研究者詳細 - 宮島　正博

論文 - 宮島　正博

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The Roles and Regulatory Mechanisms of Tight Junction Protein Cingulin and Transcription Factor Forkhead Box Protein O1 in Human Lung Adenocarcinoma A549 Cells and Normal Lung Epithelial Cells.

Daichi Ishii, Yuma Shindo, Wataru Arai, Takumi Konno, Takayuki Kohno, Kazuya Honda, Masahiro Miyajima, Atsushi Watanabe, Takashi Kojima

International journal of molecular sciences 25 ( 3 ) 2024年01月 [国際誌]

Tight junction (TJ) protein cingulin (CGN) and transcription factor forkhead box protein O1 (FOXO1) contribute to the development of various cancers. Histone deacetylase (HDAC) inhibitors have a potential therapeutic role for some cancers. HDAC inhibitors affect the expression of both CGN and FOXO1. However, the roles and regulatory mechanisms of CGN and FOXO1 are unknown in non-small cell lung cancer (NSCLC) and normal human lung epithelial (HLE) cells. In the present study, to investigate the effects of CGN and FOXO1 on the malignancy of NSCLC, we used A549 cells as human lung adenocarcinoma and primary human lung epithelial (HLE) cells as normal lung tissues and performed the knockdown of CGN and FOXO1 by siRNAs. Furthermore, to investigate the detailed mechanisms in the antitumor effects of HDAC inhibitors for NSCLC via CGN and FOXO1, A549 cells and HLE cells were treated with the HDAC inhibitors trichostatin A (TSA) and Quisinostat (JNJ-2648158). In A549 cells, the knockdown of CGN increased bicellular TJ protein claudin-2 (CLDN-2) via mitogen-activated protein kinase/adenosine monophosphate-activated protein kinase (MAPK/AMPK) pathways and induced cell migration, while the knockdown of FOXO1 increased claudin-4 (CLDN-4), decreased CGN, and induced cell proliferation. The knockdown of CGN and FOXO1 induced cell metabolism in A549 cells. TSA and Quisinostat increased CGN and tricellular TJ protein angulin-1/lipolysis-stimulated lipoprotein receptor (LSR) in A549. In normal HLE cells, the knockdown of CGN and FOXO1 increased CLDN-4, while HDAC inhibitors increased CGN and CLDN-4. In conclusion, the knockdown of CGN via FOXO1 contributes to the malignancy of NSCLC. Both HDAC inhibitors, TSA and Quisinostat, may have potential for use in therapy for lung adenocarcinoma via changes in the expression of CGN and FOXO1.

DOI PubMed

Experimental and histological evaluation of each clamp technique for pulmonary artery.

Yoshiki Chiba, Yuki Takahashi, Yoshiaki Takase, Kodai Tsuruta, Ryunosuke Maki, Masahiro Miyajima, Hirofumi Ohnishi, Atsushi Watanabe

Interdisciplinary cardiovascular and thoracic surgery 2023年07月 [査読有り] [国際誌]

OBJECTIVES: The double-loop technique has been used in our clinical settings for pulmonary arterioplasty and/or injured artery repair during thoracoscopic anatomical lung resection. We evaluated the pressure resistance capacity and intimal load to determine the effectiveness and safety of the double-loop technique. METHODS: The double-loop technique, DeBakey clamp, Fogarty clamp, endovascular clips, and vessel loop technique were evaluated. During an experimental study, a polyvinyl alcohol main pulmonary artery model, manometer, and in-deflation device were used to measure the burst pressure. The maximum clamp pressure was measured using a pressure-measuring film. Each measurement was performed 10 times. During the histological study, we measured the burst pressure and evaluated the intimal damage of the human pulmonary artery associated with the double-loop technique and DeBakey clamp. RESULTS: The experimental burst pressure (mmHg) and maximum clamp pressure (MPa) between the double-loop technique and DeBakey at the third notch were not significantly different (24.6 ± 2.8 and 21.8 ± 2.8, P = 0.094; 1.54 ± 0.12 and 1.49 ± 0.12, P = 0.954). During the histological study, the burst pressures of the double-loop technique and DeBakey at the third notch were also not significantly different (P = 0.754). Furthermore, the double-loop technique resulted in only intimal deformation in each five samples. CONCLUSIONS: The double-loop technique is feasible for thoracoscopic anatomical lung resection because it has similar pressure resistance capacity and intimal load as DeBakey at the third notch.

DOI PubMed

特集縦隔･胸壁腫瘍に対する低侵襲手術 1. ロボット支援下手術手術支援ロボットを用いた縦隔腫瘍に対する低侵襲手術-ポート配置の工夫と適応の変遷

槙龍之輔, 鶴田航大, 千葉慶宜, 石井大智, 大湯岳, 佐藤大軌, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 76 ( 7 ) 506 - 509 2023年07月 [査読有り]

DOI

Recognition of subsuperior segmental vein for thoracoscopic subsuperior segmentectomy.

Daichi Ishii, Yoshiaki Takase, Ryunosuke Maki, Yoshiki Chiba, Yuki Takahashi, Kodai Tsuruta, Masahiro Miyajima, Atsushi Watanabe

JTCVS techniques 19 135 - 139 2023年06月 [査読有り] [国際誌]

DOI PubMed

Metastatic pulmonary pleomorphic carcinoma replaced by a granulomatous lesion after spontaneous regression and PD-1 blockade-induced regression: can epithelioid granuloma be a histological hallmark of cancer immunity?

Naoki Shijubou, Yuichiro Asai, Michiko Hosaka, Keiko Segawa, Terufumi Kubo, Masahiro Miyajima, Tomohide Tsukahara, Yoshihiko Hirohashi, Takayuki Kanaseki, Kenji Murata, Atsushi Watanabe, Tadashi Hasegawa, Hirofumi Chiba, Toshihiko Torigoe

Immunological medicine 46 ( 2 ) 93 - 96 2023年06月 [国際誌]

Immune checkpoint inhibitors (ICIs) for various types of malignancy, including non-small-cell lung cancer, have improved prognosis in some cases. Granuloma formation after ICI administration suggests a tumor antigen-specific cytotoxic T cell response with abundant interferon-gamma production, which can be used to estimate the curative effect of ICIs. In this report, we present a case with a resected lung lesion, clinically suspected to be lung cancer, that consisted of a granulomatous lesion. A tumor was also found in the duodenum that was presumed to be derived from the pulmonary pleomorphic carcinoma. Duodenal tumor cells highly expressed PD-L1, suggesting PD-1/PD-L1 axis-mediated immune escape. As expected, pembrolizumab induced a complete response for the duodenal lesion. Interestingly, in histopathological analysis, the duodenal lesion was also replaced by an epithelial granuloma and multinucleated giant cells. We conclude that autoimmunity regressed the untreated primary lung lesion spontaneously, while the metastatic duodenal lesion responded to PD-1 blockade. Tumor-associated epithelioid granulomas, even before ICI administration, may be an important pathological finding indicating an immune response with interferon-gamma production by cytotoxic T cells to the tumor.

DOI PubMed

クリーゼ中に胸腺摘除術を施行し良好な転帰が得られた胸腺腫合併抗AChR抗体陽性全身型重症筋無力症の一例

河田由香, 種本真将, 山田稔, 横川和樹, 齋藤太郎, 岩原直敏, 松村晃寛, 鈴木秀一郎, 久原真, 高瀬貴章, 宮島正博, 渡辺敦

臨床神経学 ( (一社)日本神経学会 ) 63 ( 5 ) 325 - 325 2023年05月

Number of lymph nodes dissected and upstaging rate of the N factor in robot-assisted thoracic surgery versus video-assisted thoracic surgery for patients with cN0 primary lung cancer.

Yuma Shindo, Masahiro Miyajima, Yasuyuki Nakamura, Yoshiki Chiba, Wataru Arai, Miho Aoyagi, Ryunosuke Maki, Kodai Tsuruta, Yuki Takahashi, Makoto Tada, Yoshiaki Takase, Atsushi Watanabe

Surgery today 53 ( 4 ) 428 - 434 2023年04月 [査読有り] [国内誌]

PURPOSE: The accuracy of lymph node (LN) dissection in robotic surgery for lung cancer remains controversial. We compared the accuracy of LN dissection in robot-assisted thoracic surgery (RATS) vs. video-assisted thoracic surgery (VATS). METHODS: The subjects of this retrospective analysis were 226 patients with cN0 primary lung cancer who underwent robot-assisted or video-assisted thoracic lobectomy with LN dissection, in our department, between April, 2016 and February, 2021. We compared the numbers of all LNs and mediastinal LNs dissected, the time required for LN dissection, complications, and upstaging rates of the N factor between the groups. Furthermore, we performed an inverse probability of treatment weighting-adjusted analysis to reduce potential bias between the groups. RESULTS: The number of dissected LNs was higher in the RATS group in both the unweighted and weighted analyses. The time required for lymph node dissection was also longer in RATS. There was no significant difference in complications or in the upstaging rate of the N factor between the groups. CONCLUSION: More LNs were dissected with RATS. Thus, the usefulness of robot-assisted surgery for LN dissection needs to be investigated further.

DOI PubMed

Downregulation of angulin-1/LSR induces malignancy via upregulation of EGF-dependent claudin-2 and TGF-β-dependent cell metabolism in human lung adenocarcinoma A549 cells.

Wataru Arai, Takumi Konno, Takayuki Kohno, Yuki Kodera, Mitsuhiro Tsujiwaki, Yuma Shindo, Hirofumi Chiba, Masahiro Miyajima, Yuji Sakuma, Atsushi Watanabe, Takashi Kojima

Oncotarget 14 261 - 275 2023年03月 [査読有り] [国際誌]

Abnormal expression of bicellular tight junction claudins, including claudin-2 are observed during carcinogenesis in human lung adenocarcinoma. However, little is known about the role of tricellular tight junction molecule angulin-1/lipolysis-stimulated lipoprotein receptor (LSR). In the lung adenocarcinoma tissues examined in the present study, expression of claudin-2 was higher than in normal lung tissues, while angulin-1/LSR was poorly or faintly expressed. We investigated how loss of angulin-1/LSR affects the malignancy of lung adenocarcinoma cell line A549 and normal human lung epithelial (HLE) cells. The EGF receptor tyrosine kinase inhibitor AG1478 prevented the increase of claudin-2 expression induced by EGF in A549 cells. Knockdown of LSR induced expression of claudin-2 at the protein and mRNA levels and AG1478 prevented the upregulation of claudin-2 in A549 cells. Knockdown of LSR induced cell proliferation, cell migration and cell metabolism in A549 cells. Knockdown of claudin-2 inhibited the cell proliferation but did not affect the cell migration or cell metabolism of A549 cells. The TGF-β type I receptor inhibitor EW-7197 prevented the decrease of LSR and claudin-2 induced by TGF-β1 in A549 cells and 2D culture of normal HLE cells. EW-7197 prevented the increase of cell migration and cell metabolism induced by TGF-β1 in A549 cells. EW-7197 prevented the increase of epithelial permeability of FITC-4kD dextran induced by TGF-β1 in 2.5D culture of normal HLE cells. In conclusion, downregulation of angulin-1/LSR induces malignancy via EGF-dependent claudin-2 and TGF-β-dependent cell metabolism in human lung adenocarcinoma.

DOI PubMed

症例ロボット支援下手術で摘出した後縦隔Müller管囊胞の1例

仲澤順二, 石井大智, 大湯岳, 佐藤太軌, 千葉慶宜, 高橋有毅, 槙龍之輔, 鶴田航大, 高瀬貴章, 宮島正博, 中島慎治, 渡辺敦

胸部外科 ( 南江堂 ) 76 ( 3 ) 246 - 250 2023年03月 [査読有り]

DOI

[Mullerian Cyst in the Posterior Mediastinum Resected by Robot-assisted Thoracic Surgery:Report of a Case].

Junji Nakazawa, Daichi Ishii, Takeshi Oyu, Taiki Sato, Yoshiki Chiba, Yuki Takahashi, Ryunosuke Maki, Kodai Tsuruta, Yoshiaki Takase, Masahiro Miyajima, Shinji Nakajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 76 ( 3 ) 246 - 250 2023年03月 [査読有り] [国内誌]

Mullerian cyst in the posterior mediastinum is a rare disorder. We report on the case of a woman in her 40s with a cystic nodule which is located in the right posterior mediastinum next to the vertebra at the level of tracheal bifurcation. The tumor was suggested to be cystic by preoperative magnetic resonance imaging (MRI). The tumor was resected with robot-assisted thoracic surgery. Pathology by hematoxylin-and-eosin (H&E) revealed a thin-walled cyst lined by ciliated epithelium without cellular atypia. The diagnosis of Mullerian cyst was confirmed by immunohistochemical staining which showed the positive findings for estrogen receptor (ER) and progesterone receptor of the lining cells.

