Faculty Profiles - CHEN-YOSHIKAWA Toyofumi

Papers - CHEN-YOSHIKAWA Toyofumi

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Effectiveness and safety of rituximab in desensitization and for treatment of antibody-mediated rejection in a multicenter prospective study assessing liver, pancreas, lung, and heart transplantation

EGAWA Hiroto, ITO Taihei, ONO Minoru, CHEN-YOSHIKAWA Toyofumi, HASEGAWA Kiyoshi, NUNODA Shinichi, DATE Hiroshi, FUKUSHIMA Norihide, EGUCHI Susumu, HIBI Taizo, OGURA Yasuhiro, MIYAGI Shigehito, AKAMATSU Nobuhisa, ICHIDA Akihiko, HAGA Hironori, TERAMUKAI Satoshi

Japanese Journal of Transplantation Vol. 58 ( 1 ) page： 43 - 57 2023

Language：English Publisher：The Japan Society for Transplantation

【Background】 Few studies have assessed donor-specific antibodies (DSA) and anti-human leucocyte antigen (HLA) antibodies associated with the transplantation (Tx) of organs other than kidney.【Methods】 A total of 31 institutions participated in the current study. Patients who satisfied the study criteria were enrolled prospectively, and rituximab was used according to each institution’s clinical protocol for desensitization before Tx when patients had preexisting DSA or anti-HLA antibodies (desensitization cohort) or to treat post-Tx antibody-mediated rejection (ABMR) (ABMR treatment cohort). The desensitization cohort comprised four liver transplants, four kidney-pancreas transplants, and one heart transplant, and the ABMR treatment cohort contained two liver transplants, two heart transplants, and one lung transplant. In the desensitization cohort, organs ultimately were not allocated for the patient awaiting a heart transplant and one patient awaiting a kidney-pancreas transplant.【Results】 In the desensitization cohort, DSA or anti-HLA antibodies decreased in the four liver Tx patients and three of the kidney-pancreas Tx patients. Although T-cell mediated rejection occurred in two patients, they did not develop ABMR. One pancreatic graft was lost due to post-transplantation thrombosis; all other grafts and all patients survived. In the ABMR treatment cohort, DSA decreased after ABMR treatment in one heart Tx patient and two liver Tx patients. Acute ABMR was eliminated completely only in the patient who developed the complication early after liver Tx.【Conclusion】 Rituximab was well-tolerated, both during desensitization and as part of ABMR treatment for Tx of organs other than kidney.

DOI： 10.11386/jst.58.1_43

CiNii Research

可変形3次元画像による大規模バーチャル手術手技アトラスと呼吸器外科手術ガイドシステムの創出

芳川豊史, 中尾恵

生体医工学 Vol. Annual61 ( Abstract ) page： 128_2 - 128_2 2023

Language：Japanese Publisher：公益社団法人日本生体医工学会

目的：低侵襲化の道を進む、匠の技である、無形の呼吸器外科手術手技について、可変形3次元画像と大規模なバーチャル手術手技アトラスを用いて有形化する。さらに、呼吸器外科手術ガイドシステムの創出により、呼吸器外科手術の高位平準化を図る。方法：本研究は、現有のシーズである画像変形推定技術と切離プロセスマッピングという技術を用いて、患者個人のCT情報をもとに、可変形3次元バーチャル画像を作成し研究開発を行う。結果：これまでの開発において達成し得たものを紹介する。まず、種々の手術術式において、可変形3次元バーチャル画像を作成し実際の手術画像と対比させたバーチャル手術手技アトラスを作成できた。次に、肺切除で最も肝要な、肺門や葉間というレベルでの血管や気管支という脈管構造の剥離のシミュレーションを、患者個人のCT情報をもとに、可変形3次元バーチャル画像を用いて行い得た。その際に、肺内を透見できる画像技術や手前の構造物を消去する技術を導入した。実際の手術において、患者個人のCT情報をもとに作成した可変形3次元バーチャル画像を自由に動かし、実際の手術における手術ガイドを10数例の解剖学的肺切除で行い得た。結語：我々が手掛けている可変形3次元バーチャル画像による手術ガイドについて進捗を紹介した。

