研究者詳細 - 芳川　豊史

論文 - 芳川　豊史

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Ischemia–reperfusion injury in lung transplantation

Chen-Yoshikawa T.F.

Cells 10 巻 ( 6 ) 2021年6月

記述言語：日本語出版者・発行元：Cells

Lung transplantation has been established worldwide as the last treatment for end-stage respiratory failure. However, ischemia–reperfusion injury (IRI) inevitably occurs after lung transplantation. The most severe form of IRI leads to primary graft failure, which is an important cause of morbidity and mortality after lung transplantation. IRI may also induce rejection, which is the main cause of mortality in recipients. Despite advances in donor management and graft preservation, most donor grafts are still unsuitable for transplantation. Although the pulmonary endothelium is the primary target site of IRI, the pathophysiology of lung IRI remains incompletely understood. It is essential to understand the mechanism of pulmonary IRI to improve the outcomes of lung transplantation. Therefore, we reviewed the state-of-the-art in the management of pulmonary IRI after lung transplantation. Recently, the ex vivo lung perfusion (EVLP) system has been clinically introduced worldwide. Various promising therapeutic strategies for the protection of the endothelium against IRI, including EVLP, inhalation therapy with therapeutic gases and substances, fibrinolytic treatment, and mesenchymal stromal cell therapy, are awaiting clinical application. We herein review the latest advances in the field of pulmonary IRI in lung transplantation.

DOI： 10.3390/cells10061333

Scopus

Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non-small-cell lung cancer

Tanaka S., Ozeki N., Mizuno Y., Nakajima H., Hattori K., Inoue T., Nagaya M., Fukui T., Nakamura S., Goto M., Sugiyama T., Nishida Y., Chen-Yoshikawa T.F.

Journal of Cachexia, Sarcopenia and Muscle 12 巻 ( 3 ) 頁： 646 - 656 2021年6月

記述言語：日本語出版者・発行元：Journal of Cachexia, Sarcopenia and Muscle

Background: Despite the associations of both preoperative sarcopenia and physical performance with post-operative mortality in non-small-cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC. Methods: This retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex-specific tertile) and non-sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross-sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post-operative overall survival (OS) and disease-free survival (DFS). Results: The 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non-sarcopenia/long-distance group (58%), sarcopenia/long-distance group (26%), non-sarcopenia/short-distance group (9%), and sarcopenia/short-distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow-up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short-distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79–6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27–3.51; P = 0.004) compared with the non-sarcopenia/long-distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre-existing risk model increased the area under the curve on time-dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery. Conclusions: The presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post-operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.

DOI： 10.1002/jcsm.12691

Scopus

Native lung complications after living-donor lobar lung transplantation

Mineura K., Chen-Yoshikawa T.F., Tanaka S., Yamada Y., Yutaka Y., Nakajima D., Ohsumi A., Hamaji M., Menju T., Date H.

Journal of Heart and Lung Transplantation 40 巻 ( 5 ) 頁： 343 - 350 2021年5月

記述言語：日本語出版者・発行元：Journal of Heart and Lung Transplantation

Background: Living-donor lobar lung transplantation (LDLLT) is viable for critically ill patients in situations of donor shortage. Because it is sometimes difficult to find 2 ideal living donors with suitable graft sizes, we developed native lung-sparing procedures, including single LDLLT and native upper lobe-sparing LDLLT. This study aimed to investigate native lung complications (NLCs) in native lung-sparing LDLLT. Methods: Between April 2002 and March 2019, 92 LDLLTs and 124 cadaveric lung transplantations (CLTs) were performed at the Kyoto University Hospital. Our prospectively maintained database and clinical records were reviewed to compare NLCs among recipients who underwent native lung-sparing LDLLT (n = 21) with those among recipients who underwent single CLT (n = 61). Results: Among 21 recipients who underwent native lung-sparing LDLLT, 11 NLCs occurred in 8 recipients. No fatal NLC was noted; however, 2 required surgical intervention. Post-transplant survival was not significantly different between native lung-sparing LDLLT recipients with NLCs and those without NLCs. The incidence of NLCs was comparable between native lung-sparing LDLLT recipients and single CLT recipients (8/21 vs 26/61, p = 0.80); however, NLCs occurred significantly later in LDLLT recipients than in CLT recipients (median: 665 vs 181.5 days after transplantation, p = 0.014). Conclusions: NLCs after native lung-sparing LDLLT had favorable outcomes. Therefore, native lung-sparing LDLLT is a useful treatment option for severely ill patients who cannot wait for CLT. However, it is important to recognize that NLCs may occur later in LDLLT than in CLT.