PubMed

特集肺癌縮小手術における工夫と現況 1. 区域切除の実際と手技低侵襲肺悪性腫瘍縮小手術に対する手術手技の工夫

鶴田航大, 宮島正博, 石井大智, 大湯岳, 佐藤太軌, 千葉慶宜, 高橋有毅, 槙龍之輔, 高瀬貴章, 渡辺敦

胸部外科 ( 南江堂 ) 76 ( 1 ) 9 - 13 2023年01月 [査読有り]

DOI

[Novel Surgical Techniques for Lung Segmentectomy of Malignant Lung Tumors].

Kodai Tsuruta, Masahiro Miyajima, Daichi Ishii, Takeshi Oyu, Taiki Sato, Yoshiki Chiba, Yuki Takahashi, Ryunosuke Maki, Yoshiaki Takase, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 76 ( 1 ) 9 - 13 2023年01月 [査読有り] [国内誌]

For a long time, lobectomy and lymph node dissection have been the standard surgery for treating non-small cell lung cancer. Recently, segmentectomy has been introduced as an alternative surgical procedure for treating early-stage lung cancer. Moreover, a growing number of segmentectomies are performed due to the increasing number of elderly patients, and the expansion of indications, including early- stage lung cancer with a ground glass nodule or peripheral nodule under 2 cm in diameter. However, the use of segmentectomy remains under debate. We have been performing thoracoscopic lung segmentectomy for malignant lung tumors since 2003. The number of surgeries has increased over the past few years, since robot-assisted lung resection of the right lobe became covered by health insurance in April 2018. In addition, lung segmentectomy is performed for lung metastases of malignant tumors in other organs. In deciding on the surgical approach, the increased technical difficulty of segmentectomy compared to lobectomy, owing to the anatomical complexity of the peripheral vessels and bronchi, needs to be considered, and novel surgical procedures and preoperative planning based on three-dimensional computed tomography( CT) images are necessary. We describe the preoperative management and surgical techniques used in approximately 250 lung segmentectomy procedures performed at our hospital up to May 2022, with no conversion to thoracotomy.

PubMed

留置マーカーの術中変位により肺切除範囲を拡大した転移性肺腫瘍の1例

石井大智, 髙瀬貴章, 千葉慶宜, 鶴田航大, 宮島正博, 渡辺敦

日本臨床外科学会雑誌 ( 日本臨床外科学会 ) 84 ( 1 ) 76 - 81 2023年 [査読有り]

触診が困難な小結節に対する肺部分切除術では，マーキングが有用である．近年，気管支鏡を用いたデジタルマーキング技術である，radiofrequency identification （RFID）が臨床応用された．RFIDマーキングは肺深部に存在する病変でも位置同定を可能とする．しかし，その合併症に関する報告はほとんどない．今回，気管支に留置されたRFIDタグが術中に変位する症例を経験したので報告する．患者は71歳，女性．転移性肺腫瘍疑い（左肺S10に8mm大の結節影）に対し，2箇所にRFIDタグを留置し，部分切除術を施行したところ，術中にタグの1つが気管支中枢側へ変位した．このタグを病変と一塊にして切除するため，結果的に切除肺の拡大を要した．原因として，鉗子の把持操作や自動縫合器による複数回のクランプが考えられた．部分切除では単一病変に対しタグ1つを末梢気管支に留置することを原則とし，留置部近傍での鉗子操作は避けるべきである．

DOI

今月の話題肺癌に対する右肺S6＋S＊区域切除

石井大智, 槙龍之輔, 大湯岳, 佐藤太軌, 千葉慶宜, 髙橋有毅, 鶴田航大, 髙瀬貴章, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 75 ( 13 ) 1088 - 1091 2022年12月 [査読有り]

DOI

[Thoracoscopic Superior and Subsuperior Segmentectomy of the Right Lower Lung for Lung Cancer].

Daichi Ishii, Ryunosuke Maki, Takeshi Ohyu, Taiki Sato, Yoshiki Chiba, Yuki Takahashi, Kodai Tsuruta, Yoshiaki Takase, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 75 ( 13 ) 1088 - 1091 2022年12月 [査読有り] [国内誌]

The subsuperior segment (S*) is not frequently observed between the superior (S6) and posterior basal segments (S10). We present a case of video-assisted thoracoscopic surgery of S6+S* segmentectomy for a primary lung cancer patient. A 71-year-old man with a 20-mm nodule on the right S6, suspected of primary lung cancer( cT1bN0M0, stageⅠA2), was admitted to our hospital. Three-dimensional chest computed tomography (CT) revealed a subsuperior segmental bronchus (B*), originating from the common trunk of the lateral basal segmental bronchus( B9) and posterior basal segmental bronchus (B10). In order to obtain enough surgical margin, we performed S6+S* segmentectomy. The pathological diagnosis was invasive adenocarcinoma( pT1cN0M0, stageⅠA3). S* segmentectomy was considered to be useful method to ensure sufficient surgical margin when the lesion is in S* or in segments adjacent to it.

PubMed

Robotic free pericardial fat pledget technique for treating pulmonary air leak.

Yoshiaki Takase, Yuki Takahashi, Masahiro Miyajima, Atsushi Watanabe

JTCVS techniques 16 153 - 156 2022年12月 [査読有り] [国際誌]

DOI PubMed

肺腺癌におけるタイト結合分子cingulinおよび転写因子FOXO1の役割

石井大智, 進藤悠真, 新井航, 金野匠, 幸野貴之, 宮島正博, 小島隆, 渡辺敦

肺癌 ( (NPO)日本肺癌学会 ) 62 ( 6 ) 635 - 635 2022年11月

Clinical effect of soft coagulation for air leak treatment during pulmonary lobectomy.

Yuki Takahashi, Ryunosuke Maki, Kodai Tsuruta, Makoto Tada, Wataru Arai, Yuma Shindo, Yasuyuki Nakamura, Masahiro Miyajima, Atsushi Watanabe

Journal of cardiothoracic surgery 17 ( 1 ) 253 - 253 2022年10月 [査読有り] [国際誌]

BACKGROUND: Soft coagulation using the VIO soft coagulation system is used to treat minor lung air leaks during pulmonary resection in Japan. We previously reported that it has a similar effect as the air leak treatment with fibrin glue. We evaluated the efficacy of soft coagulation using the VIO soft coagulation system for lung air leakage during pulmonary resection. METHODS: Intraoperative air leaks from the interlobar lung parenchyma were observed in 42 of the 283 patients who underwent video-assisted thoracoscopic surgery lobectomy between 2016 and 2018. We retrospectively reviewed these 42 patients who were treated using the VIO soft coagulation system for air leaks. We classified the air leaks in to grades using the Macchiarini scale score and evaluated the surgical outcomes of air leak treatment. RESULTS: Air leaks from the interlobar lung parenchyma having Macchiarini scale scores 1, 2, and 3 occurred in 8, 17, and 17 patients, respectively. In all the 8 patients with score 1 air leaks (100%), the air leaks could be controlled using the VIO soft coagulation system alone, and none had delayed pneumothorax requiring intervention. Of the score 2 and 3 air leaks, 52.9% and 35.3% were controlled using the VIO soft coagulation system alone, respectively. CONCLUSIONS: Macchiarini scale score 1 air leaks from the interlobar lung parenchyma could be well controlled using the VIO soft coagulation system. Therefore, soft coagulation with this system may be an alternative method for treating minor air leaks during pulmonary resection surgery.

DOI PubMed

Causes and management of intraoperative complications in robot-assisted anatomical pulmonary resection for lung cancer.

Yoshiaki Takase, Masahiro Miyajima, Yoshiki Chiba, Daichi Ishii, Taiki Sato, Yuma Shindo, Yasuyuki Nakamura, Miho Aoyagi, Kodai Tsuruta, Atsushi Watanabe

Journal of thoracic disease 14 ( 9 ) 3221 - 3233 2022年09月 [査読有り] [国際誌]

BACKGROUND: To perform safe robot-assisted anatomical lung resections, the details of intraoperative complications need to be shared among thoracic surgeons. However, only limited data are available. METHODS: This retrospective, single-institutional study evaluated 134 patients who underwent robot-assisted anatomical lung resection. We examined the causes, management, and outcomes of all intraoperative complications. RESULTS: Of the 134 eligible patients, 118 (88%) underwent lobectomy and 16 (12%) underwent segmentectomy. Intraoperative complications occurred in 17 (12.7%) patients. These complications included pulmonary artery (PA) injuries in seven patients, pulmonary vein (PV) injuries in three, azygos vein (AV) injury in one, superior vena cava (SVC) injury in one, bronchial injuries in three, and lung injuries in four. Most PA injuries were at a distal side and controlled by pressure, fibrin sealant, or stapling of the proximal side. In the three PV injuries, right upper PV was sandwiched by robotic instruments, V6 was punctured by the tip of the Maryland bipolar forceps, and the distal side of V2t was injured during tunneling of a minor interlobar fissure. These were controlled the same way as the PA injuries. The AV injury occurred during hilar lymph node (LN) dissection and was controlled by suturing. The SVC injury was caused by interference of the robotic forceps and the suction tube outside the field of view during upper mediastinal LN dissection. The injury was controlled by continuous pressure while layering polyglycolic acid sheets and fibrin glue. In the three bronchial injuries, B10 was injured during subcarinal LN dissection, right main bronchus was injured during upper bronchus dissection and the stapling failure of the bronchus occurred by strong traction. They were all repaired by suturing. All lung parenchymal injuries were caused by manipulation of robotic instruments outside the field of view. The lung injuries were repaired by suturing with pledgets. No cases were converted to thoracotomy. The 30-day mortality rate was 0.7%. The cause of mortality was pneumonia. CONCLUSIONS: In robot-assisted anatomical pulmonary resection for lung cancer, most major intraoperative complications can be safely managed robotically without conversion to thoracotomy.

DOI PubMed

臨床経験エキノコックス症による縦隔･肝臓病変に対する一期的手術

宇塚武司, 武川慶, 内山博貴, 在原綾香, 橋口仁喜, 山田健司, 宮島正博, 横田良一, 佐々木昭彦

胸部外科 ( 南江堂 ) 75 ( 9 ) 674 - 677 2022年09月 [査読有り] [国内誌]

Cystic echinococcosis is an uncommon zoonosis in Japan. Typical location of the cyst is the liver and the lung. Mediastinal hydatidosis is found in less than 0.1% of all hydatid disease patients. We report a rare case of 68 years old male with mediastinal and liver hydatid cysts. Serological test confirmed the diagnosis of hydatidosis. The patient underwent complete resection of mediastinal and liver cysts successfully. Postoperative follow-up for two years has not shown any signs of recurrence. Simultaneous resection of the cysts in different sites including mediastinum is rare and has not been reported in Japan. Hydatid disease is an important differential diagnosis for patient who has cryptogenic liver cyst and history of contact to wildlife or unsterile water.

DOI PubMed

Robot-assisted and video-assisted thoracoscopic surgery for thymoma: comparison of the perioperative outcomes using inverse probability of treatment weighting method.

Yoshiki Chiba, Masahiro Miyajima, Yoshiaki Takase, Kodai Tsuruta, Yuma Shindo, Yasuyuki Nakamura, Daichi Ishii, Taiki Sato, Miho Aoyagi, Tomoko Shiraishi, Tomoko Sonoda, Atsushi Watanabe

Gland surgery 11 ( 8 ) 1287 - 1300 2022年08月 [査読有り] [国際誌]

BACKGROUND: Minimally invasive surgery is the standard treatment for early-stage thymoma. We compared the perioperative outcomes between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for thymoma. METHODS: Between April 2011 and August 2021, patients with thymoma who underwent thymectomy by RATS (n=20) or VATS (n=37) at our hospital were retrospectively reviewed. We evaluated the postoperative quality of life (QOL), surgical outcomes, complications, mortality, and pain grade. Postoperative QOL was assessed according to the time to achieve "B duration" and "CIII duration" based on the Nursing Dependency Score and Nursing Criteria, respectively. RESULTS: After the inverse probability of treatment weighting (IPTW), the B duration and CIII duration were significantly shorter with RATS than with VATS (P<0.001 and P=0.037, respectively). These superior results of RATS group compared to those of the VATS group were confirmed with logistic regression analysis (OR 0.25, 95% CI: 0.10-0.63, P=0.003; and OR 0.31, 95% CI: 0.12-0.76, P=0.011, respectively). After the IPTW, the VATS group had significantly fewer patients with epidural analgesia than the RATS group (P=0.018). In contrast, additional regular analgesics (including those for wound pain and neuralgia) were prescribed significantly more often during postoperative hospitalization in the VATS group (P=0.033). Patients in both groups had no myasthenic crisis or mortality. The postoperative pain grade at the first and second follow-ups did not significantly differ between the two groups after the IPTW (P=0.376 and P=0.109, respectively). CONCLUSIONS: RATS offered the advantages of improved postoperative QOL according to nursing care systems compared to VATS.

