研究者詳細 - 杉本　誠一郎

論文 - 杉本　誠一郎

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乳糜胸水・腹水を考える―その原因と対策〔術後合併症としての乳糜胸水・腹水―対応に困ったこの症例〕胸部外科系術後の乳糜胸水肺リンパ脈管筋腫症(LAM)患者に合併した術後乳糜胸水

二萬英斗, 大藤剛宏, 杉本誠一郎, 宗淳一, 山根正修, 豊岡伸一, 三好新一郎

臨床外科 65 ( 10 ) 1372 - 1375 2010年10月

記述言語：日本語出版者・発行元：(株)医学書院

胸部外科系術後の乳糜胸水は,術中操作による胸管損傷に伴い発症する合併症である.胸腔ドレナージ,絶食・TPN管理(長鎖脂肪酸の制限・中鎖脂肪酸の投与),胸膜癒着術,胸管結紮術などがその治療法としてよく知られている.しかし,これらの治療法に反応せず,対応に難渋する乳糜胸水症例にも時に遭遇する.特に肺リンパ脈管筋腫症(LAM)を伴った患者に対する手術の際には注意を要する.本稿では,胸部外科術後の乳糜胸水に対する治療を中心に概説するとともに,LAM患者に対する両側生体肺移植術後の難治性乳糜胸腹水にシロリムス(ラパマイシン)の投与が有効であった症例を加え,報告する.(著者抄録)

DOI： 10.11477/mf.1407103212

Cutting Edge: MHC Class II Expression by Pulmonary Nonhematopoietic Cells Plays a Critical Role in Controlling Local Inflammatory Responses 査読国際誌

Daniel Kreisel, Steven B. Richardson, Wenjun Li, Xue Lin, Christopher G. Kornfeld, Seiichiro Sugimoto, Chyi-Song Hsieh, Andrew E. Gelman, Alexander S. Krupnick

JOURNAL OF IMMUNOLOGY 185 ( 7 ) 3809 - 3813 2010年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：AMER ASSOC IMMUNOLOGISTS

The interaction of CD4(+) T cells with MHC class II (MHCII)-expressing hematopoietic APCs plays a critical role in both the generation of protective immune responses and maintenance of tolerance in the lung. The functional significance of MHCII expression by nonhematopoietic stromal cells, however, has not been defined in vivo. Using a novel mouse model of orthotopic left lung transplantation, we demonstrate that selective elimination of MHCII expression on nonhematopoietic cells leads to an inflammatory response as a result of reduced peripheral generation of regulatory CD4(+) T cells. Absence of MHCII expression on nonhematopoietic cells also inhibits local growth of metastatic pulmonary tumor. These findings indicate that nonhematopoietic cells play a previously unrecognized role in downregulating inflammatory responses in nonlymphoid tissues. The Journal of Immunology, 2010, 185: 3809-3813.

DOI： 10.4049/jimmunol.1000971

診療に役立つ「呼吸器疾患外科治療」のすべて I 良性疾患 7.肺気腫に対するvolume reduction surgery

杉本誠一郎, 大藤剛宏, 宗淳一, 山根正修, 豊岡伸一, 三好新一郎

日本胸部臨床 69 ( 9 ) S40-S44 - S44 2010年9月

記述言語：日本語出版者・発行元：克誠堂出版(株)

肺気腫に対する肺容量減少手術(LVRS)は米国での大規模臨床試験により、特に上葉優位型肺気腫に対する有効性が示されたため、現在では適応を慎重に検討して施行されている。LVRSは姑息的治療であり、肺移植へのbridge therapyの側面をもつことは留意すべきである。(著者抄録)

肺癌肺癌の治療指針とその戦略非小細胞肺癌の治療戦略肺癌外科手術―適応,手術手技,治療成績―

杉本誠一郎, 豊岡伸一, 三好新一郎

Medical Practice 27 ( 7 ) 1181 - 1185 2010年7月

Orthotopic vascularized right lung transplantation in the mouse 査読国際誌

Wenjun Li, Seiichiro Sugimoto, Jiaming Lai, G. Alexander Patterson, Andrew E. Gelman, Alexander S. Krupnick, Daniel Kreisel

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 139 ( 6 ) 1637 - 1643 2010年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：MOSBY-ELSEVIER