DOI： 10.1016/j.healun.2021.01.1562

Scopus

Postoperative outcomes of lung transplant recipients with preformed donor-specific antibodies

Kayawake H., Chen-Yoshikawa T.F., Gochi F., Tanaka S., Yurugi K., Hishida R., Yutaka Y., Yamada Y., Ohsumi A., Hamaji M., Nakajima D., Date H.

Interactive cardiovascular and thoracic surgery 32 巻 ( 4 ) 頁： 616 - 624 2021年4月

記述言語：日本語出版者・発行元：Interactive cardiovascular and thoracic surgery

OBJECTIVES: Few studies have evaluated the outcomes of lung transplantation (LTx) in recipients with preformed donor-specific antibodies (DSAs). This study investigated the postoperative changes in preformed DSAs based on prospectively collected data of DSAs, and the influences of preformed DSAs on postoperative outcomes among LTx recipients. METHODS: Between July 2010 and December 2019, 216 recipients underwent LTx (81 living-donor lobar lung transplants and 135 deceased-donor lung transplants). We reviewed 8 cases with preformed DSAs to determine postoperative changes in DSAs and compared postoperative outcomes between recipients with and without DSAs. RESULTS: The preoperative mean fluorescence intensity of preformed DSAs ranged from 1141 to 14 695. Two recipients experienced antibody-mediated rejection within 2 weeks after LTx. DSAs disappeared in 7 recipients; however, 1 recipient experienced the relapse of DSAs and died from chronic lung allograft syndrome (CLAD), whereas 1 recipient had persisting DSAs within the study period and died from CLAD. Neither overall survival (OS) nor CLAD-free survival was significantly different between recipients with and without DSAs (P = 0.26 and P = 0.17, respectively). However, both OS and CLAD-free survival were significantly lower in recipients with DSAs against HLA class II than in those without these antibodies {5-year OS: 25.0% [95% confidence interval (CI): 0.9-66.5%] vs 72.1% (95% CI: 63.8-78.9%), P = 0.030 and 5-year CLAD-free survival: 26.7% (95% CI: 1.0-68.6%) vs 73.7% (95% CI: 66.5-79.5%), P = 0.002}. CONCLUSIONS: Prognosis in recipients experiencing the relapse of preformed DSAs and those with persisting DSAs may be poor. The recipients with anti-HLA class II preformed DSAs had a significantly worse prognosis.

DOI： 10.1093/icvts/ivaa311

Scopus

閉塞性細気管支炎における気管支拡張の意義について

古郷摩利子, 松本久子, 田辺直也, 芳川豊史, 中島直樹, 吉澤明彦, 小熊毅, 佐藤晋, 野村奈都子, 森本千絵, 砂留広伸, 後藤慎平, 大角明宏, 伊達洋至, 平井豊博

日本呼吸器学会誌 10 巻 ( 増刊 ) 頁： 195 - 195 2021年4月

Fluorescence-guided thoracic surgery 招待有り査読有り

Shota Nakamura, Masaki Goto, Toyofumi F. Chen-Yoshikawa

Journal of Visualized Surgery 7 巻頁： 18 - 18 2021年4月

Left brachiocephalic vein aneurysm: a case report

Ueno Harushi, Yazawa Mari, Tsubouchi Hideki, Nakanishi Keita, Sugiyama Tomoshi, Kadomatsu Yuka, Goto Masaki, Ozeki Naoki, Nakamura Shota, Fukui Takayuki, Mutsuga Masato, Yoshikawa Toyofumi Fengshi Chen