DOI PubMed

Anatomy of the left subsuperior segment for segmentectomy.

Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Hirofumi Adachi, Atsushi Watanabe

Surgery today 52 ( 7 ) 1054 - 1062 2022年07月 [査読有り] [国内誌]

PURPOSE: The subsuperior segmental bronchi (B*) forms the subsuperior segment (S*) between the superior (S6) and basal segment (S7, S8, S9, S10) of the lung. However, the anatomical planes of S* remains undefined. The present study clarified the anatomical features of S*. METHODS: We reviewed the anatomical patterns of pulmonary vessels and the left lung bronchus in 539 patients using three-dimensional computed tomography. We report the anatomic structure in S*. RESULTS: A total of 537 patients were analyzed. B* was observed in 129 (24.0%) patients. The intersegmental vein between S6 and S* was complete in all cases. The absence of intersegmental veins of S* was observed in 77 (14.3%) patients, reaching 59.7% of B* cases. Twenty-two (4.1%) cases of B* diverged from the trunk of the basal bronchus, and about half of the B* branched to the dorsolateral (n = 77, 14.3%) or dorsal (n = 2, 0.37%) direction. CONCLUSION: Our study revealed the branching patterns of B* and anatomical intersegmental veins of S*. Our results provide useful information regarding anatomical segmentectomy including or adjusting to the left S*.

DOI PubMed

Interlobar division using vessel-sealing system in robot-assisted pulmonary lobectomy.

Masahiro Miyajima, Yuma Shindo, Kodai Tsuruta, Yasuyuki Nakamura, Yoshiaki Takase, Miho Aoyagi, Atsushi Watanabe

JTCVS techniques 13 211 - 216 2022年06月 [査読有り] [国際誌]

担当区分：筆頭著者 , 責任著者

OBJECTIVE: We investigated the safety of a novel interlobar fissure division technique using the da Vinci vessel sealing system in robot-assisted pulmonary lobectomy. METHODS: The medical records of patients who underwent robotic pulmonary lobectomy with node dissection for primary lung cancer between 2018 and 2020 were reviewed. The inclusion criteria were fulfilled by 111 patients, whose perioperative factors and postoperative results were compared with those previously reported. Furthermore, the new robotic lung interlobar division technique using the da Vinci vessel sealing system without a robotic stapler was evaluated in patients with low-grade incomplete fissure. We considered the Craig and Walker classification of lung fissures grades 1 and 2 as a good adaptation for the vessel sealing system interlobar fissure division. RESULTS: The vessel sealing system group had shorter mean operative and console times (P = .03 and P = .01, respectively) and lesser median intraoperative blood loss (20 mL vs 50 mL; P = .01). The vessel sealing system group had lower surgical complication rates (2.2% vs 20.0%; P = .01). The incidence of persistent postoperative air leak was lower (0% vs 10.0%; P = .06), and fewer robotic stapler cartridges were used during surgery (3.4 vs 5.6; P < .001) in the vessel sealing system group than in the stapler group. CONCLUSIONS: We report the safety of using the da Vinci vessel sealing system as an alternative to the use of robotic staples for interlobar fissure division in robot-assisted pulmonary lobectomy. This technique seems easy and feasible though limited to the low-grade incomplete fissure.

DOI PubMed

Robot-assisted vs. video-assisted thoracoscopic surgery in lung cancer.

Masahiro Miyajima, Ryunosuke Maki, Wataru Arai, Kodai Tsuruta, Yuma Shindo, Yasuyuki Nakamura, Atsushi Watanabe

Journal of thoracic disease 14 ( 6 ) 1890 - 1899 2022年06月 [国際誌]

BACKGROUND: The major advantages of robot-assisted surgery are the fine field of view provided by the high-precision three-dimensional (3D) images and the good operability provided by the robotic arms that enables precise movements. A growing number of retrospective studies have compared robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS), but the number of cases is limited and the results are contradictory. METHODS: We studied the medical records of primary lung cancer patients who underwent lobectomy with lymph node dissection between 2017 and 2020. Four hundred and eleven patients fulfilled the inclusion criteria in this study (RATS: 103; VATS: 308). We compared the perioperative factors and postoperative results of the VATS and RATS groups. Further, we adjusted background factors using propensity score matching (PSM) then compared the results of 200 patients (100 patients in each group). In this study, we matched interlobar fissure completeness, which affects operative difficulty and operative time; however, this has been superficially compared in previous studies. RESULTS: After PSM, a significant difference was observed in the intraoperative blood loss (RATS: 53.3 mL, VATS: 120.3 mL, P=0.04). The rates of surgical complications were comparable between the groups (10.0% vs. 13.0%, P=0.66) with similar mean operation times (RATS: 215.0 min, VATS: 210.1 min, P=0.57). The mean postoperative stay in the RATS group was shorter than that in the VATS group (10.0 vs. 11.5 days, P=0.04). CONCLUSIONS: Initial experience of RATS had no obvious drawbacks when compared with that of VATS on propensity-matched analysis.

DOI PubMed

Robotic single right anterior medial (S3b) subsegmentectomy for early primary lung cancer in a patient with a small physique.

Yoshiaki Takase, Masahiro Miyajima, Atsushi Watanabe

Multimedia manual of cardiothoracic surgery : MMCTS 2022 2022年05月 [国際誌]

Subsegmentectomy is an optional treatment for early primary lung cancer presenting without adequate surgical margins for wedge resection. There are no previous reports regarding a robotic single subsegmentectomy. We report a robotic single subsegmentectomy of the right anterior medial subsegment (S3b). The lung parenchyma was dissected with a Vessel Sealer Extend along the intersubsegmental veins for proper lung mobilization to solve the directional limitations of the robotic stapler. Additionally, we inserted the most ventral port from the subcostal region to increase the distance between the ports. Performing a robotic single subsegmentectomy is challenging. However, our techniques help to achieve a safe and effective operation.

DOI PubMed

Pulmonary vessels and bronchus anatomy of the left upper lobe.

Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Hirofumi Adachi, Atsushi Watanabe

Surgery today 52 ( 4 ) 550 - 558 2022年04月 [国内誌]

PURPOSES: The bronchopulmonary vascular bifurcation patterns in the upper lobe of the left lung are diverse. Therefore, it is important for general thoracic surgeons to understand the detailed anatomy of the pulmonary segments when performing thoracoscopic anatomical pulmonary resection. This study aimed to analyze the bronchovascular patterns of the left upper lobe and summarize the anatomical information associated with pulmonary anatomical pulmonary resection. METHODS: We reviewed the anatomical patterns of pulmonary vessels and the left lung bronchus of 539 patients using computed tomography imaging data including those obtained using three-dimensional computed tomography. We herein report the anatomic structure in the left upper lobe. RESULTS: Regarding the superior division bronchi, a pattern of trifurcation into B1+2, B3, lingular division bronchus was observed in nine patients (1.7%). A pattern of proximal bifurcation of B4 was found in eight patients (1.5%). Regarding the lingular veins (LV), patterns of LV drainage into the left lower pulmonary vein were observed in 22 patients (4.1%). Regarding the pulmonary artery, mediastinal lingular arteries (MLA) were found in 161 patients (29.9%). CONCLUSION: The bifurcation patterns of the bronchovascular region in the upper lobe of the left lung were clarified. These results should be carefully noted when performing anatomical pulmonary resection.

DOI PubMed

Subcarinal Lymph Node Dissection in Solo Robot-assisted Thoracic Surgery.

Ryunosuke Maki, Masahiro Miyajima, Kodai Tsuruta, Atsushi Watanabe

The Annals of thoracic surgery 113 ( 3 ) e235-e237 2022年03月 [国際誌]

The surgical instruments used in robot-assisted thoracic surgery are flexible to enable the surgeon to approach the surgical field from any direction. However even in robot-assisted thoracic surgery subcarinal lymph node dissection requires a precise technique suitable for a small area surrounded by important organs. We present a method of subcarinal node dissection with solo robot-assisted thoracic surgery using a bronchial traction method and a metal basket suction device, the Dobon (Senko Medical Instrument Mfg, Tokyo, Japan).

DOI PubMed

症例胸腔鏡下左肺上葉切除術時に偶然発見された先天性心膜欠損症の1例

中村泰幸, 鶴田航大, 進藤悠真, 新井航, 槙龍之輔, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 74 ( 12 ) 1051 - 1054 2021年11月

DOI CiNii

Easy Suction Technique During Robotic-Assisted Thoracoscopic Lobectomy.

Kodai Tsuruta, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

The Annals of thoracic surgery 112 ( 5 ) e381-e382 2021年11月 [国際誌]

In robotic-assisted thoracoscopic surgery, surgeons may encounter bleeding issues requiring compression techniques and time to achieve hemostasis. During this time, surgeons cannot use the robot arm and may require an assistant to perform suction, thus increasing the cost of the procedure. This report describes an alternative suction device, Dobon (Senko Medical Instrument Mfg, Tokyo, Japan), which is usually used for pediatric cardiac surgery, for use in robotic-assisted thoracoscopic surgery. The report presents the technique for using this device and comments on the advantages, including decreased cost and an improved surgical visual field.

DOI PubMed

[Congenital Pericardial Defect Incidentally Found at Thoracoscopic Left Upper Lobe Resection:Report of a Case].

Yasuyuki Nakamura, Kodai Tsuruta, Yuma Shindo, Wataru Arai, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 74 ( 12 ) 1051 - 1054 2021年11月 [国内誌]

We report a rare case of a congenital pericardial defect that was incidentally found at thoracoscopic left upper lobe resection in a patient with lung cancer. A 75-year-old man with a left upper lobe lung cancer was referred to our hospital. We performed thoracoscopic left upper lobectomy and incidentally found a pericardial defect intraoperatively. Careful lymph node dissection was necessary to avoid injury of phrenic nerve and pulmonary artery. Surgery for lung cancer was completed without pericardial repair. After surgery, no complications associated with the pericardial defect has not been encountered.

PubMed

臨床経験右上葉胸壁合併切除後の脊髄梗塞

中村泰幸, 槙龍之輔, 進藤悠真, 新井航, 鶴田航大, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 74 ( 9 ) 664 - 667 2021年09月

DOI

[Spinal Cord Infarction after Right Upper Lobectomy Combined with Chest Wall Resection].

Yasuyuki Nakamura, Ryuunosuke Maki, Yuma Shindo, Wataru Arai, Kodai Tsuruta, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 74 ( 9 ) 664 - 667 2021年09月 [国内誌]

A 42-year-old man presented with a one-month history of back pain. Chest computed tomography revealed a mass (7.6×5.7 cm) in the right upper lobe, suspicious of chest wall invasion. We performed right upper lobectomy combined with chest wall resection. Partial dissections of the second to sixth ribs and the third and fourth vertebral bodies were conducted. Postoperatively, motor paralysis of the right lower extremity was observed and a diagnosis of spinal infarction was made. After cerebrospinal fluid drainage and administration of edaravone with early rehabilitation, he was able to walk with a brace and was discharged from the hospital.

PubMed

Two cases of left recurrent laryngeal nerve paralysis after right superior mediastinal node dissection.

Yasuyuki Nakamura, Yuma Shindo, Wataru Arai, Kodai Tsuruta, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

Surgical case reports 7 ( 1 ) 151 - 151 2021年06月 [国際誌]

BACKGROUND: Ipsilateral recurrent laryngeal nerve paralysis is one of the rare complications during the superior mediastinal node dissection for lung cancer. However, very few reports of contralateral recurrent laryngeal nerve paralysis during the procedure are available. CASE PRESENTATION: Two women aged 74 and 80 years developed hoarseness after undergoing right upper lobectomy and right superior mediastinal node dissection for primary lung cancer. Postoperative laryngoscopy in the two patients confirmed left vocal cord paralysis. CONCLUSION: Node dissection is performed in the standard procedure for right upper lobe lung cancer. At this time, care must be taken not to cause damage not only to the recurrent laryngeal nerve on the ipsilateral side but also to the recurrent laryngeal nerve on the contralateral side.

DOI PubMed

Effects of histone deacetylase inhibitors Tricostatin A and Quisinostat on tight junction proteins of human lung adenocarcinoma A549 cells and normal lung epithelial cells.

