaka, Yoshito Yamada, Yojiro Yutaka, Daisuke Nakajima, Akihiro Ohsumi, Masatsugu Hamaji, Hiroshi Date

Interactive cardiovascular and thoracic surgery 30 巻 ( 1 ) 頁： 24 - 29 2020年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: In a living-donor lobectomy, the donor undergoes a right or left lower lobectomy. The surgical procedures for living-donor lobectomy are sometimes influenced by the anatomical variations of the pulmonary vein (PV). The goal of this study was to analyse the PV variations in living donors and to review the influence of these variations on the surgical procedures used. METHODS: Between June 2008 and September 2018, 154 living donors underwent right or left lower lobectomy. The PV variations were analysed using 3-dimensional computed tomography (3D-CT), and the surgical management of these variations was reviewed. RESULTS: Among 154 donors, 21 PV variations that could influence the surgical procedure for a right lower lobectomy were found in 19 (12.3%) donors, whereas no such variations for a left lower lobectomy were found. Detected PV variations were dorsal branch of the right upper PV (n = 12), middle PV draining into the right lower PV (n = 6) and the superior segment branch of the right lower PV draining into the right upper PV (n = 3). Among 96 donors undergoing right lower lobectomy, 9 (9.4%) donors had PV variations that could influence the surgical procedure. In 2 donors, sparing of PV branches with multiple vascular clamps was required. Pulmonary venoplasty was not required in any donor, whereas pulmonary venoplasty in recipient surgery was required in 4 recipients. There were no complications related to the surgical procedures performed on the PV. CONCLUSIONS: Living-donor lobectomy was performed safely owing to the preoperative evaluation of PV on 3D-CT and the use of appropriate surgical approaches to PV.

DOI： 10.1093/icvts/ivz238

PubMed

中川健, 佐藤滋, 江川裕人, 赤松延久, 伊藤泰平, 上野豪久, 奥見雅由, 阪本靖介, 芳川豊史, 縄田寛, 福嶌教偉

移植 55 巻 ( 1 ) 頁： 51-59 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）

We retrospectively surveyed the status of rituximab use in treatment for antibody-mediated rejection (AMR) in Japan between 2013 and 2016 for kidney transplantation and between 2001 and 2016 for transplantation of other organs, including the liver, pancreas, heart, lung, and intestine.Two hundred twenty-seven institutions responded. AMR developed in 493 patients who underwent kidney transplantation; 288 of those patients were treated with rituximab. AMR developed in 81 patients for liver transplantation, 4 patients for pancreas transplantation, 16 patients for heart transplantation, 22 patients for lung transplantation, and 2 patients for small intestine transplantation; rituximab was used in 18, 4, 4, 14, and 1 of those patients, respectively.We also report on treatment details and rituximab dosage.

DOI： 10.11386/jst.55.1_51

抗ドナー特異的抗体陽性臓器移植の実態とrituximabの使用に関する全国使用実態調査結果

中川健, 佐藤滋, 江川裕人, 赤松延久, 伊藤泰平, 上野豪久, 奥見雅由, 阪本靖介, 芳川豊史, 縄田寛, 福嶌教偉

移植 55 巻 ( 1 ) 頁： 39-50 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）

A retrospective survey was conducted to assess the status of organ transplantation in patients with pre-formed donor-specific anti-HLA antibodies and the implementation of desensitization with rituximab in Japan. We obtained the data from 227 institutions for procedures performed between 2013 and 2016 for kidney transplantation and between 2001 and 2016 for transplantation of other organs, including the liver, pancreas, heart, lung, and intestine.Results showed pre-formed donor-specific antibodies (DSA) in recipients of 529 transplanted kidneys; rituximab was used in 462 of those transplantations. Rituximab was used in 48 of 135 liver transplantations in recipients with pre-formed DSA and in 1 of 1 small intestine transplantation involving pre-formed DSA. Such DSA was also reported in 5 heart transplants and 4 lung transplants. However, rituximab was not used for desensitization in any of those procedures.We also report on detection and assay of anti-HLA antibodies and DSA, criteria for transplantation, dosage of rituximab, and concomitant immunosuppressive drugs used at the institutions.