SURGICAL CASE REPORTS 7 巻 ( 1 ) 2021年3月

胸部CT画像による脊柱起立筋の術前指標が術後の運動耐容能および生命予後に及ぼす影響

大島洋平, 佐藤晋, 芳川豊史, 田中里奈, 山田義人, 豊洋次郎, 中島大輔, 濱路政嗣, 大角明宏, 伊達洋至, 松田秀一

移植 55 巻 ( 4 ) 頁： 515 - 516 2021年3月

胸部CT画像による脊柱起立筋の術前指標が術後の運動耐容能および生命予後に及ぼす影響

大島洋平, 佐藤晋, 芳川豊史, 田中里奈, 山田義人, 豊洋次郎, 中島大輔, 濱路政嗣, 大角明宏, 伊達洋至, 松田秀一

移植 55 巻 ( 4 ) 頁： 515 - 516 2021年3月

Factors associated with changes in the 12-m stair-climbing time after lung lobectomy

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

General Thoracic and Cardiovascular Surgery 69 巻 ( 2 ) 頁： 282 - 289 2021年2月

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：General Thoracic and Cardiovascular Surgery

Objective: Postoperative loss-of-exercise capacity is one of the main concerns for patients undergoing lung cancer surgery. This study was designed to identify the factors associated with loss-of-exercise capacity after lobectomy, using an easy surrogate measure: the 12-m stair-climbing time (SCt). Methods: Ninety-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enrolled. SCt and pulmonary function test were evaluated preoperatively as baseline and at 6 months postoperatively. At 6 months postoperatively, 20 patients dropped out. Loss-of-exercise capacity was defined as at least a 3.3% decline (lower quartile) in the estimated maximal oxygen uptake (VO2t: 43.06 − 0.4 × SCt). Factors associated with loss-of-exercise capacity were analyzed. Results: Median (interquartile range) baseline SCt was 31.5 (28.2–36.7) s. Baseline SCt was not significantly associated with complications. At 6 months postoperatively, SCt increased by + 4.4 (+ 3.2, + 6.8) s in patients with loss-of-exercise capacity. Sex, smoking status, lobe, procedure, and forced expiratory volume in 1 s showed no significant association with loss-of-exercise capacity. In the multivariable logistic regression, older age (≥ 73 years) (odds ratio: 5.25, 95% confidence interval: 1.50–18.43, p = 0.010) and lower baseline diffusing capacity of the lung for carbon monoxide (< 75%) (odds ratio: 9.23, 95% confidence interval: 1.94–43.93, p = 0.005) were significantly associated with loss-of-exercise capacity. Conclusion: Age and the baseline diffusing capacity of the lung for carbon monoxide were identified as significant variables associated with variation of exercise capacity after lung cancer surgery, using pre- and postoperative SCt.

DOI： 10.1007/s11748-020-01458-4

Scopus

Thymic lipofibroadenoma accompanied with largish calcifications

Hakiri S., Kawaguchi K., Tateyama H., Fukui T., Nakamura S., Ozeki N., Mori S., Chen-Yoshikawa T.F.

General Thoracic and Cardiovascular Surgery 69 巻 ( 2 ) 頁： 394 - 397 2021年2月

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：General Thoracic and Cardiovascular Surgery

Thymic lipofibroadenomas are extremely rare; their radiological features have never been reported. We report the first case of a lipofibroadenoma with some largish calcifications mimicking a teratoma. A 28-year-old man had an anterior mediastinal tumor with some calcifications on preoperative computed tomography, which was suspected to be a mature teratoma and resected through robot-assisted thoracic surgery. This tumor had strands of epithelial cells separated by abundant fibrous stroma containing fat cells and was thus diagnosed as a lipofibroadenoma. He was well without any recurrence 6 months postoperatively. Largish calcifications on preoperative computed tomography make distinguishing between teratomas and lipfibroadenomas difficult.