Yuma Shindo, Wataru Arai, Takumi Konno, Takayuki Kohno, Yuki Kodera, Hirofumi Chiba, Masahiro Miyajima, Yuji Sakuma, Atsushi Watanabe, Takashi Kojima

Histochemistry and cell biology 155 ( 6 ) 637 - 653 2021年06月 [国際誌]

Histone deacetylase (HDAC) inhibitors have a potential therapeutic role for non-small cell lung cancer (NSCLC). However, more preclinical studies of HDAC inhibitors in NSCLC and normal lung epithelial cells are required to evaluate their antitumor activities and mechanisms. The bicellular tight junction molecule claudin-2 (CLDN-2) is highly expressed in lung adenocarcinoma tissues and increase the proliferation of adenocarcinoma cells. Downregulation of the tricellular tight junction molecule angulin-1/LSR induces malignancy via EGF-dependent CLDN-2 and TGF-β-dependent cellular metabolism in human lung adenocarcinoma cells. In the present study, to investigate the detailed mechanisms of the antitumor activities of HDAC inhibitors in lung adenocarcinoma, human lung adenocarcinoma A549 cells and normal lung epithelial cells were treated with the HDAC inibitors Trichostatin A (TSA) and Quisinostat (JNJ-2648158) with or without TGF-β. Both HDAC inhibitors increased anguin-1/LSR, decrease CLDN-2, promoted G1 arrest and prevented the migration of A549 cells. Furthermore, TSA but not Quisinostat with or without TGF-β induced cellular metabolism indicated as the mitochondrial respiration measured using the oxygen consumption rate. In normal human lung epithelial cells, treatment with TSA and Quisinostat increased expression of LSR and CLDN-2 and decreased that of CLDN-1 with or without TGF-β in 2D culture. Quisinostat but not TSA with TGF-β increased CLDN-7 expression in 2D culture. Both HDAC inhibitors prevented disruption of the epithelial barrier measured as the permeability of FD-4 induced by TGF-β in 2.5D culture. TSA and Quisinostat have potential for use in therapy for lung adenocarcinoma via changes in the expression of angulin-1/LSR and CLDN-2.

DOI PubMed

Vessel sealing system for video-assisted lung resection for cancer reduces chylothorax and bleeding.

Masahiro Miyajima, Ryunosuke Maki, Makoto Tada, Kodai Tsuruta, Yuki Takahashi, Wataru Arai, Atsushi Watanabe

Journal of thoracic disease 13 ( 6 ) 3458 - 3466 2021年06月 [国際誌]

BACKGROUND: The objective of this study was to analyze the efficacy of the LigaSureTM vessel sealing system for lung cancer resection with node dissection, as this has not been sufficiently evaluated. METHODS: From 2004 to 2018, 948 patients underwent anatomical pulmonary resection with node dissection for non-small cell lung carcinoma (NSCLC) via the video-assisted thoracoscopic surgery (VATS) approach. Medical records of these patients were reviewed retrospectively. Univariate and multivariate analyses were conducted to determine the risk factors for chylothorax and blood loss. RESULTS: Of the 948 patients, 318 (33.5%) who underwent anatomical lung resection with node dissection by conventional methods without vessel sealing system and 630 (66.5%) who underwent lung resection with node dissection with the vessel sealing system were included. The median intraoperative blood loss was 100 mL. Postoperative chylothorax occurred in 9 (2.8%) patients in the conventional method group with 2 (0.3%) patients in the vessel sealing system group (P=0.001). Patients in the vessel sealing group who developed chylothorax were cured by conservative treatment. Univariate and multivariate analyses identified male sex [odds ratio (OR) 2.053; 95% confidence interval (CI): 1.494-2.820; P<0.001] and the use of vessel sealing system (OR 0.342; 95% CI: 0.256-0.457; P<0.001) as independent predictors of intraoperative blood loss. The univariate and multivariate analyses identified the use of the vessel sealing system (OR 0.108; 95% CI: 0.023-0.504; P=0.005) as an independent predictor of chylothorax incidence. CONCLUSIONS: Vessel sealing system for lung cancer resection could decrease chest tube duration, amount of intraoperative bleeding, and incidence of chylothorax in patients who undergo lung resection with node dissection.

DOI PubMed

正常ヒト肺上皮細胞におけるTGF-βとHDAC阻害剤のタイト結合分子および上皮バリアへの影響

進藤悠真, 新井航, 金野匠, 幸野貴之, 宮島正博, 小島隆, 渡辺敦

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 ) 35 ( 3 ) RO18 - 3 2021年05月

臨床経験縦隔腫瘍との鑑別を要した準確定診断免疫グロブリンG4(IgG4)関連大動脈周囲炎

千葉慶宜, 新井航, 大川美穂, 多田周, 槙龍之輔, 三品泰二郎, 宮島正博, 渡辺敦, 杉田真太朗

胸部外科 ( 南江堂 ) 74 ( 2 ) 108 - 111 2021年02月

DOI

区域切除のための左肺下葉における気管支肺血管の解剖—Pulmonary vessels and bronchial anatomy of the left lower lobe

槙龍之輔, 宮島正博, 小倉圭史, 多田周, 高橋有毅, 安達大史, 渡辺敦, Wataru Arai

北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会編 ( 北海道外科学会 ) 65 ( 2 ) 186 - 188 2020年12月

CiNii

The left main bronchus transected incorrectly during video-assisted thoracoscopic lobectomy: a case report.

Yuma Shindo, Masahiro Miyajima, Yasuyuki Nakamura, Wataru Arai, Ryunosuke Maki, Kodai Tsuruta, Atsushi Watanabe

Surgical case reports 6 ( 1 ) 291 - 291 2020年11月 [国際誌]

BACKGROUND: Several severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected. CASE PRESENTATION: A 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy. CONCLUSIONS: We experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons.

DOI PubMed

今月の話題左上縦隔腫瘍に対するロボット支援下手術

進藤悠真, 宮島正博, 槙龍之輔, 高橋有毅, 鶴田航大, 新井航, 渡辺敦

胸部外科 ( 南江堂 ) 73 ( 9 ) 663 - 666 2020年09月

DOI

Pulmonary vessels and bronchial anatomy of the left lower lobe.

Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Wataru Arai, Hirofumi Adachi, Atsushi Watanabe

Surgery today 50 ( 9 ) 1081 - 1090 2020年09月 [国内誌]

PURPOSE: To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL). METHODS: Using computed tomography (CT) imaging data, including that obtained using three-dimensional CT, we reviewed the anatomic patterns of the pulmonary vessels and bronchi in the left lungs of 539 patients, focusing on the LLL. RESULTS: The two-stem type in A6 was observed in 131 (24.7%) patients and the three-stem type in A6 was observed in 11 (2.1%) patients. The independent two-stem type in B6 was observed in four (0.75%) patients. The B7 with independent branching from the basal bronchi was observed in 42 (7.9%) patients. B* was observed in 129 (24.0%) patients and B* was accompanied by A* in all patients. An extrapericardial common trunk of the left pulmonary veins was identified in five patients (0.93%). CONCLUSION: We identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy.

DOI PubMed

[Successful Robotic Resection of Left Upper Mediastinal Tumor].

Yuma Shindo, Masahiro Miyajima, Ryunosuke Maki, Yuki Takahashi, Koudai Tsuruta, Wataru Arai, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 73 ( 9 ) 663 - 666 2020年09月 [国内誌]

A man was diagnosed with a left upper mediastinal mass. The mass was located near the left subclavian vein, phrenic nerve, vagus nerve, left subclavian artery, and left brachiocephalic vein. He underwent a robotic surgery without additional approaches such as cervical approach on transmanubrial approach. Robotic surgery enabled to remove the tumor safely due to the highly flexible robot forceps under a 3-dimensional visual field. Robotic surgery may be effective for tumors in the upper mediastinum, where important blood vessels and nerves are closely present.

PubMed

[Left Upper Lobectomy Followed by Left Lower Pulmonary Vein Reconstruction after Miscutting the Common Trunk of the Left Pulmonary Veins].

Yuma Shindo, Ryunosuke Maki, Wataru Arai, Yuki Takahashi, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 73 ( 8 ) 590 - 593 2020年08月 [国内誌]

PubMed

特集ロボット支援下肺葉切除術—Robot-assisted thoracic surgery for lung cancer

宮島正博, 槙龍之輔, 高橋有毅, 多田周, 鶴田航大, 新井航, 進藤悠真, 渡辺敦

北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会編 ( 北海道外科学会 ) 65 ( 1 ) 14 - 17 2020年06月

CiNii

Pulmonary metastasectomy is associated with prolonged survival among patients with bone and soft tissue sarcoma.

Junya Shimizu, Makoto Emori, Yasutaka Murahashi, Tomoko Sonoda, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe, Shintaro Sugita, Kohichi Takada, Kazuyuki Murase, Tadashi Hasegawa, Toshihiko Yamashita

Molecular and clinical oncology 12 ( 5 ) 429 - 434 2020年05月 [国際誌]

The aim of the present study was to evaluate the survival impact of surgical resection among patients with pulmonary metastases from bone and soft tissue sarcomas. A total of 34 consecutive patients with ≤5 pulmonary metastases from bone and soft tissue sarcomas were retrospectively reviewed. The patients included 19 men and 15 women, with a median age of 64.0 years and a median follow-up of 14.5 months. The oncological outcome was compared between patients who underwent surgical and non-surgical treatment. A total of 22 patients underwent surgery and 12 patients did not undergo surgery. The surgery group had 3- and 5 year overall survival rates of 62 and 53%, respectively. None of the patients in the non-surgery group survived to 3 years. Compared with the non-surgery group, surgery achieved significantly better 3- and 5 year overall survival rates. Pulmonary metastasectomy was associated with significantly improved survival among patients who were aged <64 years (P=0.0155), as well as those who were aged ≥64 years (P=0.0444), which indicated that age was not associated with a difference in survival between the two groups. Therefore, pulmonary metastasectomy may improve the prognosis of patients with pulmonary metastases from bone and soft tissue sarcomas.

DOI PubMed

Quality assessment using EQ-5D-5L after lung surgery for non-small cell lung cancer (NSCLC) patients.

Ryo Koide, Ami Kikuchi, Masahiro Miyajima, Taijiro Mishina, Yuki Takahashi, Miho Okawa, Izumi Sawada, Junko Nakajima, Atsushi Watanabe, Toru Mizuguchi

General thoracic and cardiovascular surgery 67 ( 12 ) 1056 - 1061 2019年12月 [国内誌]

OBJECTIVES: Aim of this study was to elucidate an alteration of quality of life (QOL) score before and after video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer (NSCLC) patients using the 5-level EuroQol-5D questionnaire (EQ-5D-5L). We also investigated how the preoperative QOL scores affected the postoperative clinical outcome prospectively. METHODS: Between July 2018 and December 2018, 24 consecutive NSCLC patients who underwent VATS were recruited. The EQ-5D-5L for Japanese was used with face-to-face interviews to estimate the utility values of QOL. RESULTS: QOL scores were significantly declined after surgery (0.81 ± 0.19 vs. 0.74 ± 0.11: P = 0.049). The levels of EQ-5D-5L questionnaire were not significantly different before and after surgery except Q4 (pain control). The levels of Q4 were significantly worsened after surgery (1.33 ± 0.56 vs. 1.88 ± 0.61, P < 0.001). Operation time and bleeding in the preoperative low-QOL score group (N = 13) was longer (215.4 ± 52.3 min. vs. 173.5 ± 42.3 min., respectively: P = 0.045) and more (116.2 ± 152.7 ml vs. 22.7 ± 20.1 ml, respectively: P = 0.049) than those in the high-QOL score group (N = 11). CONCLUSIONS: QOL survey for lung cancer patients using EQ-5D-5L is simple and useful to identify the issue facing at the medical team. Preoperative low QOL score could be a predicting factor for the longer operation time and more bleeding.

DOI PubMed

Treatment outcome of chest wall soft tissue sarcomas: Analysis of prognostic factors.

Naoya Nakahashi, Makoto Emori, Hiroyuki Tsuchie, Hiroyuki Nagasawa, Tomoko Sonoda, Kohichi Takada, Masahiro Miyajima, Atsushi Watanabe, Yoichi Shimada, Toshihiko Yamashita

Journal of surgical oncology 120 ( 7 ) 1235 - 1240 2019年12月 [国際誌]

BACKGROUND: Primary soft tissue sarcomas (STSs) involving the chest wall are uncommon. The aim of this study was to identify factors that influence the prognosis of patients with primary chest wall STS. METHODS: The records of 38 patients (23 men and 15 women) who were treated at our institutions during 2002 to 2018 were reviewed. The following variables were evaluated as potential prognostic factors: sex, tumor size, chemotherapy, and completeness of surgical margins. Multivariate analysis was conducted to identify predictors of overall survival (OS) and disease-free survival (DFS). RESULTS: Of the 38 included patients, 5 had low-grade tumors and 33 had high-grade tumors. Five patients required chest wall reconstruction including rib resection. Thirty patients (79%) underwent R0 resection. The 5-year OS and DFS rates were 45% and 27%, respectively. Local recurrence developed in 7 patients. Multivariate analysis identified tumor size (hazard ratio [HR]: 4.13; 95% confidence interval [CI]: 1.05-16.24; P = .04) and R1/2 resection (HR: 3.92; 95% CI: 1.12-13.66; P = .03) as predictors of OS. CONCLUSIONS: Prognostic factors for survival included tumor size and completeness of surgical margins. Complete tumor excision is desirable, particularly in cases of early detection.