DOI： 10.11239/jsmbe.annual61.128_2

CiNii Research

Retrospective observation study of intravenous immunoglobulin therapy for antibody-mediated rejection in lung transplantation Reviewed

NAKAJIMA Daisuke, DATE Hiroshi, MATSUBARA Kei, SUGIMOTO Seiichiro, SHIRAISHI Takeshi, HIRAMA Takeshi, CHEN-YOSHIKAWA Toyofumi F., NAKAGAWA Ken, EGAWA Hiroto

Japanese Journal of Transplantation Vol. 58 ( 4 ) page： 371 - 380 2023

Authorship：Lead author Language：Japanese Publisher：The Japan Society for Transplantation

【Objective】 The aim of this study was to investigate the efficacy and safety of intravenous immunoglobulin (IVIG)-based therapy for antibody-mediated rejection (AMR) in lung transplantation in Japan.【Methods】 This retrospective observation study enrolled 48 patients, including 41 adults and 7 children, who underwent IVIG-based therapy for AMR in 4 lung transplant hospitals in Japan between April 2001 and March 2022.【Results】 AMR was treated by IVIG alone in 18 patients or IVIG combined with other therapies, including, in particular, steroid pulse therapy, plasma exchange, and/or rituximab. The total dose of IVIG was 0.15 g/kg-8.82 g/kg (median: 1.71 g/kg). Donor-specific antibody (DSA) developed in 33 patients after lung transplantation. Following IVIG-based therapy, DSA titer decreased in all DSA to human leukocyte antigen (HLA) class I and 90% of DSA to HLA class II, and AMR was ameliorated in 41 patients (85.4%). The 6- and 12-month graft survival after IVIG-based therapy were 85.4% and 83.0%, respectively. The 6- and 12-month overall survival rates after IVIG-based therapy were 93.8% and 87.5%, respectively. Serious adverse events related directly to IVIG administration were not observed in this study.【Conclusion】 IVIG-based therapy could be performed safely, could reduce circulating de novo DSA, and could improve AMR after lung transplantation.

DOI： 10.11386/jst.58.4_371

CiNii Research

Cadaveric donor lung procurement for transplantation

HOSHIKAWA Yasushi, MATSUDA Yasushi, YOSHIKAWA Toyofumi

Japanese Journal of Transplantation Vol. 58 ( 2 ) page： 71 - 76 2023

Language：Japanese Publisher：The Japan Society for Transplantation

The key to cadaveric donor lung procurement is close collaboration with the other procurement teams, especially the donor heart procurement team which shares the surgical field throughout the entire process, local anesthesiologists, and the Japan Organ Transplant Network coordinators, reliable assessment of the donor lungs, and skillful and consistent surgical technique to complete the harvest without error within a limited time frame. In order to standardize these procurement procedures and present them to all lung procurement teams in Japan, a manual on cadaveric donor lung procurement has been published on the website of the Japan Society for Transplantation. The original version of this manual was prepared through a questionnaire survey conducted from March to May 2011 among seven lung transplant centers at that time to confirm surgical techniques and collect tips and pitfalls, followed by careful e-mail discussion and consensus building. From April to June 2021, another questionnaire was sent to 10 lung transplant centers, and after careful e-mail discussion, a revised version was created. In this process, the technique was reconfirmed and standardized among 10 centers. This article outlines the preparation, preoperative meeting, and procedure for donor lung procurement in the case of heart procurement, in accordance with the Lung Procurement Manual (revised edition 2021) of the Japan Society for Transplantation.

DOI： 10.11386/jst.58.2_71

CiNii Research

脊柱起立筋の断面積は造血幹細胞移植後肺障害患者における肺移植待機中の生命予後と関連する

濱田涼太, 大島洋平, 吉岡佑二, 梶本泰志, 太田垣あゆみ, 堀江賢, 田辺直也, 池口良輔, 佐藤晋, 芳川豊史, 中島大輔, 伊達洋至, 松田秀一

呼吸理学療法学 Vol. 3 ( Suppl. ) page： 156 - 156 2023

Radiologic evaluation of compensatory lung growth using computed tomography by comparison with histological data from a large animal model Reviewed

Ohata K., Chen-Yoshikawa T.F., Hamaji M., Kubo T., Nakamura T., Date H.