DOI： 10.11386/jst.55.1_39

Survival outcomes of resection for pulmonary malignancies including non-small cell lung cancer and pulmonary metastasis after esophagectomy for esophageal carcinoma

Yamanashi K

General Thoracic and Cardiovascular Surgery 68 巻 ( 10 ) 頁： 1179 - 1186 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：General Thoracic and Cardiovascular Surgery

Objectives: This study investigated survival outcomes of resection for pulmonary malignancies after esophagectomy for esophageal carcinoma, comparing non-small cell lung cancer and pulmonary metastases. Methods: We retrospectively reviewed consecutive patients who underwent resection for pulmonary malignancies after esophagectomy for esophageal carcinoma between 2009 and 2018. The overall survival and relapse-free survival rate were assessed using Kaplan–Meier analysis. Results: Eleven patients had non-small cell lung cancer and eight patients had pulmonary metastases from esophageal carcinoma. The 5-year overall survival rate was 92.9% in all patients with a median follow-up period of 50.4 (range: 9.1–130.2) months. While the 5-year overall survival rate was 100.0% in patients with non-small cell lung cancer, it was 85.7% in patients with pulmonary metastases from esophageal carcinoma. The 5-year relapse-free survival rate was 85.7% in patients with non-small cell lung cancer. Conclusions: Our data suggest that resection for pulmonary malignancies after esophagectomy for esophageal carcinoma is associated with favorable survival outcomes and should be considered in selected patients.

DOI： 10.1007/s11748-020-01373-8

Scopus

PubMed

Commentary: Infants Toddle Before They Ambulate. Where Are We Now?

Okabe R

Seminars in Thoracic and Cardiovascular Surgery 33 巻 ( 1 ) 頁： 274 - 275 2020年

Is left-side DaVinci™ procedure challenging? Initial experiences of a single institute

Sato T

General Thoracic and Cardiovascular Surgery 68 巻 ( 11 ) 頁： 1285 - 1289 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：General Thoracic and Cardiovascular Surgery

Objective: Among the standard techniques for anatomical lung cancer resection, left upper lobectomy has been regarded as challenging by thoracic surgeons. Thus, this study aimed to examine whether laterality of robot-assisted thoracoscopic procedures has any influence on the incidence of conversion to thoracotomy, operation time, amount of bleeding, and postoperative complications in the introduction phase of this procedure. Methods: The first consecutive 65 patients (right upper/middle/lower lobe with 31/3/15 cases, left upper/lower lobe with 10/6 cases) who underwent robot-assisted thoracoscopic lobectomy from December 2011 to April 2019 in Kyoto University were retrospectively reviewed. Results: Five cases were converted to open thoracotomy, including four for the left upper lobectomy and one for the right lower lobectomy (p = 0.011). The mean operation time was 229.9 ± 53.9 min (n = 12) and 192.8 ± 53.1 min (n = 48) for the left-sided and right-sided procedures, respectively (p = 0.043, conversion cases were not included). The mean bleeding amount was 29.1 ± 75.7 g (n = 49) and 136.8 ± 330.9 g (n = 16) for the right side and left side, respectively (p = 0.036). The mean operation time (min) for each lobe was as follows: 253.5 ± 73.9 for the left upper lobe (n = 6), 206.3 ± 41.3 for the left lower lobe (n = 6), 189.7 ± 51.3 for the right upper lobe (n = 31), 192.3 ± 57.5 for the right middle lobe (n = 3), and 199.9 ± 61.8 for the right lower lobe (n = 14). Conclusion: Robot-assisted thoracoscopic surgery on the left side was associated with higher conversion rate, longer operation time, and more blood loss than that on the right side.