DOI PubMed

Left upper pulmonary vein connected to the persistent left superior vena cava and the left atrium.

Ryunosuke Maki, Masahiro Miyajima, Taijiro Mishina, Atsushi Watanabe

General thoracic and cardiovascular surgery 67 ( 8 ) 723 - 725 2019年08月 [国内誌]

DOI PubMed

MCL1 inhibition enhances the therapeutic effect of MEK inhibitors in KRAS-mutant lung adenocarcinoma cells.

Makoto Tada, Toshiyuki Sumi, Yusuke Tanaka, Sachie Hirai, Miki Yamaguchi, Masahiro Miyajima, Toshiro Niki, Hiroki Takahashi, Atsushi Watanabe, Yuji Sakuma

Lung cancer (Amsterdam, Netherlands) 133 88 - 95 2019年07月 [国際誌]

OBJECTIVES: MCL1 is an anti-apoptotic BCL2 family member that is highly expressed in various malignant tumors. However, little is known about the role of MCL1 in KRAS-mutant lung adenocarcinomas. In this study, we aimed to clarify whether MCL1 could be a therapeutic target in KRAS-mutant lung adenocarcinomas for which no effective molecular targeted drugs are available. MATERIALS AND METHODS: We examined to what extent MCL1 knockdown either alone or in combination with MEK inhibitor trametinib suppressed growth or induced apoptosis in the KRAS-mutant lung adenocarcinoma cell line H441 and EGFR-mutant lung adenocarcinoma cell line H1975. Furthermore, we investigated the therapeutic effects of dual inhibition of MCL1 and Bcl-xL, another anti-apoptotic BCL2 family member, in these two cell lines. RESULTS: MCL1 knockdown alone did not induce apoptosis in H441 or H1975 cells. However, MCL1-depleted H441 and H1975 cells underwent apoptosis and decreased in number in the presence of trametinib. We also confirmed that combined therapy by MCL1 knockdown and trametinib almost completely suppressed the growth of H441 cells in vivo. Moreover, dual knockdown of MCL1 and Bcl-xL induced extensive apoptosis in H441 and H1975 cells. CONCLUSION: These findings suggest that combined treatments of MCL1 knockdown and trametinib or dual inhibition of MCL1 and Bcl-xL would be effective therapies for lung adenocarcinomas including the KRAS-mutant subtype.

DOI PubMed

Outcomes of completion lobectomy long after segmentectomy.

Yuki Takahashi, Masahiro Miyajima, Makoto Tada, Ryunosuke Maki, Taijiro Mishina, Atsushi Watanabe

Journal of cardiothoracic surgery 14 ( 1 ) 116 - 116 2019年06月 [国際誌]

BACKGROUND: Completion lobectomy long after segmentectomy in the same lobe is extremely difficult because of severe adhesions around hilar structures, especially in cases involving video-assisted thoracoscopic surgery (VATS) completion lobectomy. We report and compare the surgical outcomes of patients who underwent VATS or thoracotomy completion lobectomy long after radical segmentectomy for lung cancer. METHODS: We retrospectively evaluated the surgical outcomes of completion lobectomies performed at our institute long after radical segmentectomies for lung cancer in the same lobe. The efficacy and safety of VATS completion lobectomy was compared to that of thoracotomy completion lobectomy. RESULTS: Ten of 228 patients who underwent radical segmentectomy for lung cancer between 2009 and 2018 underwent completion lobectomy at least a month after segmentectomy; five patients underwent VATS completion lobectomy. None of the patients underwent VATS left upper completion lobectomy, and conversion to thoracotomy was required in one patient. There were no significant differences between VATS and thoracotomy completion lobectomies in the median operative times (VATS 295 min, thoracotomy 339 min, p = 0.55), intraoperative blood loss volumes (VATS 350 mL, thoracotomy 500 mL, p = 0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40 months, thoracotomy 48 months, p = 0.55), and number of patients with pulmonary artery injury (VATS 1, thoracotomy 2, p = 0.49). There was no operation-related mortality. CONCLUSIONS: VATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.

DOI PubMed

今月の話題パラフィン充塡術40年後に起きた脊髄麻痺

新井航, 大川美穂, 高橋有毅, 多田周, 槙龍之介, 三品泰二郎, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 72 ( 5 ) 344 - 347 2019年05月

DOI

[Paraffinoma with Spinal Paralysis 40 Years After Pleural Plombage for Tuberculosis].

Wataru Arai, Miho Ohkawa, Yuki Takahashi, Makoto Tada, Ryunosuke Maki, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 72 ( 5 ) 344 - 347 2019年05月 [国内誌]

Paraffin had been used for pleural plombage in the treatment of tuberculosis. However, paraffin use has been reported to cause late postoperative complications. A 79-year-old man was presented with an extramedullary tumor and spinal paralysis. Forty-seven years ago, he had undergone pleural plombage using paraffin for the treatment of pulmonary tuberculosis. Since the extramedullary tumor was found to be paraffinoma, paraffin in the vertebral canal and thoracic cavity was removed surgically. All the paraffin in the vertebral canal and thoracic cavity was removed. After surgery, the patient remains well, without spinal paralysis.

PubMed

臨床経験膵液瘻に伴う膿気胸に対する外科治療

大川美穂, 新井航, 髙橋有毅, 槇龍之輔, 多田周, 三品泰二郎, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 72 ( 3 ) 209 - 212 2019年03月

DOI CiNii

[Surgical Treatment for Pneumopyothorax Secondary to Pancreatic Fistula].

Miho Ohkawa, Wataru Arai, Yuki Takahashi, Ryunosuke Maki, Makoto Tada, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 72 ( 3 ) 209 - 212 2019年03月 [国内誌]

A 46-year-old woman with cervical cancer with multiorgan metastasis visited our hospital. She underwent a total gastrectomy, splenectomy, distal pancreatectomy, left adrenalectomy, and left partial diaphragmatic resection. Postoperatively, she developed pleural effusion with high level of amylase secondary to a pancreatic ﬁstula, consequently causing left-sided empyema. She developed acute respiratory distress syndrome. Urgent surgical treatment was scheduled, and left lower lobectomy, with diaphragmatic partial resection were performed under the venovenous extracorporeal membrane oxygenation. After surgery, intensive care for 45 days was necessary and she was discharged home 6 months post operatively.

PubMed

Thoracoscopic Right Basilar Segmentectomy After Right Upper Lobectomy.

Makoto Tada, Masahiro Miyajima, Taijiro Mishina, Yuki Takahashi, Ryunosuke Maki, Atsushi Watanabe

The Annals of thoracic surgery 107 ( 2 ) e123-e125 2019年02月 [国際誌]

This report describes a case of thoracoscopic right basilar segmentectomy after upper lobectomy. A 76-year-old man who underwent right upper lobectomy for lung tuberculosis 50 years earlier had a diagnosis of squamous cell carcinoma, stage IB (T2a N0 M0), in the right lower lobe and underwent right basilar segmentectomy for limited resection. The postoperative course was uneventful. The patient showed no recurrence clinically, and the 1-year postoperative chest computed tomographic scan showed adequate volume of the middle and residual right lower lobe without emphysematous changes.

DOI PubMed

特異な病態を呈した孤立性線維性腫瘍の3例

髙橋有毅, 宮島正博, 辻脇光洋, 多田周, 槙龍之輔, 渡辺敦

日本呼吸器外科学会雑誌 ( 特定非営利活動法人日本呼吸器外科学会 ) 33 ( 1 ) 37 - 41 2019年01月

Solitary fibrous tumor（SFT）は，間葉系細胞由来の稀な腫瘍である．今回，特異な病態を呈した3例を経験した．症例1は76歳男性，右肺上葉中枢側に60 mm大の腫瘤影を認め，原発性肺癌の疑いで右上葉切除を行った．病理診断は肺原発SFTであった．症例2は46歳女性，右下葉肺原発悪性SFTに対する下葉切除術後4年目に右中葉肺転移，胸膜播種をきたした．このため中葉切除と胸膜播種巣切除術，胸腔内化学療法を行った．その後，再発し初回手術から77ヵ月後に原病死した．症例3は63歳女性，CTで右胸腔に190 mm大の一部石灰化と血管新生を伴う巨大な腫瘤を認め，Chronic Expanding Hematomaの疑いで手術目的に当科紹介となった．術中出血低減目的に肋間動脈，内胸動脈塞栓術を施行した後手術を行い，病理診断はSFTであった．

DOI CiNii

A Case of Ankylosing Spinal Hyperostosis with Massive Hemothorax Due to Thoracic Vertebral Fracture Caused by Minor Trauma.

Ryosuke Hirota, Hideto Irifune, Nobuyuki Takahashi, Makoto Emori, Atsushi Teramoto, Mitsunori Yoshimoto, Masahiro Miyajima, Atsushi Watanabe, Toshihiko Yamashita

Spine surgery and related research 3 ( 3 ) 274 - 276 2019年 [国内誌]

DOI PubMed

左肺全摘後，体外式肺補助下に胸腔鏡下右肺区域切除を行った1例

多田周, 高橋有毅, 槙龍之輔, 三品泰二郎, 宮島正博, 渡辺敦

肺癌 ( 特定非営利活動法人日本肺癌学会 ) 58 ( 4 ) 298 - 302 2018年08月

背景．異時性多発肺癌に対する3回以上の解剖学的肺切除や，片肺全摘後の残肺解剖学的切除例の報告はいまだ少ない．症例．66歳男性．50歳時に左上葉肺癌（肺癌取扱い規約第8版：微小浸潤性腺癌，stage IA1）に対して左上葉切除術，61歳時に左下葉異時性多発肺癌（微小浸潤性腺癌，stage IA1）に対して左下葉切除術の既往があった．定期検診で胸部異常陰影を指摘された．術前残存肺呼吸機能は肺活量2.32 l，1秒量1.59 lであった．組織学的な確定診断は得られなかったが，CT所見から原発性肺癌が強く疑われたため，体外式肺補助（ECLA）下に胸腔鏡下右S⁶区域切除を施行した．術後合併症はなく，術後14日目に退院した．組織学的診断は上皮内腺癌であった．結論．ECLAの使用により，左肺全摘後，右肺に出現した異時性肺癌（3重癌）に対し，安全に胸腔鏡下区域切除を施行することが可能であった．

DOI DOI2 CiNii

Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer.

Yuki Takahashi, Masahiro Miyajima, Taijiro Mishina, Ryunosuke Maki, Makoto Tada, Kodai Tsuruta, Atsushi Watanabe

Journal of cardiothoracic surgery 13 ( 1 ) 86 - 86 2018年07月 [国際誌]

BACKGROUND: Combined resection of a phrenic nerve is occasionally required in T3 primary lung carcinomas invading the phrenic nerve to completely remove a malignant tumour, resulting in diaphragmatic paralysis. We describe the first case of thoracoscopic lobectomy and diaphragmatic plication as a one-stage surgery for lung cancer invading the phrenic nerve. CASE PRESENTATION: A 56-year-old woman with a T3N0M0 primary adenosquamous carcinoma in the left upper lobe presented with suspicious invasion to the anterior mediastinal fat tissue and left phrenic nerve and underwent left upper lobectomy, node dissection, and partial resection of the anterior mediastinal fat tissue with the left phrenic nerve. Furthermore, thoracoscopic diaphragmatic plication was performed as a concomitant procedure. The patient's postoperative course was favourable, without any complications, and respiratory function was preserved for 1 year postoperatively. CONCLUSIONS: Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer invading the phrenic nerve is effective for preservation of postoperative pulmonary function.

DOI PubMed

症例 p40陰性肺類基底細胞型扁平上皮癌の1例

槙龍之輔, 杉田真太朗, 小野祐輔, 宮島正博, 多田周, 高橋有毅, 三品泰二郎, 渡辺敦

胸部外科 ( 南江堂 ) 71 ( 7 ) 547 - 550 2018年07月

DOI CiNii

Truncus Superior Artery Ventral to the Apical Vein of the Right Upper Lobe.

Ryunosuke Maki, Masahiro Miyajima, Taijiro Mishina, Atsushi Watanabe

The Annals of thoracic surgery 106 ( 1 ) e39 2018年07月 [国際誌]

DOI PubMed

[p40 Negative Basaloid Squamous Cell Carcinoma of the Lung;Report of a Case].