Scientific Reports Vol. 12 ( 1 ) 2022.12

Language：English Publisher：Scientific Reports

Non-invasive analysis using computed tomography (CT) data may be a promising candidate to evaluate neo-alveolarization in adult lungs following lung resection. This study evaluates and compares the validity of CT analysis with histologic morphometry for compensatory lung growth in a large animal model. We calculated the radiologic tissue volume and the radiologic lung weight from CT data taken at 1, 3, and 6 months post-surgery on 15 male beagle dogs that had a right thoractotomy, bilobectomy, or pneumonectomy (n = 5 in each group). Results were analyzed using one-way ANOVA and were subsequently compared to histologic findings of tissue samples at 6 months post-surgery using Pearson’s correlation. An increase in radiologic tissue volume and radiologic lung weight was identified, which was positively correlated with histologic lung parenchymal amounts (correlation coefficient = 0.955 and 0.934, respectively, p < 0.001). Histology of lung specimens at 6 months post-surgery revealed an increase in the tissue amount in both Bilobectomy and Peumonectomy groups, which was consistent with compensatory lung growth. Radiologic tissue volume and radiologic lung weight reflected compensatory lung growth following lung resection. Radiologic assessment using CT data can be a promising clinical modality to evaluate postoperative lung growth.

DOI： 10.1038/s41598-022-06398-y

Scopus

Adjuvant atezolizumab in Japanese patients with resected stage IB-IIIA non-small cell lung cancer (IMpower010) Reviewed

Kenmotsu H., Sugawara S., Watanabe Y., Saito H., Okada M., Chen-Yoshikawa T.F., Ohe Y., Nishio W., Nakagawa S., Nagao H.

Cancer Science Vol. 113 ( 12 ) page： 4327 - 4338 2022.12

Language：English Publisher：Cancer Science

The global phase 3 IMpower010 study evaluated adjuvant atezolizumab versus best supportive care (BSC) following platinum-based chemotherapy in patients with resected stage IB–IIIA non-small cell lung cancer (NSCLC). Here, we report a subgroup analysis in patients enrolled in Japan. Eligible patients had complete resection of histologically or cytologically confirmed stage IB (tumors ≥4 cm)–IIIA NSCLC. Upon completing 1–4 cycles of adjuvant cisplatin-based chemotherapy, patients were randomized 1:1 to receive atezolizumab (fixed dose of 1200 mg every 21 days; 16 cycles or 1 year) or BSC. The primary endpoint of the global IMpower010 study was investigator-assessed disease-free survival, tested hierarchically first in patients with stage II–IIIA NSCLC whose tumors expressed programmed death-ligand 1 (PD-L1) on ≥1% of tumor cells, then in all randomized patients with stage II–IIIA NSCLC, and finally in the intention-to-treat (ITT) population (stage IB–IIIA NSCLC). Safety was evaluated in all patients who received atezolizumab or BSC. The study comprised 149 enrolled patients in three populations: ITT (n = 117; atezolizumab, n = 59; BSC, n = 58), all-randomized stage II–IIIA (n = 113; atezolizumab, n = 56; BSC, n = 57), and PD-L1 tumor cells ≥1% stage II–IIIA (n = 74; atezolizumab, n = 41; BSC, n = 33). At the data cutoff date (January 21, 2021), a trend toward disease-free survival improvement with atezolizumab vs BSC was observed in the PD-L1 tumor cells ≥1% stage II–IIIA (unstratified hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.25–1.08), all-randomized stage II–IIIA (unstratified HR, 0.62; 95% CI, 0.35–1.11), and ITT (unstratified HR, 0.61; 95% CI, 0.34–1.10) populations. Atezolizumab-related grade 3/4 adverse events occurred in 16% of patients; no treatment-related grade 5 events occurred. Adjuvant atezolizumab showed disease-free survival improvement and a tolerable toxicity profile in Japanese patients in IMpower010, consistent with the global study results.