DOI： 10.1007/s11748-020-01382-7

Scopus

PubMed

Commentary: Local chemotherapy with nanoparticles: A ray of light in the dark?

Nakamura S

Journal of Thoracic and Cardiovascular Surgery 160 巻 ( 3 ) 頁： e169 - e170 2020年

Analysis of Optimal Health-Related Quality of Life Measures in Patients Waitlisted for Lung Transplantation

Tokuno J

Canadian Respiratory Journal 2020 巻 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Canadian Respiratory Journal

Background. Improving health-related quality of life (HRQL) is an important goal of lung transplantation, and St. George's Respiratory Questionnaire (SGRQ) is frequently used for assessing HRQL in patients waitlisted for lung transplantation. We hypothesized that chronic respiratory failure (CRF)-specific HRQL measures would be more suitable than the SGRQ, considering the underlying disease and its severity in these patients. Methods. We prospectively collected physiological and patient-reported data (HRQL, dyspnea, and psychological status) of 199 patients newly registered in the waiting list of lung transplantation. CRF-specific HRQL measures of the Maugeri Respiratory Failure Questionnaire (MRF) and Severe Respiratory Insufficiency Questionnaire (SRI) were assessed in addition to the SGRQ. Results. Compared to the MRF-26 and SRI, the score distribution of the SGRQ was skewed toward the worse ends of the scale. All domains of the MRF-26 and SRI were significantly correlated with the SGRQ. Multiple regression analyses to investigate factors predicting each HRQL score indicated that dyspnea and psychological status accounted for 12% to 28% of the variance more significantly than physiological measures did. The MRF-26 Total and SRI Summary significantly worsened from the baseline to 1 year (p<0.001 and p=0.010, respectively) in 103 patients who underwent a follow-up assessment without lung transplantation, while the SGRQ showed a marginal significant worsening (p=0.040). Conclusions. The MRF-26 and SRI are valid, discriminative, and responsive in patients waitlisted for lung transplantation. In terms of the score distribution and responsiveness, CRF-specific measures may function better in their HRQL assessment than the currently used measures do.

DOI： 10.1155/2020/4912920

Scopus

Prognostic factors of stage I thymic epithelial tumors

Fukui T

General Thoracic and Cardiovascular Surgery 69 巻 ( 1 ) 頁： 59 - 66 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：General Thoracic and Cardiovascular Surgery

Objective: According to the tumor-node-metastasis classification for thymic malignancies, the proportion of patients diagnosed with stage I is expected to increase significantly. However, whether those patients have homogenous clinicopathological features and survival has not been fully evaluated. Methods: We reviewed 153 consecutive patients with stage I thymic epithelial tumors (133 thymomas, 15 thymic carcinomas, and 5 neuroendocrine tumors) who underwent complete resection at our institution between 2001 and 2016 and evaluated the prognostic significance of their clinicopathological factors. Results: The stage I patients accounted for 78% of all thymic epithelial tumors. The 5-year overall survival and recurrence-free survival rates of the 153 patients were 94% and 80%, respectively. The patients with the histology of thymic carcinoma or neuroendocrine tumor and with a tumor larger than 5.0 cm showed significantly worse recurrence-free survival in multivariate analysis (p = 0.027 and 0.038, respectively). Only the tumor size was revealed as a significant prognostic factor for recurrence-free survival when limited in the 133 cases of thymoma (p = 0.048). Conclusions: Patients with large tumors showed significantly worse recurrence-free survival than those with small tumors both in stage I thymic epithelial tumors and thymomas.