DOI： 10.1007/s11748-020-01475-3

Scopus

生体肺移植周術期における脊柱起立筋CT値の低下は予後不良因子である

大島洋平, 佐藤晋, 吉岡佑二, 濱田涼太, 佐藤達也, 太田垣あゆみ, 芳川豊史, 伊達洋至, 南角学, 松田秀一

日本呼吸ケア・リハビリテーション学会誌 30 巻 ( Suppl. ) 頁： 154s - 154s 2021年2月

脳死肺移植における術前の脊柱起立筋CT値の低下は予後不良因子である

大島洋平, 佐藤晋, 吉岡佑二, 濱田涼太, 佐藤達也, 太田垣あゆみ, 芳川豊史, 伊達洋至, 南角学, 松田秀一

日本呼吸ケア・リハビリテーション学会誌 30 巻 ( Suppl. ) 頁： 154s - 154s 2021年2月

肺移植待機中の間質性肺疾患患者における運動耐容能に影響を及ぼす因子の検討

佐藤達也, 佐藤晋, 大島洋平, 吉岡佑二, 濱田涼太, 田平一行, 芳川豊史, 半田知宏, 伊達洋至, 松田秀一

日本呼吸ケア・リハビリテーション学会誌 30 巻 ( Suppl. ) 頁： 154s - 154s 2021年2月

Protective Effects of a Hydrogen-Rich Preservation Solution in a Canine Lung Transplantation Model

Kayawake H., Chen-Yoshikawa T.F., Saito M., Yamagishi H., Yoshizawa A., Hirano S.i., Kurokawa R., Date H.

Annals of Thoracic Surgery 111 巻 ( 1 ) 頁： 246 - 252 2021年1月

記述言語：日本語出版者・発行元：Annals of Thoracic Surgery

Background: Molecular hydrogen (H2) has protective effects against ischemia-reperfusion injury in various organs. Because they are easier to transport and safer to use than inhaled H2, H2-rich solutions are suitable for organ preservation. In this study, we examined the protective effects of an H2-rich solution for lung preservation in a canine left lung transplantation (LTx) model. Methods: Ten beagles underwent orthotopic left LTx after 23 hours of cold ischemia followed by reperfusion for 4 hours. Forty-five minutes after reperfusion, the right main pulmonary artery was clamped to evaluate the function of the implanted graft. The beagles were divided into two groups: control group (n = 5), and H2 group (n = 5). In the control group, the donor lungs were flushed and immersed during cold preservation at 4°C using ET-Kyoto solution, and in the H2 group, these were flushed and immersed using H2-rich ET-Kyoto solution. Physiologic assessments were performed during reperfusion. After reperfusion, the wet-to-dry ratios were determined, and histology examinations were performed. Results: Significantly higher partial pressure of arterial oxygen and significantly lower partial pressure of carbon dioxide were observed in the H2 group than in the control group (P =.045 and P <.001, respectively). The wet-to-dry ratio was significantly lower in the H2 group than in the control group (P =.032). Moreover, in histology examination, less lung injury and fewer apoptotic cells were observed in the H2 group (P <.001 and P <.001, respectively). Conclusions: Our results demonstrated that the H2-rich preservation solution attenuated ischemia-reperfusion injury in a canine left LTx model.

DOI： 10.1016/j.athoracsur.2020.05.076

Scopus

解剖学的ランドマークとの相対位置を用いたカーネル法による気胸肺の変形推定

山本詩子, 中尾恵, 大関真之, 徳野純子, 芳川豊史, 松田哲也

生体医工学 Annual59 巻 ( Abstract ) 頁： 515 - 515 2021年

記述言語：日本語出版者・発行元：公益社団法人日本生体医工学会

<p>肺が生体内にあるときは膨らんでいる（含気状態）が、手術中は肺が萎む（脱気状態）。ビデオ胸腔鏡下手術では、肺結節の切除をサポートするリアルタイムの映像を医師に提供するために、肺がどのように変形しているのかを高精度に推定することが期待されている。本研究では、カーネル法に基づいて、膨らんだ肺から萎んだ肺への変形を推定する手法を提案する。本手法では、肺表面に設定した少数のランドマーク点との相対位置を利用して、肺表面全体の変形を推定する。実験には、9例のビーグル犬の左肺を含気状態と脱気状態でCT撮像し、肺表面の3次元メッシュモデルを構築して用いた。上葉と下葉のメッシュモデルはそれぞれの頂点数400で別々に構築し、含気状態と脱気状態の肺の形状マッチングを行った。形状マッチングのプロセスはデータとして用いる既知の肺のみに必要で、未知の肺で行う必要は無い。ランドマークは肺の外側の表面に設定し、6点のランドマークを用いた実験では、全体の体積が40%萎んだ肺に対して、平均の局所位置誤差2.74mm、ハウスドルフ距離6.11mm、ダイス係数0.94で推定することができた。ランドマークを大葉間裂のみに配置した場合にも、平均の局所位置誤差3.29mm、ハウスドルフ距離6.77mm、ダイス係数0.93で推定することができた。また、学習に用いる症例数を減らした実験では4例以上を学習すれば平均の局所位置誤差3mm未満で推定することができた。</p>