DOI： 10.1111/cas.15564

Scopus

Prognostic impact of the number of peri-tumoral alveolar macrophages in patients with stage I lung adenocarcinoma Reviewed

Noritake Osamu, Aokage Keiju, Suzuki Ayako, Tane Kenta, Miyoshi Tomohiro, Samejima Joji, Yoshikawa Toyohumi, Murata Shawhay Charles, Nakai Tokiko, Tsuboi Masahiro, Ishii Genichiro

JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY Vol. 148 ( 12 ) page： 3437 - 3447 2022.12

Language：English Publisher：Journal of Cancer Research and Clinical Oncology

Purpose: Intratumoral macrophages are reportedly involved in tumor progression in non-small cell lung cancer; however, little is known about the prognostic impact and function of alveolar macrophages (AMs). This study aims to investigate the prognostic impact of the number of peri-tumoral AMs in patients with stage I lung adenocarcinoma. Methods: We investigated 514 patients with pathological stage I lung adenocarcinoma who underwent complete resection with lobectomy or pneumonectomy. The numbers of peri-tumoral AMs were counted, and patients were classified into two groups based on the number of peri-tumoral AMs. Using the Cancer Genome Atlas (TCGA) database of stage I lung adenocarcinoma, we compared gene expression profiles of high and low peri-tumoral AM contents. Results: The median number of peri-tumoral AMs per alveolar space was 15.5. Patients with a high peri-tumoral AM content had significantly shorter disease-free survival and overall survival than patients with a low peri-tumoral AM content (both p < 0.01). In the multivariate analyses, a higher number of peri-tumoral AMs were an independent prognostic factor (p = 0.02). The analysis of TCGA database revealed that patients with a high peri-tumoral AM content had shorter disease-free survival than those with a low peri-tumoral AM content (p = 0.04). Gene expression analysis of TCGA stage I lung adenocarcinoma revealed enrichment of biological processes, such as chemotaxis and epithelial proliferation, in patients with a high peri-tumoral AM content. Conclusion: The number of peri-tumoral AMs had a strong impact on disease-free survival in patients with stage I lung adenocarcinoma.

DOI： 10.1007/s00432-022-04056-4

Web of Science

Scopus

Assessing the development status of intraoperative fluorescence imaging for anatomy visualisation, using the IDEAL framework Reviewed

Ishizawa T., Mcculloch P., Stassen L., Van Den Bos J., Regimbeau J.M., Dembinski J., Schneider-Koriath S., Boni L., Aoki T., Nishino H., Hasegawa K., Sekine Y., Chen-Yoshikawa T., Yeung T., Berber E., Kahramangil B., Bouvet M., Diana M., Kokudo N., Dip F., White K., Rosenthal R.J.

BMJ Surgery, Interventions, and Health Technologies Vol. 4 ( 1 ) 2022.11

Language：English Publisher：BMJ Surgery, Interventions, and Health Technologies

Objectives Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: visualising anatomy, assessing tissue perfusion, identifying/localising cancer and mapping lymphatic systems. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging used to visualise anatomical structures using the IDEAL framework, a framework designed to describe the stages of innovation in surgery and other interventional procedures. Design IDEAL staging based on a thorough literature review. Setting All publications on intraoperative fluorescence imaging for visualising anatomical structures reported in PubMed through 2020 were identified for five surgical procedures: cholangiography, hepatic segmentation, lung segmentation, ureterography and parathyroid identification. Main outcome measures The IDEAL stage of research evidence was determined for each of the five procedures using a previously described approach. Results 225 articles (8427 cases) were selected for analysis. Current status of research evidence on fluorescence imaging was rated IDEAL stage 2a for ureterography and lung segmentation, IDEAL 2b for hepatic segmentation and IDEAL stage 3 for cholangiography and parathyroid identification. Enhanced tissue identification rates using fluorescence imaging relative to conventional white-light imaging have been documented for all five procedures by comparative studies including randomised controlled trials for cholangiography and parathyroid identification. Advantages of anatomy visualisation with fluorescence imaging for improving short-term and long-term postoperative outcomes also were demonstrated, especially for hepatobiliary surgery and (para)thyroidectomy. No adverse reactions associated with fluorescent agents were reported. Conclusions Intraoperative fluorescence imaging can be used safely to enhance the identification of anatomical structures, which may lead to improved postoperative outcomes. Overviewing current research knowledge using the IDEAL framework aids in designing further studies to develop fluorescence imaging techniques into an essential intraoperative navigation tool in each surgical field.