Ryunosuke Maki, Shintaro Sugita, Yusuke Ono, Masahiro Miyajima, Makoto Tada, Yuki Takahashi, Taijirou Mishina, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 71 ( 7 ) 547 - 550 2018年07月 [国内誌]

Immunohistochemical staining is important for the differential diagnosis of basaloid squamous cell carcinoma(BSC)and other similar carcinomas, such as small-cell carcinomas and large-cell neuroendocrine carcinomas. p40 is a useful marker of squamous cell carcinoma that can be used for the diagnosis of BSC. We present the case of a 64-year-old man who was referred to our hospital for investigation of an abnormal shadow revealed on chest radiography. Computed tomography(CT) revealed a 16×11 mm nodule in the left lung(S1+2), and a thoracoscopic left upper lobectomy was performed. Histologically, lobular pattern with peripheral palisading was observed and the immunohistochemical staining revealed the tumor cells to be positive for p63 and negative for both p40 and neuroendocrine markers, leading to the diagnosis of BSC.

PubMed

特集呼吸器外科領域の救急外科治療—Emergency treatment for chest trauma

三品泰二郎, 宮島正博, 高橋有毅, 槙龍之輔, 多田周, 大川美穂, 新井航, 渡辺敦

北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会編 ( 北海道外科学会 ) 63 ( 1 ) 2 - 5 2018年06月

CiNii

Reply to Suciu et al.

Taijiro Mishina, Atsushi Watanabe, Masahiro Miyajima

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 53 ( 4 ) 896 - 896 2018年04月 [国際誌]

DOI PubMed

What factors determine the survival of patients with an acute exacerbation of interstitial lung disease after lung cancer resection?

Masahiro Miyajima, Atsushi Watanabe, Toshihiko Sato, Satoshi Teramukai, Masahito Ebina, Kazuma Kishi, Yukihiko Sugiyama, Haruhiko Kondo, Satoru Kobayashi, Yutaka Takahashi, Hiroyuki Ito, Ryoji Yamamoto, Shigeki Sawada, Hideki Fujimori, Kazunori Okabe, Jun Arikura, Yasushi Shintani, Hiroshige Nakamura, Shinichi Toyooka, Tohru Hasumi, Takehiro Watanabe, Yoshinobu Hata, Hisashi Iwata, Minoru Aoki, Kazuhito Funai, Shuhei Inoue, Osamu Kawashima, Tomohiko Iida, Hiroshi Date

Surgery today 48 ( 4 ) 404 - 415 2018年04月 [国内誌]

PURPOSES: Acute exacerbation of interstitial pneumonia (AEIP) is a leading cause of death after lung cancer resection in patients with interstitial lung disease. METHODS: We retrospectively analyzed 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease (ILD) who underwent lung cancer resection between 2000 and 2009 at 61 hospitals in Japan. AEIP occurred in 164 of 1763 (9.3%) patients with a mortality rate of 43.9% (72/164). Univariate and multivariate analyses were carried out to identify possible risk factors of fatal AEIP. We then analyzed the 164 patients who developed postoperative AEIP and identified the preoperative and postoperative risk factors. RESULTS: A multivariate regression analysis identified that the sex, percent vital capacity, neoadjuvant radiation, preoperative history of AEIP, preoperative use of steroids, usual interstitial pneumonia pattern on CT, and surgical procedures were independent preoperative risk factors for death due to AEIP. ILD patients with emphysema somehow showed a lower risk of fatal AEIP than those without emphysema in this study. CONCLUSIONS: This study revealed eight risk factors for fatal AEIP.

DOI PubMed

A new ENG mutation in a Japanese family with hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations.

Keiki Yokoo, Gen Yamada, Hirofumi Chiba, Aki Ishikawa, Hiroko Morisaki, Hiroshi Saijo, Sayaka Kudoh, Yasuo Kitamura, Naoki Hirokawa, Masahiro Miyajima, Atsushi Watanabe, Hiroki Takahashi

Respiratory medicine case reports 25 73 - 77 2018年 [国際誌]

We present a case series of four siblings with hereditary hemorrhagic telangiectasia (HHT) and pulmonary arteriovenous malformations (PAVM). The patients' mother has HHT. Case 1: A 22-year-old man developed dyspnea and epistaxis. CT revealed a large PAVM, treated by segmentectomy. Case 2: A 27-year-old woman developed epistaxis and dyspnea. CT revealed three PAVMs, treated by partial resection. Case 3: A 20-year-old woman developed dyspnea. CT revealed multiple PAVMs, treated with endovascular occlusion of the largest one. Case 4: A 12-year-old woman developed epistaxis. CT revealed multiple PAVMs, observed without treatment. Genetic testing identified a new mutation, ENG c.1517T>C (p.Leu506Pro), in all patients and their mother. We suspect that HHT in these patients may be associated with this ENG mutation.

DOI PubMed

Video-assisted thoracoscopic surgery node dissection for lung cancer treatment.

Atsushi Watanabe, Masahiro Miyajima, Taijiro Mishina, Kodai Tsuruta, Yuki Takahashi, Ryunosuke Maki, Makoto Tada

Surgery today 47 ( 12 ) 1419 - 1428 2017年12月 [国内誌]

PURPOSE: Mediastinal node dissection (MND) is an integral component of the surgical treatment for non-small cell lung cancer (NSCLC). Although video-assisted thoracoscopic surgery (VATS) has been used increasingly for lung cancer treatment, the accuracy of by VATS MND still remains controversial. We reviewed the surgical results of VATS MND for NSCLC. METHODS: A systematic review of literature was performed, and articles that fully described the surgical procedure, devices, and results of VATS MND were selected to compare the efficacy of MND by VATS and thoracotomy. RESULTS: Various techniques and equipments have been shown to perform adequate MND, but there is an argument as to the method of estimation of the accuracy of MND. Most of the recent studies showed that the nodal upstaging and number of dissected nodes are significantly lower by VATS than after thoracotomy. Oppositely, some studies showed VATS noninferiority in these issues. Complications such as chylothorax, pleural effusion, bleeding, and nerve damage were similar in both groups. CONCLUSIONS: Although ND by VATS remains controversial, VATS MND is becoming easier and more feasible owing to the development of more advanced endoscopic cameras and equipments. We should learn further to become more adept at performing adequate ND by VATS.

DOI PubMed

Elevated expression of JAM-A promotes neoplastic properties of lung adenocarcinoma.

Kazufumi Magara, Akira Takasawa, Makoto Osanai, Misaki Ota, Yohei Tagami, Yusuke Ono, Kumi Takasawa, Masaki Murata, Yoshihiko Hirohashi, Masahiro Miyajima, Gen Yamada, Tadashi Hasegawa, Norimasa Sawada

Cancer science 108 ( 11 ) 2306 - 2314 2017年11月 [国際誌]

A cell-cell adhesion protein, junctional adhesion molecule-A (JAM-A), has been shown to be involved in neoplasia of various organs. However, the fundamental role of JAM-A in tumorigenesis is still under debate because dysregulated expression of this protein has distinct effects, playing opposite roles in carcinogenesis depending on the target tissues. In the present study, we found elevated levels of JAM-A expression in lung adenocarcinoma and its preinvasive lesions, including atypical adenomatous hyperplasia and adenocarcinoma in situ by immunohistochemistry. We also showed that suppression of constitutive JAM-A expression conferred target cells with increased susceptibility to apoptosis in lung adenocarcinoma cells. Consequently, inhibition of JAM-A activity decreased colony-forming capability in vitro and tumorigenicity in vivo. The transformed phenotype following suppression of JAM-A expression was sufficient to reduce motile and invasive capacities. Importantly, knockout of JAM-A had striking effects on cells. Our observations suggest that increased expression of JAM-A promotes neoplasia of lung adenocarcinoma. In addition, an anti-JAM-A antibody efficiently reduced cell proliferation and provoked apoptosis, indicating the potential feasibility of JAM-A-inhibitory cancer therapy.

DOI PubMed

Relationship between onset of spontaneous pneumothorax and weather conditions.

Taijiro Mishina, Atsushi Watanabe, Masahiro Miyajima, Junji Nakazawa

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 52 ( 3 ) 529 - 533 2017年09月 [国際誌]

OBJECTIVES: Spontaneous pneumothorax (SP) results from the rupture of blebs or bullae. It has been suggested that changes in weather conditions may trigger the onset of SP. Our aim was to examine the association between the onset of primary SP with weather changes in the general population in Sapporo, Japan. METHODS: From January 2008 through September 2013, 345 consecutive cases with a diagnosis of primary SP were reviewed. All cases of primary SP developed in the area within 40 km from the Sapporo District Meteorological Observatory. Climatic measurements were obtained from the Observatory, which included 1-h readings of weather conditions. Logistic regression model was used to obtain predicted risks for the onset of SP with respect to weather conditions. RESULTS: SP occurred significantly when the atmospheric pressure decreased by - 18 hPa or less during 96 h before the survey date (odds ratio = 1.379, P = 0.026), when the pressure increased by 15 hPa or more during 72 h before the survey date (odds ratio = 1.095, P = 0.007) and when maximum fluctuation in atmospheric pressure over 22 hPa was observed during 96 h before the survey date (odds ratio = 1.519, P = 0.001). Other weather conditions, including the presence of thunderstorms, were not significantly correlated with the onset of pneumothorax. CONCLUSIONS: Changes in atmospheric pressure influence the onset of SP. Future studies on the relationship between the onset of SP and weather conditions on days other than before the onset and with large number of patients may enable us to predict the onset of SP in various regions and weather conditions.

DOI PubMed

[Management of Pulmonary Thromboembolism].

Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 70 ( 8 ) 678 - 682 2017年07月 [国内誌]

Pulmonary thromboembolism is a fatal perioperative complication in general thoracic surgery. There is a report on its incidence of 2.68 cases out of 10,000 general thoracic surgeries. To prevent pulmonary thromboembolism, risk evaluation of an individual case and steady implementation of recommended preventive techiques are required. Because of the prevalence of guidelines for prevention, the incidence of pulmonary thromboembolism in the perioperative period is reducing. However, maximum prevention of deep vein thrombosis(DVT), which can lead to pulmonary thromboembolism, is impossible even if preventive measures are strictly implemented in the perioperative period. Mindful of potential DVT postoperatively, it is crucial to speculate perioperative acute pulmonary thromboembolism when sudden sensation of postoperative dyspnea occurs. For lifesaving measures, treatment along with diagnosis is necessary. In the presence of shock, pulmonary endarterectomy is recommended with percutaneous cardiopulmonary support, while in the absence of shock, treatment depends on a patient's condition.

PubMed

Fibroblastic foci, covered with alveolar epithelia exhibiting epithelial-mesenchymal transition, destroy alveolar septa by disrupting blood flow in idiopathic pulmonary fibrosis.

Miki Yamaguchi, Sachie Hirai, Yusuke Tanaka, Toshiyuki Sumi, Masahiro Miyajima, Taijiro Mishina, Gen Yamada, Mitsuo Otsuka, Tadashi Hasegawa, Takashi Kojima, Toshiro Niki, Atsushi Watanabe, Hiroki Takahashi, Yuji Sakuma

Laboratory investigation; a journal of technical methods and pathology 97 ( 3 ) 232 - 242 2017年03月 [国際誌]

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease of unknown cause. IPF has a distinct histopathological pattern of usual interstitial pneumonia in which fibroblastic foci (FF) represent the leading edge of fibrotic destruction of the lung. Currently there are three major hypotheses for how FF are generated: (1) from resident fibroblasts, (2) from bone marrow-derived progenitors of fibroblasts, and (3) from alveolar epithelial cells that have undergone epithelial-mesenchymal transition (EMT). We found that FF dissociated capillary vessels from the alveolar epithelia, the basement membranes of which are fused in normal physiological conditions, and pushed the capillaries and elastic fibers down ~100 μm below the alveolar epithelia. Furthermore, the alveolar epithelial cells covering the FF exhibited a partial EMT phenotype. In addition, normal human alveolar epithelial cells in vitro underwent dynamic EMT in response to transforming growth factor-β signaling within 72 h. Because it seems that resident fibroblasts or bone marrow-derived cells cannot easily infiltrate and form FF between the alveolar epithelia and capillaries in tight contact with each other, FF are more likely to be derived from the epithelial-to-mesenchymal transitioned alveolar epithelia located over them. Moreover, histology and immunohistochemistry suggested that the FF formed in the lung parenchyma disrupt blood flow to the alveolar septa, thus destroying them. Consequently, collapse of the alveolar septa is likely to be the first step toward honeycombing in the lung during late stage IPF. On the basis of these findings, inhibition of transforming growth factor-β signaling, which can suppress EMT of the alveolar epithelial cells in vitro, is a potential strategy for treating IPF.