Objectives: Orthotopic left lung transplantation in the mouse, as recently developed by our laboratory, represents a physiologic model for studies in transplantation biology. However, because of the limited overall respiratory contribution of the murine left lung, left lung transplant recipients remain healthy despite immune-mediated graft necrosis. We sought to develop a lung transplantation model in which animal survival depends on graft function.
Methods: Orthotopic vascularized right lung transplantations using cuff techniques were performed in syngeneic and allogeneic strain combinations. Grafts were assessed histologically or functionally by measuring arterial blood gases from 7 to 28 days after transplantation. In a parallel set of experiments, syngeneic and immunosuppressed allogeneic hosts underwent a left pneumonectomy 2 weeks after right lung transplantation, with assessment of graft function 1 week later.
Results: We performed 40 right lung transplantations, with a survival rate of 87.5%. Syngeneic grafts remain free of inflammation as far as 28 days after transplantation. On day 7, arterial oxygen levels in syngeneic recipients (481 +/- 90 mm Hg) are equivalent to those in naive mice (503 +/- 59 mm Hg) after left hilar occlusion. Alternatively, allogeneic grafts develop histologic evidence of acute rejection, and arterial oxygen levels are significantly decreased after left hilar clamping (53.3 +/- 10.3 mm Hg). Both syngeneic and immunosuppressed allogeneic right lung recipients tolerate a left pneumonectomy.
Conclusions: Right lung transplantation followed by left pneumonectomy represents the first survival model of vascularized lung transplantation in the mouse and will therefore allow for the design of novel studies in experimental lung transplantation. (J Thorac Cardiovasc Surg 2010;139:1637-43)

DOI： 10.1016/j.jtcvs.2009.11.019

CCR2 regulates monocyte recruitment as well as CD4⁺ T <inf>h</inf>1 allorecognition after lung transplantation

A. E. Gelman, M. Okazaki, S. Sugimoto, W. Li, C. G. Kornfeld, J. Lai, S. B. Richardson, F. H. Kreisel, H. J. Huang, J. R. Tietjens, B. H. Zinselmeyer, G. A. Patterson, M. J. Miller, A. S. Krupnick, D. Kreisel

American Journal of Transplantation 10 ( 5 ) 1189 - 1199 2010年5月

掲載種別：研究論文（学術雑誌）

Graft rejection remains a formidable problem contributing to poor outcomes after lung transplantation. Blocking chemokine pathways have yielded promising results in some organ transplant systems. Previous clinical studies have demonstrated upregulation of CCR2 ligands following lung transplantation. Moreover, lung injury is attenuated in CCR2-deficient mice in several inflammatory models. In this study, we examined the role of CCR2 in monocyte recruitment and alloimmune responses in a mouse model of vascularized orthotopic lung transplantation. The CCR2 ligand MCP-1 is upregulated in serum and allografts following lung transplantation. CCR2 is critical for the mobilization of monocytes from the bone marrow into the bloodstream and for the accumulation of CD11c+ cells within lung allografts. A portion of graft-infiltrating recipient CD11c+ cells expresses both recipient and donor MHC molecules. Two-photon imaging demonstrates that recipient CD11c+ cells are associated with recipient T cells within the graft. While recipient CCR2 deficiency does not prevent acute lung rejection and is associated with increased graft infiltration by T cells, it significantly reduces CD4+ Th1 indirect and direct allorecognition. Thus, CCR2 may be a potential target to attenuate alloimmune responses after lung transplantation. © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

DOI： 10.1111/j.1600-6143.2010.03101.x

Volume reduction surgery for pulmonary emphysema

Sugimoto, S., Oto, T., Soh, J., Yamane, M., Toyooka, S., Miyoshi, S.

Japanese Journal of Chest Diseases 69 ( SUPPL. ) 2010年

Apyrase treatment prevents ischemia-reperfusion injury in rat lung isografts 査読国際誌

Seiichiro Sugimoto, Xue Lin, Jiaming Lai, Mikio Okazaki, Nitin A. Das, Wenjun Li, Alexander S. Krupnick, Ridong Chen, Soon Seog Jeong, G. A. Patterson, Daniel Kreisel, Andrew E. Gelman

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 138 ( 3 ) 752 - 759 2009年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：MOSBY-ELSEVIER