DOI： 10.11239/jsmbe.annual59.515

CiNii Research

肺移植後の抗体関連拒絶に対するrituximab（遺伝子組換え）

芳川豊史, 伊達洋至, 杉本誠一郎, 白石武史, 中川健, 江川裕人

移植 56 巻 ( 1 ) 頁： 53 - 68 2021年

Commentary: Change the temperature before we have to

Kadomatsu Y., Chen-Yoshikawa T.F.

Journal of Thoracic and Cardiovascular Surgery 2021年

Kernel-based modeling of pneumothorax deformation using intraoperative cone-beam CT images

Nakao M., Maekawa H., Mineura K., Chen-Yoshikawa T.F., Matsuda T.

Progress in Biomedical Optics and Imaging - Proceedings of SPIE 11598 巻 2021年

記述言語：日本語出版者・発行元：Progress in Biomedical Optics and Imaging - Proceedings of SPIE

In this study, we introduce statistical modeling methods for pneumothorax deformation using paired cone-beam computed tomography (CT) images. We designed a deformable mesh registration framework for shape changes involving non-linear deformation and rotation of the lungs. The registered meshes with local correspondences are available for both surgical guidance in thoracoscopic surgery and building statistical deformation models with inter-patient variations. In addition, a kernel-based deformation learning framework is proposed to reconstruct intraoperative dfl ated states of the lung from the preoperative CT models. This paper reports the findings of pneumothorax deformation and evaluation results of the kernel-based deformation framework.

DOI： 10.1117/12.2581388

Scopus

Erector spinae muscle radiographic density is associated with survival after lung transplantation

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

Journal of Thoracic and Cardiovascular Surgery 2021年

記述言語：日本語出版者・発行元：Journal of Thoracic and Cardiovascular Surgery

Objective: The study objective was to verify whether low preoperative radiographic density of erector spinae muscles is associated with poor prognosis after lung transplantation. Methods: Preoperative chest computed tomography scans for patients who underwent deceased-donor lung transplantation between 2013 and 2019 at Kyoto University Hospital were retrospectively retrieved. The radiographic density of erector spinae muscles was quantitatively evaluated as the mean attenuation of erector spinae muscles, and low mean radiographic density of the erector spinae muscles was defined as a mean radiographic density of the erector spinae muscles value below the median value for all patients. Overall survival and chronic lung allograft dysfunction-free survival with high and low mean radiographic density of the erector spinae muscles were estimated using the Kaplan–Meier method and evaluated by the log-rank test, as well as by univariate and multivariate Cox proportional hazard analyses. Results: Of the 107 adult patients who underwent primary transplantation, 96 underwent at least 1 chest computed tomography scan within 24 hours before lung transplantation. The median mean radiographic density of the erector spinae muscles in these 96 patients was 49.2 Hounsfield units. A low mean radiographic density of the erector spinae muscles value was significantly associated with decreased overall survival (hazard ratio, 4.50; P =.030) and chronic lung allograft dysfunction–free survival (hazard ratio, 3.18; P =.028) in the multivariate analysis. Additionally, patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles value had a worse overall survival (P <.001) and chronic lung allograft dysfunction–free survival (P <.001) than patients with preoperative steroid use and a high mean radiographic density of the erector spinae muscles value and those without preoperative steroid use. Conclusions: Low mean radiographic density of the erector spinae muscles was closely associated with a poor prognosis after lung transplantation. The prognosis was particularly poor in patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles. These results may be useful when considering the indications for lung transplantation or preoperative interventions. Video Abstract:[Figure presented]

DOI： 10.1016/j.jtcvs.2021.07.039

Scopus

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