DOI PubMed

高齢者気管腺様嚢胞癌に対し気管管状切除・再建術を施行した1例

多田周, 高橋有毅, 槙龍之輔, 三品泰二郎, 宮島正博, 渡辺敦

肺癌 ( 特定非営利活動法人日本肺癌学会 ) 57 ( 7 ) 870 - 874 2017年

背景．高齢者に対する気管切除・再建術の報告はいまだ少ない．症例．84歳女性．検診で胸部異常陰影を指摘された．胸部CT検査で胸部中部気管前壁の結節性病変を認めた．前医で行われた経気管支鏡生検で腺様嚢胞癌の診断であった．胸骨正中切開で気管管状切除・再建術を施行した．術後合併症はなく，術後33日目に退院した．結論．80歳代女性患者の気管原発腺様嚢胞癌に対して気管切除・再建術を施行した．切除後12か月無再発生存中である．

DOI DOI2 CiNii

下行大動脈損傷予防のために肋骨骨折端を摘除した胸部外傷の１例

上村修二, 宮島正博, 窪田生美, 喜屋武玲子, 平山傑, 井上弘行, 渡辺敦, 成松英智

日本外傷学会雑誌 ( 一般社団法人日本外傷学会 ) 30 ( 1 ) 23 - 26 2016年

症例は19歳女性，交通事故で頭部，顔面挫創，両肺挫傷，両側気胸，両側多発肋骨骨折，肝損傷と腸骨開放骨折を受傷．来院後，気道緊急のため気管挿管施行し人工呼吸管理とした．CTで左第９肋骨骨折端と下行大動脈の距離が12mmと近接しており経過観察としていたが，受傷後５日には４mmと近接したため，胸腔鏡下に肋骨骨折端摘除術を施行した．左下後部肋骨骨折による遅発性の下行大動脈損傷は稀ではあるが発生すると致命的である．本症例は予防的に肋骨骨折端を摘除することにより下行大動脈損傷を予防することができた．

DOI CiNii

[Pulmonary Carcinoid Tumor with Cushing's Syndrome in a Patient who Underwent Pulmonary Resection by Video-Assisted Thoracic Surgery;Report of a Case].

Hiroshi Sato, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 68 ( 7 ) 543 - 5 2015年07月 [国内誌]

Pulmonary carcinoid tumor with Cushing's syndrome is comparatively rare disease. It is difficult to make an early diagnosis due to small size lesion in its early stage. We report a case of pulmonary carcinoid tumor with Cushing's syndrome successfully localised by positron emission tomography/computed tomography and was resected in the early stage. The levels of serum cortisol and adrenocorticotropic hormone( ACTH) decreased immediately after surgery, and the symptoms of Cushing's syndrome were relieved.

PubMed

低用量造影剤による肺癌術前3D-CT肺動静脈選択撮影法

小倉圭史, 渡辺敦, 宮島正博, 三品泰二郎, 吉川健太, 蝶野大樹, 三角昌吾, 田仲健朗, 虻川雅基

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 ) 29 ( 3 ) P38 - 1 2015年04月

転移性肺腫瘍—Metastatic lung tumors—特集肺に対する外科治療

宮島正博, 三品泰二郎, 渡辺敦

北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会編 ( 北海道外科学会 ) 59 ( 1 ) 9 - 13 2014年06月

CiNii

救急領域における呼吸器外科—Emergency thoracic surgery—外科的な救急疾患

宮島正博, 三品泰二郎, 渡辺敦

北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会編 ( 北海道外科学会 ) 59 ( 1 ) 19 - 23 2014年06月

CiNii

胸壁･横隔膜の手術-その1 胸壁再建法長径多穴性金属プレートによる曲面を維持した胸壁再建術後の遠隔期成績

田中明彦, 櫻庭幹, 松井俊尚, 三品泰二郎, 宮島正博, 小濱卓朗, 山内昭彦, 村木里誌, 大澤久慶

胸部外科 ( 南江堂 ) 67 ( 1 ) 54 - 59 2014年01月

DOI CiNii

[Evaluation of long-term results in patients who underwent reconstruction of thoracic wall with curved metal plates].

Akihiko Tanaka, Motoki Sakuraba, Toshihisa Matsui, Taijiro Mishina, Masahiro Miyajima, Takuro Obama, Akihiko Yamauchi, Satoshi Muraki, Hisayoshi Osawa

Kyobu geka. The Japanese journal of thoracic surgery 67 ( 1 ) 54 - 9 2014年01月 [国内誌]

Between 1992 and 2011, 22 patients underwent surgery of reconstruction of thoracic wall with curved metal plates for multiple rib fracture and resection of thoracic wall tumor. They were divided into 2 groups according to original disorders. Twelve cases of group A accepted surgical stabilization of traumatic multiple rib fractures with the metal plates fixed on the fractured ribs as an external brace. Ten patients of group B were suffered from thoracic wall tumors, including 1 fibrous dysplagia, 1 chondroma, 5 invasive lung cancer, 2 rib metastases and 1 primary chest wall cancer. After the resection of tumors, an average of 3.2 ribs were removed, the defects of full thickness chest wall were reconstructed using a combination of a polypropylene mesh and the metal plates. In both groups, there were no displacement of the plates and allergic reaction. Only 2 patients needed removal of the fixed plates due to pyothorax caused by pneumonia after crushing thoracic injuries. The long metal reconstruction plates with many perforations were very useful for reconstruction of chest wall because they were long enough to cover the whole length of widely resected chest defects and moderately soft enough to be appropriately bent or twist by hand at the time of operation. Moreover long-term result of the reconstructed chest wall was safe and satisfactory without severe complication.

PubMed

[Henoch-Schönlein Purpura with lung abscess].

Junji Nakazawa, Atsushi Watanabe, Tomohiro Nakajima, Taijiro Mishina, Masahiro Miyajima, Tetsuya Higami

Kyobu geka. The Japanese journal of thoracic surgery 66 ( 10 ) 886 - 9 2013年09月 [国内誌]

A 72-year-old man had underwent left lower lobectomy for squamous cell carcinoma in our hospital in 2008. Postoperative stage was I A (T1N0M0). In 2010, follow-up chest computed tomography (CT) images showed similar cavitary nodules in segments 2 and 8 of the right lung with positive uptake on fluorodeoxyglucose-positron emission tomography (FDG-PET) images. Physical examination, blood tests, and levels of serum tumor markers showed no abnormality. Transbronchial lung biopsy revealed the absence of malignant cells. Segment 8 of the right lower lobe with the nodule was partially resected, and pathological examination demonstrated lung abscess. He was discharged but was hospitalized in another hospital for purpuric rash, fever, and arthralgia. Microscopic albuminuria was noted, and renal biopsy revealed nephritis with immunoglobulin A( IgA)deposition. He was made a diagnosis of Henoch-Schönlein purpura. Oral steroid therapy( prednisolone 60 mg/d) was initiated, resulting in the improvement of symptoms and disapearance of the cavitary nodule in the right lung segment 2.

PubMed

Two separate thoroscopic segmentectomies with vessel sealing system.

Atsushi Watanabe, Masahiro Miyajima, Nobuyoshi Kawaharada, Tetsuya Higami

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 41 ( 4 ) e62-4 2012年04月 [国際誌]

Total thoracoscopic segmentectomy is an appealing concept in terms of providing a parenchyma-sparing treatment. We describe our technique of two seperate total thoracoscopic segmentectomies by using a vessel sealing system (VSS). A 76-year old female with four gradually enlarging ground glass lesions on the right segment 2 (10 and 3 mm) and segment 6 (8 and 3 mm) was admitted to our institute for surgical diagnosis and treatment. Preoperative three-dimensional computed tomography showed that the A2 is composed of descending A2 and ascending A2, branch of V6 coursed to V2 and B1a originated from B2 and B1b from B3. Two separate segmentectomies were subsequently scheduled. Pulmonary vessel division was performed with VSS after proximal ligation. Intersegmental division by VSS and electrocautery was performed with the use of inflation-deflation demarcation line and the pulmonary veins along the intersegmental plane (V2a and V2c for segment 2 and V6b and V6c for segment 6) as guides to confirm the intersegmental plane after pulmonary artery and bronchial divisions. The intraoperative frozen-section examinations revealed adenocarcinoma in situ. Two separate segmentectomies were successfully completed, with a total operative time of 240 min and blood loss of 30 ml. VSS is a very useful and safe device for intersegmental division and pulmonary vessel division.

DOI PubMed

Thoracoscopic mediastinal lymph node dissection for lung cancer.

Atsushi Watanabe, Jyunnji Nakazawa, Masahiro Miyajima, Ryo Harada, Shinji Nakashima, Tohru Mawatari, Tetsuya Higami

Seminars in thoracic and cardiovascular surgery 24 ( 1 ) 68 - 73 2012年 [国際誌]

In lung cancer, mediastinum lymphatic spread occurs. We review our technique and experience of thoracoscopic mediastinal lymphnode dissection (MLND). Between 1997 and 2011, 992 patients with primary lung cancer underwent thoracoscopic major pulmonary resection with MLND. Initially we used a combination of electrocautery and clips to divide blood vessels and lymphatic channels; our current technique relies on a vessel sealing system (VSS) which is expeditious and leads to less lymphorrhea. Furthermore, dissection of station 7 nodes is performed after each main bronchus or right intermediate bronchus is taped with a 0 silk suture, which is then brought out of the thorax through the access incision for antero-lateral retraction of the tracheal carina. We dissect between 3 and 4 N2 lymph node stations and a total of approximately 20 N2 lymph nodes. Postoperative complications related to MLND occurred in 35 of 992 patients (3.5%), 15 (1.5%) for recurrent laryngeal nerve injury, 3 (0.3%) for bilateral vagal injury, 14 (1.4%) for chylothorax and 3 (0.3%) for airway injury. However, none were lethal. Thoracoscopic mediastinal dissection is safe and feasible in treating lung cancer. We believe our technique and VSS are very useful for thoracoscopic MLND.

DOI PubMed

Successful treatment by fibrin glue sealant for pneumothorax with chronic GVHD resistant to autologous blood patch pleurodesis.

Satoshi Iyama, Tsutomu Sato, Kazuyuki Murase, Shohei Kikuchi, Yusuke Kamihara, Kaoru Ono, Kohichi Takada, Koji Miyanishi, Yasushi Sato, Rishu Takimoto, Masayoshi Kobune, Takuro Obama, Masahiro Miyajima, Atsushi Watanabe, Tetsuya Higami, Yasuo Hirayama, Junji Kato

Internal medicine (Tokyo, Japan) 51 ( 15 ) 2011 - 4 2012年 [国内誌]

Pneumothorax associated with chronic graft-versus-host disease (cGVHD) after stem cell transplantation is a rare complication. Autologous blood has been used successfully for pleurodesis, which was less toxic than chemical agents. However, when pneumothorax is resistant to pleurodesis, no other procedure is more effective and conservative. Here, we describe a case of myelodysplastic syndromes complicated with cGVHD-related pneumothorax. His pneumothorax has been resistant to pleurodesis using autologous blood and was treated successfully with fibrin glue sealant. In our limited experience, we believe the best success could be achieved when this method is used to treat persistent pneumothorax with cGVHD.

PubMed

Total thoracoscopic lung segmentectomy of anterior basal segment of the right lower lobe (RS8) for NSCLC stage IA (case report).

Masahiro Miyajima, Atsushi Watanabe, Mayuko Uehara, Takuro Obama, Junji Nakazawa, Tomohiro Nakajiima, Keishi Ogura, Tetsuya Higami

Journal of cardiothoracic surgery 6 115 - 115 2011年09月 [国際誌]

A 69-year-old woman with a pulmonary nodule in anterior basal segment of the right lower lobe (RS8) was referred to our department. The diameter of the tumor was 12 mm, and it had increased over a few months. First, video-assisted thoracoscopic lung surgery (VATS) biopsy of the pulmonary nodule was carried out. Frozen section examination of this nodule confirmed the diagnosis of bronchioloalveolar carcinoma (BAC). Segmentectomy of RS8 with lower mediastinal node dissection (ND2a-1) was performed. The intersegmental plane was identified using the intersegmental veins as landmarks and the demarcation between the resected (inflated) and preserved (collapsed) lungs. Electrocautery at 70 watts was used to divide the intersegmental plane. A vessel sealing system was used to seal and cut the pulmonary arteries. Postoperative histopathological examination revealed that the tumor was T1aN0M0 BAC, and the minimal distance between the surgical margin and the tumor edge was 15 mm. The patient was discharged from hospital on postoperative day 5 without any complications.

DOI PubMed

Early acceptance of renal allografts in mice is dependent on foxp3(+) cells.