DOI： 10.1007/s11748-020-01427-x

Scopus

PubMed

Sleep quality and its association with health-related quality of life of patients on lung transplantation waitlist in Japan

Tokuno J

Sleep and Breathing 25 巻 ( 1 ) 頁： 219 - 225 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Sleep and Breathing

Purpose: Poor quality of sleep is a common feature in patients with various lung diseases and affects their health-related quality of life (HRQL). We evaluated sleep quality and HRQL in patients on the waitlist for lung transplantation in Japan. Methods: In this prospective study, patient-reported and physiological data were collected from patients newly registered on the waitlist for lung transplantation in Japan. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and HRQL using the St. George’s Respiratory Questionnaire (SGRQ). The frequency of poor sleep quality, correlations between sleep quality and various clinical parameters, and predictive factors of sleep quality were examined. Results: Of 193 patients, the three most-frequent indications for lung transplantation were interstitial pneumonia (n = 96), pulmonary complications of hematopoietic stem cell transplantation (n = 25), and pulmonary hypertension (n = 17). Poor sleep quality (PSQI > 5) was observed in 102 patients (53%) and was significantly associated with worse Hospital Anxiety and Depression Score (HADS), worse SGRQ score, worse modified Medical Research Council Dyspnea score, and shorter 6-min walk distance. However, it was not associated with sex, pulmonary function, interstitial pneumonia, or arterial blood gas. Stepwise multiple regression analysis indicated that poor sleep quality was explained significantly by HADS anxiety (23%) and SGRQ Symptoms (10%). Conclusion: Poor sleep quality was found to be common among patients on the lung transplantation waitlist in Japan. The two most significant factors responsible for impaired sleep quality were anxiety and respiratory symptoms. Additional care should be taken to ensuring a better quality of sleep for such patients.

DOI： 10.1007/s11325-020-02092-3

Scopus

Expanded indications for lung transplantation for pulmonary complications after hematopoietic stem cell transplantation

Noguchi M., Chen-Yoshikawa T.F., Arai Y., Kondo T., Ohsumi A., Nakajima D., Hamaji M., Takita J., Takaori-Kondo A., Date H.

Journal of Thoracic and Cardiovascular Surgery 2020年

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Thoracic and Cardiovascular Surgery

Objectives: Pulmonary complications after hematopoietic stem cell transplantation (HSCT) are associated with poor survival and can be treated by lung transplantation (LT). However, the indications for LT in patients with pulmonary complications after HSCT remain unclear due to low number of cases. HSCT is frequently conducted for hematologic malignancies, which have different recurrence patterns from solid-organ malignancies. Some patients also experience ABO blood type changes post-HSCT. This study aimed to reassess the indication of LT for pulmonary complications post-HSCT, focusing on disease-free interval (DFI) and ABO-incompatibility. Methods: Retrospective chart reviews were performed in patients who underwent LT for post-HSCT pulmonary complications. In patients with previous hematologic malignancy, indication was based on estimated recurrence rate instead of DFI. Donors were selected based on the recipient anti-A/B antibody profile rather than ABO type. Post-LT survival and complication rates were examined. Results: Forty consecutive patients undergoing LT after HSCT (including 31 with previous hematologic malignancy) were analyzed. The median DFI between HSCT and LT was 64.5 months. Thirteen patients with previous hematologic malignancy had DFI <5 years but none experienced recurrence. There was no significant difference in 5-year post-LT survival between patients undergoing (74.7%) and not undergoing HSCT (68.4%). There was no significant difference in survival between patients with DFI ≥5 years (63.8%) and patients with DFI <5 years (83.3%). Five patients underwent LTs from major ABO-incompatible donors, but none developed incompatibility-related complications. Conclusions: Indications based on estimated recurrence rates and recipients' anti-A/B antibody profiles may increase the use of LT for patients after HSCT.

DOI： 10.1016/j.jtcvs.2020.10.065

Scopus

Commentary: Continuous steady development is made by taking 2 steps forward, 1 step back

Mutsuga M., Chen-Yoshikawa T.F.