DOI： 10.1136/bmjsit-2022-000156

Scopus

Comparison of international and Japanese predictive equations for maximal respiratory mouth pressures Reviewed

Hamada R., Oshima Y., Yoshioka Y., Chen-Yoshikawa T.F., Nakajima D., Nankaku M., Ikeguchi R., Date H., Matsuda S., Sato S.

Respiratory Investigation Vol. 60 ( 6 ) page： 847 - 851 2022.11

Language：Japanese Publisher：Respiratory Investigation

Respiratory muscle weakness has attracted attention because sarcopenia and respiratory muscle dysfunction may play a key role in the development of respiratory failure. To evaluate respiratory muscle strength appropriately, individual factors such as sex, age, body size, and ethnicity should be considered. This study aimed to compare equations available in Japan and other countries for predicting respiratory muscle strength. We tested 21 equations for maximal inspiratory pressure (MIP) and 17 for maximal expiratory pressure (MEP) for each sex (76 equations in total) in 159 normal, healthy subjects. We observed wide variations in the overall agreement among the MIP and MEP equations. Some equations showed a proper normal distribution, with median values of almost 100%, and the Japanese equations released in 1997 generally showed the best distributions of both %MIP and %MEP. We can conclude that it is better to use Japanese equations when evaluating respiratory muscle strength in Japanese subjects.

DOI： 10.1016/j.resinv.2022.07.003

Scopus

Neoadjuvant Therapy for Patients with Non-small Cell Lung Cancer Complicated with Chest Wall Invasion Reviewed

Sato K., Nakamura S., Kadomatsu Y., Ueno H., Kato T., Ozeki N., Fukumoto K., Chen-Yoshikawa T.F.

Anticancer Research Vol. 42 ( 11 ) page： 5539 - 5546 2022.11

Authorship：Last author Language：English Publisher：Anticancer Research

Background/Aim: Multidisciplinary treatment including anatomical pulmonary and chest wall resection is recommended for lung cancer complicated by chest wall invasion. The present study aimed to investigate the survival benefit and safety of preoperative therapy followed by surgery for non-small cell lung cancer with chest wall invasion. Patients and Methods: Sixty-five patients who underwent surgical excision of lung cancer complicated with chest wall invasion between 2009 and 2020 were enrolled in this study. Results: The median age was 65 (37-81) years old, with 59 males and 6 females. Histological types included squamous cell carcinoma (n=32) and adenocarcinoma (n=21). The median tumor diameter was 5.5 cm (2.3-12.5 cm). The clinical nodal status was N0 in 49 cases and N positive in 16 cases. Of the 65 eligible patients, 5- and 10-year overall survival (OS) rates were 58.4% and 46.0%, respectively, and 5- and 10-year progression-free survival (PFS) rates were 54.2% and 41.7%, respectively. For patients receiving preoperative therapy followed by surgery (Pre-Tx), 5- and 10-year OS survival rates were 69.2% and 62.9%, and among patients receiving up-front surgery (UFS) were 48.5% and 29.1%, respectively (p=0.03). The 5- and 10-year PFS rates for pre-Tx were 65.8% and 59.2%, respectively, and 44.7% and 26.8% for UFS, respectively (p=0.02). Cox regression analysis preoperative therapy was significantly associated with OS and PFS. Conclusion: We demonstrate the survival benefit of preoperative therapy followed by surgery for patients with lung cancer and chest wall invasion.

DOI： 10.21873/anticanres.16059

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Diagnostic value and safety of endobronchial ultrasonography with a guide sheath transbronchial biopsy for diagnosing peripheral pulmonary lesions in patients with interstitial lung disease Reviewed

Ito T., Okachi S., Iwano S., Kinoshita F., Wakahara K., Hashimoto N., Chen-Yoshikawa T.F.