Masahiro Miyajima, Catharine M Chase, Alessandro Alessandrini, Evan A Farkash, Patricia Della Pelle, Gilles Benichou, Jay A Graham, Joren C Madsen, Paul S Russell, Robert B Colvin

The American journal of pathology 178 ( 4 ) 1635 - 45 2011年04月 [国際誌]

Mouse renal allografts have a remarkable ability to promote acceptance across full major histocompatibility complex incompatibilities in certain strain combinations without immunosuppression. The mechanism is unknown but is believed to involve immunoregulation. This study tests whether Foxp3(+) T-regulatory cells are responsible in the early phase of graft acceptance, using B6.Foxp3(DTR) mice that express diphtheria toxin receptor (DTR) in Foxp3(+) cells. The administration of DT to B6.Foxp3(DTR) recipients with accepted DBA/2 kidneys, 3 weeks to 3 months after transplantation, caused a marked depletion of Foxp3 cells and triggered acute cellular rejection, manifested by a sudden increase in blood urea nitrogen within a week. None of the controls showed an increase in blood urea nitrogen, including DT-treated B6 wild-type recipients of DBA/2 kidneys or B6.Foxp3(DTR) recipients of isografts. Accepted DBA/2 allografts showed prominent lymphoid sheaths around arteries containing numerous CD3(+)Foxp3(+) cells, CD4(+) cells, dedritic cells, and B cells, which was independent of CCR4. The lymphoid sheaths disintegrate after Foxp3 depletion, accompanied by widespread CD8 interstitial mononuclear inflammation, tubulitis, and endarteritis. The Foxp3 depletion caused an increased frequency of donor-reactive cells in the spleen by interferon (IFN) γ enzyme-linked immunosorbent spot (ELISPOT) assays and increased expression of the maturation markers, CD86 and IA(b), on dendritic cells in the spleen and kidney. We conclude that Foxp3(+) cells are needed to maintain acceptance of major histocompatibility complex-incompatible renal allografts in the first 3 months after transplantation and may act by inhibiting DC maturation.

DOI PubMed

左下葉切除にて救命された体動脈左下葉静脈瘻による重症喀血症例―大動脈瘤手術後膿胸合併の既往との関連について—大動脈瘤手術後膿胸合併の既往との関連について

中島智博, 渡辺敦, 小濱卓朗, 宮島正博, 仲澤順二, 樋上哲哉

日本呼吸器外科学会雑誌 ( 特定非営利活動法人日本呼吸器外科学会 ) 25 ( 5 ) 497 - 501 2011年

患者は59歳，女性．2000年に他院で胸部下行大動脈瘤に対して人工血管置換術を受けた．しかし，術後膿胸を合併したため胸腔内洗浄を施行され軽快退院した．2010年4月に喀血を主訴に他院へ救急搬送された．血管造影検査にて体動脈から左肺下葉内に流入する血管が数本造影され，CTで中枢側吻合部仮性瘤が認められた．2010年6月に再度喀血を生じて当院に搬送された．開胸手術にて左肺下葉切除術を行った．肺組織に至るまでの結合組織には新生血管が豊富にあり動脈性出血の止血に難渋した．術後8日目に独歩退院した．また，仮性動脈瘤については1ヵ月後にステントグラフト内挿術で治療された．膿胸による慢性炎症によって胸壁から肺内に向かう血管が新生され，体動脈肺静脈瘻が形成され喀血に至ったと考えられた．血管新生に対する考察を加えて報告する．

DOI CiNii

Dendritic cell maturation occurs through the inhibition of GSK-3β.

Alessandro Alessandrini, Stephanie De Haseth, Michael Fray, Masahiro Miyajima, Robert B Colvin, Winfred W Williams, A Benedict Cosimi, Gilles Benichou

Cellular immunology 270 ( 2 ) 114 - 25 2011年 [国際誌]

Dendritic cell (DC) maturation results in changes in antigen processing and presentation, governing the fate of adaptive immunity. Understanding the intracellular signaling pathways governing DC maturation is therefore critical. In this study, we observed that the kinase, GSK-3β, is present in its active form in resting immature DCs isolated from the spleen and bone marrow of mice. Induction of DC maturation using GM-CSF, IL-4 and TNF-α resulted in GSK-3β inhibition, as reflected by increased phosphorylation of Serine 9 on the kinase, and concomitant stabilization of its substrate, β-catenin. Treatment of immature DCs with a GSK-3β inhibitor increased cell surface expression of CD80, CD86 and CD40 on DCs, enhancing their ability to present antigen and activating IL-2 secretion by T cells. GSK-3β inhibition also parallels dendritic cell maturation in vivo. Our results show that GSK-3β signaling controls DC maturation and suggest that this kinase could be manipulated to modulate adaptive immunity.

DOI PubMed

肝細胞癌肋骨転移に対する胸腔鏡補助下外科治療

中島智博, 渡辺敦, 小濱卓朗, 宮島正博, 仲澤順二, 樋上哲哉

日本呼吸器外科学会雑誌 ( 特定非営利活動法人日本呼吸器外科学会 ) 25 ( 6 ) 621 - 625 2011年

画像所見で肋骨腫瘍が疑われ，胸腔鏡補助下に肋骨切除術を行った1例を経験した．症例は74歳，男性で2010年に右側胸部痛があり近医整形外科を受診した．右第4肋骨背側に3cm超の腫瘤があり，全身精査の為に当院を紹介され受診した．CTにて肝臓S6に4cmの腫瘤影があり，肋骨部の腫瘤が肝細胞癌転移の可能性があるため，診断および切除目的に手術となった．胸腔鏡補助下に第4肋骨と第5肋骨を合併切除した．病理診断の結果は肝細胞癌の肋骨転移であった．肋骨腫瘍に対して胸腔鏡補助下の切除術を行うことで，皮膚および胸壁筋切開範囲を縮小し，同部への損傷を少なくすることが可能であった．

DOI CiNii

Delayed closure of postinfarction ventricular septal rupture.

Masahiro Miyajima, Toshiya Kawashima, Tatsuya Saito, Hideo Yokoyama, Katsumi Ohori, Kenji Kuwaki, Akihiko Sasaki, Tetsuya Higami

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 16 ( 2 ) 128 - 30 2010年04月 [国内誌]

We present the case of a patient with postinfarction ventricular septal rupture (VSR) who underwent delayed repair using a modified infarction exclusion technique. The patient was taken to the operating room 21 days after the first incidence of acute myocardial infarction because the intra-aortic balloon pump maintained a stable circulatory condition without cardiogenic shock. In our procedure, a Dacron patch was sutured to the healthy endocardium to exclude the infarcted septum, and the VSR was subsequently closed with another Dacron patch. After three years of postoperation, the patient's condition remains normal with good ventricular kinesis and no residual shunt. We describe herein a novel procedure for repairing postinfarction VSR by using two Dacron patches.

PubMed

Suppression of alloreactivity and allograft rejection by SP600125, a small molecule inhibitor of c-Jun N-terminal kinase.

Akihiro Tabata, Masayuki Morikawa, Masahiro Miyajima, Brydon L Bennett, Yoshitaka Satoh, Jianhua Huang, Yasuaki Tamura, Noriyuki Sato, Tomio Abe

Transplantation 83 ( 10 ) 1358 - 64 2007年05月 [国際誌]

BACKGROUND: c-Jun N-terminal kinase (JNK) is reported to play crucial roles in T-cell activation and differentiation, and SP600125 is a small molecule that inhibits JNK. The aim of this study was to examine immunosuppressive action of this compound. METHODS: Rat heterotopic heart transplantation, popliteal lymph node (PLN) hyperplasia bioassay and lymphocyte proliferation assay. RESULTS: SP600125 treatment reduced histological rejection, and dose-dependently extended median survival time of cardiac allografts from 7 days (vehicle) up to 20 days (40 mg/kg/day). Alloantigen-induced PLN hyperplasia was also inhibited by SP600125 in a similar fashion. SP600125 suppressed mixed lymphocyte reaction and OX52-positive lymphocyte proliferation (IC50: 1.5-5.7 microM). Thus, SP600125 inhibits both T-lymphocyte expansion in vitro and T-cell-mediated alloimmune responses in vivo. In addition, SP600125 interacted with cyclosporine additively to prolong cardiac allograft survival. CONCLUSION: Our data provide the first evidence indicating the potential for JNK as a therapeutic target to inhibit the alloimmune response.

PubMed

胸部･気道損傷の治療穿通創肺･気管刺創に対する術式の工夫

田中明彦, 宮島正博, 小濱卓朗, 黒田陽介, 原田亮, 前田俊之, 村木里誌, 渡辺祝安, 松井俊尚, 牧瀬博

胸部外科 ( 南江堂 ) 59 ( 11 ) 1018 - 1022 2006年10月

DOI CiNii

Adamkiewicz artery demonstrated by MRA for operated posterior mediastinal tumors.

Satoshi Muraki, Akihiko Tanaka, Masahiro Miyajima, Ryo Harada, Noriyasu Watanabe, Hideki Hyodoh

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 12 ( 4 ) 270 - 2 2006年08月 [国内誌]

In the thoracolumbar region, it is well known that the great anterior medullary artery (the artery of Adamkiewicz: AKA) is the dominant feeder of the spinal cord. During surgery for posterior mediastinal tumor adjacent to the lower thoracic aorta, perioperative distortion of the spinal cord blood supply could lead to neurological complication. To avoid postoperative paralysis, it would be useful to know the level of the intercostal artery from which the AKA originates. Recently, we have attempted to identify the AKA preoperatively using magnetic resonance angiography (MRA).

PubMed

JNK特異的阻害剤による免疫抑制の可能性とその機序

宮島正博, 森川雅之, 田畑哲寿, 一宮慎吾, 佐藤昇志, 安倍十三夫

日本外科学会雑誌 ( 一般社団法人日本外科学会 ) 107 ( 2 ) 709 2006年03月

CiNii

Concomitant mitral and tricuspid valve infective endocarditis: report of a case.

Yoshikazu Hachiro, Hideyuki Harada, Toshio Baba, Yukiko Honma, Masahiro Miyajima, Tomio Abe

Surgery today 34 ( 8 ) 695 - 7 2004年 [国内誌]

PubMed

Medical students' views on thoracic surgery residency programs in a Japanese medical school.

Kiyofumi Morishita, Shu-ichi Naraoka, Masahiro Miyajima, Takeshi Uzuka, Tatsuya Saito, Tomio Abe

The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai zasshi 51 ( 9 ) 475 - 7 2003年09月 [国内誌]

There has been a decline in the number of medical students applying for thoracic surgery training programs. We obtained knowledge of medical students' views on thoracic surgery residency programs. After completion of thoracic surgery clerkship, 17 students were asked to fill out questionnaires on first-year thoracic surgery residency programs. The majority of students considered thoracic surgery to be held in high regard by the general public, and felt that the salary was sufficient. However, only one student chose a thoracic surgery training program. The main reason for not applying for thoracic surgery residency was lifestyle issues. The factors in determining career choice included quality of education and work hours. Medical students are likely to select specialties other than thoracic surgery. Since the main factor influencing medical students' career is the quality of education in a residency program, efforts should be made to improve the quality of education.

PubMed

Descending or thoracoabdominal aortic aneurysm repair without intercostal vessel reconstruction using contrast magnetic resonance angiography: report of two cases.

Johji Fukada, Kiyofumi Morishita, Hideki Hyodoh, Nobuyoshi Kawaharada, Satoshi Muraki, Masahiro Miyajima, Tomio Abe

Surgery today 32 ( 2 ) 163 - 6 2002年 [国内誌]

Two high-risk patients underwent a graft replacement for descending thoracic or thoracoabdominal aortic aneurysms without the reconstruction of any intercostal and lumbar arteries. The first patient was an 81-year-old woman with asthma and renal dysfunction who was diagnosed to have a descending thoracic aortic aneurysm extending from the Th8 to Th12 level. Contrast magnetic resonance angiography (MRA) demonstrated the Adamkiewicz artery to originate from the left second lumbar artery. The second patient was a 59-year-old man with left ventricular dysfunction due to aortic and mitral stenoses who was diagnosed to have a Crawford type IV thoracoabdominal aortic aneurysm. Contrast MRA showed the Adamkiewicz artery to originate from the left ninth intercostal artery. In general, the reestablishment of the spinal cord's blood supply, whenever possible, is generally considered to be necessary in such patients to prevent spinal cord injury. However, the reimplantation of intercostal vessels is the most complex aspect of this surgical modality, and therefore, it may cause a substantial increase in the cardiopulmonary bypass time. However, at least in some cases, such as the two cases presented herein, the use of contrast MRA was found to reduce the risk in surgery for descending thoracic or thoracoabdominal aortic aneurysms by eliminating the need for any intraoperative management of the intercostal and lumbar arteries.

PubMed

3) 急性冠症候群による心停止症例に対する治療戦略

小柳哲也, 小松幹志, 宮島正博, 宇塚武司, 奈良岡秀一, 塚本勝, 安倍十三夫, 栗本義彦, 長谷守, 浅井康文

( 社団法人日本循環器学会 ) 65 585 2001年04月

CiNii

50) 再大動脈弁置換後に発生した左室-右室,右房交通症

宮島正博, 塚本勝, 小松幹志, 小柳哲也, 藤澤康聡, 奈良岡秀一, 安倍十三夫

( 社団法人日本循環器学会 ) 65 590 2001年04月

CiNii

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