Journal of Thoracic and Cardiovascular Surgery 2020年

臓器別パネルディスカッション「拡大基準ドナーに対するコンセンサス　肺」

星川康, 芳川豊史, 渡辺有為, 此枝千尋, 田中里奈

移植 55 巻 ( 3 ) 頁： 145 - 153 2020年

移植医療とCOVID-19

山永成美, 江川裕人, 蛭子洋介, 大澤良介, 小野稔, 剣持敬, 十川博, 名取洋一郎, 日比泰造, 矢野晴美, 芳川豊史, 吉川美喜子, 吉田一成, 湯沢賢治

移植 55 巻 ( Supplement ) 頁： 194_1 - 194_1 2020年

記述言語：日本語出版者・発行元：一般社団法人日本移植学会

2019年末からの中国武漢での報告後、瞬く間に世界中に拡散した新型コロナウイルス感染症 (COVID-19)は、現在も収束することなく、2020年8月31日時点で全世界で2500万人以上が感染していると報告されている。COVID-19は、移植医療の在り方に大きな影響をもたらし、世界中の多くの移植施設で、生命に関わる臓器の移植を除き、生体移植を中心とした待機可能な移植は一時停止を余儀なくされた。ドナーからの伝播の可能性、院内感染の可能性、移植患者への感染対応など、様々な状況を想定し、院内のコンセンサスを得ることで、現状では多くの施設が移植医療の提供を再開した。しかし、安心安全な移植医療を提供するためには、COVID-19以前とは異なる、新しい移植医療の様式を実践していく必要がある。また、移植患者は免疫抑制剤を服用しており、ウイルス感染症に脆弱である一方、COVID-19は、感染後期での免疫抑制剤使用による重症化抑制も知られている。相反する病態を理解し、免疫抑制剤調整を含めた移植患者の管理を適切に行うことも重要である。これまでに得られたCOVID-19と移植医療に関する文献的報告をレビューし、新しい移植医療の様式について提言したい。

DOI： 10.11386/jst.55.supplement_194_1

CiNii Research

Fcγ受容体IIAの一塩基多型と肺移植後の感染性合併症との相関

栢分秀直, 芳川豊史, 田中里奈, 田中友加, 大段秀樹, 豊洋次郎, 山田義人, 大角明宏, 中島大輔, 濱路政嗣, 江川裕人, 伊達洋至

移植 55 巻 ( Supplement ) 頁： 354_1 - 354_1 2020年

記述言語：日本語出版者・発行元：一般社団法人日本移植学会

【背景】固形臓器移植後の術後成績にFcγ受容体の一塩基多型（SNP）が与えうる影響についての研究はいくつかあるが、肺移植に関する研究はほとんどない。本研究の目的はFcγ受容体IIA（FCGR2A）のSNPが肺移植後の術後成績に与える影響を検討することである。【対象と方法】2008年から2018年までに201例の肺移植が施行された。この中から再肺移植症例、残余DNAサンプルがない症例、ICU退室不可症例を除いた191例を対象とした。この191例に関してFCGR2AのSNP（131 histidine [H] or arginine [R]）を解析し、術後成績とSNPとの関連について検討した。【結果】FCGR2AのSNPの内訳は、H/H（n=120）、H/R（n=66）、R/R（n=5）であった。H/H群（H/H）とR群（H/R or R/R）の2群で解析を行ったところ、ICU退室から術後1年以内の肺炎の頻度および真菌感染症の頻度は、R群で有意に高かった（p=0.004およびp=0.012）。全生存率に関しては2群間に有意差を認めなかった（p=0.67）。【結語】FCGR2AのSNPに関して、予後には2群間で有意な差を認めなかったが、R群では1年以内の肺炎および真菌感染症の頻度が有意に高かった。

DOI： 10.11386/jst.55.supplement_354_1

CiNii Research

Impact of diabetes mellitus on postoperative outcomes in individuals with non-small-cell lung cancer: A retrospective cohort study. 国際誌