Journal of Thoracic Disease Vol. 14 ( 11 ) page： 4361 - 4371 2022.11

Authorship：Last author Language：English Publisher：Journal of Thoracic Disease

Background: Radial endobronchial ultrasonography transbronchial biopsy with and without a guide sheath is a useful method for diagnosing peripheral pulmonary lesions (PPLs). However, the diagnostic yield and complications of radial endobronchial ultrasonography transbronchial biopsy for PPLs remains elusive in patients with interstitial lung disease (ILD). Methods: We retrospectively analysed 431 patients (69 with and 362 without ILD) who underwent radial endobronchial ultrasonography with a guide sheath transbronchial biopsy (EBUS-GS TBB) for PPLs from April 1, 2011, to March 31, 2020. We investigated the diagnostic yield and complications of the procedure for PPLs and compared them between patients with and without ILD. We also evaluated the factors contributing to successful diagnosis. Results: The diagnostic yield of radial endobronchial ultrasonography in patients with ILD was significantly lower than in those without ILD (62.3% vs. 75.4%, P=0.024). Multivariate analysis showed that the presence of ILD as background lung [odds ratio (OR) =0.517], probe position within the lesion (OR =4.654), and the presence of solid lesion (OR =1.946) significantly affected the diagnostic yield of PPLs. There was a significant difference in the rate of pneumothorax between the patients with ILD and those without ILD (4.3% vs. 0.6%, P=0.031). Conclusions: The presence of ILD as the background lung significantly affected the diagnostic yield of PPLs with radial EBUS-GS TBB. Regarding the complications, pneumothorax occurred more frequently in patients with ILD than in those without ILD.

DOI： 10.21037/jtd-22-809

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A novel system applying artificial intelligence in the identification of air leak sites Reviewed

Kadomatsu Y., Nakao M., Ueno H., Nakamura S., Chen-Yoshikawa T.F.

JTCVS Techniques Vol. 15 page： 181 - 191 2022.10

Authorship：Last author Language：English Publisher：JTCVS Techniques

Objective: Prolonged air leak is the most common complication of thoracic surgery. Intraoperative leak site detection is the first step in decreasing the risk of leak-related postoperative complications. Methods: We retrospectively reviewed the surgical videos of patients who underwent lung resection at our institution. In the training phase, deep learning-based air leak detection software was developed using leak-positive endoscopic images. In the testing phase, a different data set was used to evaluate our proposed application for each predicted box. Results: A total of 110 originally captured and labeled images obtained from 70 surgeries were preprocessed for the training data set. The testing data set contained 64 leak-positive and 45 leak-negative sites. The testing data set was obtained from 93 operations, including 58 patients in whom an air leak was present and 35 patients in whom an air leak was absent. In the testing phase, our software detected leak sites with a sensitivity and specificity of 81.3% and 68.9%, respectively. Conclusions: We have successfully developed a deep learning-based leak site detection application, which can be used in deflated lungs. Although the current version is still a prototype with a limited training data set, it is a novel concept of leak detection based entirely on visual information.

DOI： 10.1016/j.xjtc.2022.06.011

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Is it true that less is more in thoracic surgery? Invited Reviewed

Chen-Yoshikawa T.F.

Journal of Thoracic Disease Vol. 14 ( 10 ) page： 3674 - 3676 2022.10

The impact of COVID-19 on thoracic surgical procedures in Japan: Analysis of data from the National Clinical Database Reviewed

Sato Y., Yamamoto H., Ikeda N., Konishi H., Endo S., Okada Y., Kondo H., Shintani Y., Toyooka S., Nakamura H., Hoshikawa Y., Chen-Yoshikawa T.F., Yoshino I., Kakizoe T., Chida M.

Lung Cancer Vol. 172 page： 127 - 135 2022.10

Language：English Publisher：Lung Cancer

Objective: The COVID-19 pandemic has far-reaching collateral health impacts on the ongoing delivery of surgical care worldwide. The current study was designed to analyze the impact of the COVID-19 pandemic on the number of surgeries of general thoracic surgery in Japan. Methods: Changes in the number of surgeries for total and three representative tumors were analyzed using the National Clinical Database data with reference to the pandemic infection rate and lung cancer screening. Results: In 2020, the number of surgeries in total and for primary lung cancer and mediastinal lung tumor decreased by 4.9, 5.1, and 5.0 %, respectively. Considering the five-year trend towards a 5 % annual increase, there was a potential 10 % decrease in the number of primary lung cancer surgeries. The number of primary lung cancer surgeries bottomed in July 2020 but recovered towards the end of the year. In contrast, the number of metastatic lung tumor surgeries in 2020 increased by 3.2 %, following a similar trend observed over the previous five years. The number of lung cancer screening examinees decreased markedly with the lowest number in May. Our findings indicate that surgical triage had a limited impact on the decrease in primary lung cancer surgeries during the pandemic; rather, the decrease in lung cancer screening, which was a few months preceding, is most likely responsible. Conclusions: The decrease in primary lung cancer was mainly caused by the decrease in lung cancer screening, indicating that continuing screening is vital even during a pandemic.

DOI： 10.1016/j.lungcan.2022.08.011

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Prevention of droplet dispersal with ‘e-mask’: A new daily use endoscopic mask during bronchoscopy Reviewed

Ito T., Okachi S., Sato K., Yasui H., Fukatsu N., Ando M., Chen-Yoshikawa T.F., Saka H.

Respirology Vol. 27 ( 10 ) page： 863 - 873 2022.10

Language：English Publisher：Respirology

Background and objective: Bronchoscopy is an airborne particle-generating procedure. However, few methods for safe bronchoscopy have been developed. To reduce airborne particles during bronchoscopy, we created an ‘e-mask’, which is a simple, disposable mask for patients. Our objective was to evaluate the e-mask's protective ability against airborne particles and to assess respiratory adverse events and complications. Methods: Patients with stage 2–4 chronic obstructive pulmonary disease were excluded. We performed visualization and quantifying experiments on airborne particles with and without the e-mask. We prospectively evaluated whether wearing the e-mask during bronchoscopy was associated with the incidence of patients requiring >5 L/min oxygen to maintain >90% oxygen saturation, and patients with >45 mm Hg end-tidal carbon dioxide (EtCO2) elevation, in addition to complications, compared to historical controls. Results: In the visualization experiment, more than ten thousand times of airborne particles were generated without the e-mask than with the e-mask. The volume of airborne particles was significantly reduced with the e-mask, compared to that without the e-mask (p = 0.011). Multivariate logistic regression analysis revealed that wearing the e-mask had no significant effect on the incidence of patients requiring >5 L/min oxygen to maintain >90% oxygen saturation, (p = 0.959); however, wearing the e-mask was a significant factor in >45 mm Hg EtCO2 elevation (p = 0.026). No significant differences in complications were observed between the e-mask and control groups (5.8% vs. 2.5%, p = 0.395). Conclusion: Wearing the e-mask during bronchoscopy significantly reduced the generation of airborne particles during bronchoscopy without increasing complications.

DOI： 10.1111/resp.14321

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Skeletal muscle and related protein expression as prognostic factors in thymic squamous cell carcinoma Reviewed

Nakanishi K., Ozeki N., Tateyama H., Kadomatsu Y., Ueno H., Goto M., Nakamura S., Fukumoto K., Chen-Yoshikawa T.F.