Teruya Komatsu, Toyofumi F Chen-Yoshikawa, Masaki Ikeda, Koji Takahashi, Akiko Nishimura, Shin-Ichi Harashima, Hiroshi Date

PloS one 15 巻 ( 11 ) 頁： e0241930 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: Studies showing that individuals with non-small cell lung cancer (NSCLC) and diabetes mellitus (DM) have reported poor outcomes after pulmonary resection with varying results. Therefore, we investigated the clinical impact of preoperative DM on postoperative morbidity and survival in individuals with resectable NSCLC. PATIENTS AND METHODS: Data of individuals who underwent pulmonary resection for NSCLC from 2000 to 2015 were extracted from the database of Kyoto University Hospital. The primary endpoint was the incidence of postoperative complications, and secondary endpoints were postoperative length of hospital stay and overall survival. The survival rate was analyzed using the Kaplan-Meier method. RESULTS: A total of 2,219 patients were eligible for the study. The median age of participants was 67 years. Among them, 39.5% were women, and 259 (11.7%) presented with DM. The effect of DM on the incidence of postoperative complications and postoperative length of hospital stay was not significant. Although the 5-year survival rates were similar in both patients with and without DM (80.2% versus 79.4%; p = 0.158), those with DM who had a hemoglobin A1c level ≥ 8.0% had the worst survival. CONCLUSIONS: In individuals with resectable NSCLC, preoperative DM does not influence the acute phase postoperative recovery. However, poorly controlled preoperative DM could lead to low postoperative survival rates.

DOI： 10.1371/journal.pone.0241930

PubMed

Nocturnal hypercapnia with daytime normocapnia in patients with advanced pulmonary arterial hypertension awaiting lung transplantation. 査読有り国際誌

Yoshinari Nakatsuka, Toyofumi Chen-Yoshikawa, Hideyuki Kinoshita, Akihiro Aoyama, Hiroyasu Kubo, Kimihiko Murase, Satoshi Hamada, Hirofumi Takeyama, Takuma Minami, Naomi Takahashi, Kiminobu Tanizawa, Tomohiro Handa, Toyohiro Hirai, Hiroshi Date, Kazuo Chin

PloS one 15 巻 ( 4 ) 頁： e0227775 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Pulmonary arterial hypertension (PAH) is frequently complicated by sleep disordered breathing (SDB), and previous studies have largely focused on hypoxemic SDB. Even though nocturnal hypercapnia was shown to exacerbate pulmonary hypertension, the clinical significance of nocturnal hypercapnia among PAH patients has been scarcely investigated. METHOD: Seventeen patients with PAH were identified from 246 consecutive patients referred to Kyoto University Hospital for the evaluation of lung transplant registration from January 2010 to December 2017. Included in this study were 13 patients whose nocturnal transcutaneous carbon dioxide partial pressure (PtcCO2) monitoring data were available. Nocturnal hypercapnia was diagnosed according to the guidelines of the American Academy of Sleep Medicine. Associations of nocturnal PtcCO2 measurements with clinical features, the findings of right heart catheterization and pulmonary function parameters were evaluated. RESULTS: Nocturnal hypercapnia was diagnosed in six patients (46.2%), while no patient had daytime hypercapnia. Of note, nocturnal hypercapnia was found for 5 out of 6 patients with idiopathic PAH (83.3%). Mean nocturnal PtcCO2 levels correlated negatively with the percentage of predicted total lung capacity (TLC), and positively with cardiac output and cardiac index. CONCLUSION: Nocturnal hypercapnia was prevalent among advanced PAH patients who were waiting for lung transplantation, and associated with %TLC. Nocturnal hypercapnia was associated with the increase in cardiac output, which might potentially worsen pulmonary hypertension especially during sleep. Further studies are needed to investigate hemodynamics during sleep and to clarify whether nocturnal hypercapnia can be a therapeutic target for PAH patients.

DOI： 10.1371/journal.pone.0227775

PubMed

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