Journal of Thoracic Disease Vol. 14 ( 9 ) page： 3245 - 3254 2022.9

Authorship：Last author Language：English Publisher：Journal of Thoracic Disease

Background: Sarcopenia and its marker, the psoas muscle index (PMI), have attracted attention as prognostic factors for various types of cancers. The fragile X-related 1 (FXR1) gene is highly expressed in myocytes, and FXR1 overexpression is a candidate biomarker for poor survival in several types of cancers. Thymic squamous cell carcinoma (TSQCC) is rare, and no studies assessing its prognostic factors, particularly in terms of skeletal muscle mass and FXR1 expression, are available. Methods: We retrospectively investigated the prognostic significance of PMI in 34 patients who underwent TSQCC resection, considering the status of FXR1 and tumor programmed death-ligand 1 (PD-L1). PMI was calculated from the bilateral psoas muscle using preoperative computed tomography (CT). Patients were divided into two groups: low PMI (<58.2%, n=17) and normal PMI (≥58.2%, n=17). Immunohistochemical analysis was performed to determine the FXR1 and PD-L1 expression levels. Results: Low PMI was significantly associated with worse overall survival (OS) (5-year survival rate; 86% vs. 100%; P=0.026) and marginally associated with worse disease-free survival (DFS) (5-year survival rate; 39% vs. 66%; P=0.090) compared with normal PMI. The immunohistochemical analysis revealed that the FXR1 intensity score (0–1+: 6% vs. 0%; 2+–3+: 94% vs. 100%; P=0.31), median FXR1 distribution (95% vs. 90%; P=0.63), and PD-L1 status (high: 47% vs. 59%; P=0.49) were not significantly different between the two groups. Conclusions: Our findings suggest that PMI might be considered as a potential prognostic factor in TSQCC and that FXR1 is widely expressed regardless of the PMI status. Skeletal muscle mass may play a role in the prognosis of TSQCC.

DOI： 10.21037/jtd-22-385

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Reply From Authors: How a cell dies matters and how to evaluate it also matters Reviewed

Ueda S., Chen-Yoshikawa T.F., Tanaka S., Yamada Y., Nakajima D., Ohsumi A., Date H.

JTCVS Open Vol. 11 2022.9

Long-term Follow-up Study of Thymic Epithelial Tumors. Report of the Updated Nation-wide Database in Japan Reviewed

Okumura M., Yoshino I., Shintani Y., Nakanishi R., Yoshikawa T., Date H., Toyooka S-I., Shimizu K., Nakajima J., Tsuboi M., Watanabe S-I., Asamura H.

JOURNAL OF THORACIC ONCOLOGY Vol. 17 ( 9 ) page： S78 - S79 2022.9

Chest three-dimensional-computed tomography imaging data analysis for the variation of exercise capacity after lung lobectomy Reviewed

Ozeki N., Iwano S., Nakamura S., Kawaguchi K., Mizuno Y., Inoue T., Nagaya M., Chen-Yoshikawa T.F.

Clinical Physiology and Functional Imaging Vol. 42 ( 5 ) page： 362 - 371 2022.9

Authorship：Last author Language：English Publisher：Clinical Physiology and Functional Imaging

Background: Postoperative loss of exercise capacity and pulmonary function is a major concern among lung cancer patients. In this study, the time for a stair-climbing to 12-m height was used to investigate whether preoperative chest 3D-computed tomography (CT) could be a useful tool for predicting postoperative variations in exercise capacity and pulmonary function. Methods: Seventy-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enroled. Preoperatively, lobe volume and low attenuation volume (LAV) were evaluated using the SYNAPSE VINCENT system. Preoperative data on stair-climbing time, spirometry and diffusing capacity of the lung for carbon monoxide (DLCO) at baseline and 6-month postoperative data were used to evaluate variations in exercise capacity and pulmonary function. Maximal oxygen uptake (VO2t) was evaluated based on the stair-climbing time. Results: Significant differences in the variation of exercise capacity at 6 months postoperatively were found between the groups categorized by target lobe volume and LAV status: The large volume/LAV (+) group had a greater decline in VO2t. Mean loss of VO2t was −6.2%, −1.4%, −1.6% and −0.1% in the large volume/LAV (+), large volume/LAV (−), small volume/LAV (+) and small volume/LAV (−) groups, respectively. The large volume/LAV (−) group had a greater decline in forced expiratory volume in 1 s. The small volume/LAV (+) group showed a reduced decline in the DLCO. Conclusions: Analysis of chest 3D-CT scans is a potential tool for predicting the loss of exercise capacity and pulmonary function after lung lobectomy.

DOI： 10.1111/cpf.12777

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