Objective: Endothelial cells express the ectoenzyme ectonucleoside adenosine triphosphate diphosphohydrolase, an apyrase that inhibits vascular inflammation by catalyzing the hydrolysis of adenosine triphosphate and adenosine diphosphate. However, ectonucleoside adenosine triphosphate diphosphohydrolase expression is rapidly lost following oxidative stress, leading to the potential for adenosine triphosphate and related purigenic nucleotides to exacerbate acute solid organ inflammation and injury. We asked if administration of a soluble recombinant apyrase APT102 attenuates lung graft injury in a cold ischemia reperfusion model of rat syngeneic orthotopic lung transplantation.
Methods: Male Fisher 344 donor lungs were cold preserved in a low-potassium dextrose solution in the presence or absence of APT102 for 18 hours prior to transplantation into syngeneic male Fisher 344 recipients. Seven minutes after reperfusion, lung transplant recipients received either a bolus of APT102 or vehicle (saline solution). Four hours after reperfusion, APT102- and saline solution-treated groups were evaluated for lung graft function and inflammation.
Results: APT102 significantly reduced lung graft extracellular pools of adenosine triphosphate and adenosine diphosphate, improved oxygenation, and protected against pulmonary edema. Apyrase treatment was associated with attenuated neutrophil graft sequestration and less evidence of tissue inflammation as assessed by myeloperoxidase activity, expression of proinflammatory mediators, and numbers of apoptotic endothelial cells.
Conclusions: Administration of a soluble recombinant apyrase promotes lung function and limits the tissue damage induced by prolonged cold storage, indicating that extracellular purigenic nucleotides play a key role in promoting ischemia-reperfusion injury following lung transplantation.

DOI： 10.1016/j.jtcvs.2009.04.049

Experimental orthotopic lung transplantation model in rats with cold storage 査読

Ryujiro Sugimoto, Atsunori Nakao, Itaru Nagahiro, Junichi Kohmoto, Seiichiro Sugimoto, Mikio Okazaki, Masaomi Yamane, Hidetoshi Inokawa, Takahiro Oto, Kazunori Tahara, Jianghua Zhan, Yoshifumi Sano, Kenneth R. McCurry

SURGERY TODAY 39 ( 7 ) 641 - 645 2009年7月

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

This report describes a new experimental procedure, a rat unilateral, orthotopic lung transplantation with cold storage, and evaluates its relevancy and reliability to study the early events during cold ischemia/reperfusion (I/R) injury. This model, using the cuff technique, does not require extensive training and is relatively easy to be established. The model can induce reproducible degrees of pulmonary graft injury including impaired gas exchange, proinflammatory cytokine upregulation, or inflammatory infiltrates, depending on the preservation time. The results are consistent with the previous clinical evidence, thus suggesting that this model is a valid and reliable animal model of cold I/R injury.

DOI： 10.1007/s00595-008-3929-x

Cutting Edge: Acute Lung Allograft Rejection Is Independent of Secondary Lymphoid Organs 査読国際誌

Andrew E. Gelman, Wenjun Li, Steven B. Richardson, Bernd H. Zinselmeyer, Jiaming Lai, Mikio Okazaki, Christopher G. Kornfeld, Friederike H. Kreisel, Seiichiro Sugimoto, Jeremy R. Tietjens, John Dempster, G. Alexander Patterson, Alexander S. Krupnick, Mark J. Miller, Daniel Kreisel

JOURNAL OF IMMUNOLOGY 182 ( 7 ) 3969 - 3973 2009年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：AMER ASSOC IMMUNOLOGISTS

It is the prevailing view that adaptive immune responses are initiated in secondary lymphoid organs. Studies using alymphoplastic mice have shown that secondary lymphoid organs are essential to initiate allograft rejection of skin, heart, and small bowel. The high immunogenicity of lungs is well recognized and allograft rejection remains a major contributing factor to poor outcomes after lung transplantation. We show in this study that alloreactive T cells are initially primed within lung allografts and not in secondary lymphoid organs following transplantation. In contrast to other organs, lungs are acutely rejected in the absence of secondary lymphoid organs. Two-photon microscopy revealed that recipient T cells cluster predominantly around lung-resident, donor-derived CD11c(+) cells early after engraftment. These findings demonstrate for the first time that alloimmune responses following lung transplantation are initiated in the graft itself and therefore identify a novel, potentially clinically relevant mechanism of lung allograft rejection. The Journal of Immunology, 2009, 182: 3969-3973.

DOI： 10.4049/jimmunol.0803514

Orthotopic mouse lung transplantation as experimental methodology to study transplant and tumor biology 査読国際誌

Alexander S. Krupnick, Xue Lin, Wenjun Li, Mikio Okazaki, Jiaming Lai, Seiichiro Sugimoto, Steven B. Richardson, Christopher G. Kornfeld, Joel R. Garbow, G. Alexander Patterson, Andrew E. Gelman, Daniel Kreisel

NATURE PROTOCOLS 4 ( 1 ) 86 - 93 2009年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：NATURE PUBLISHING GROUP

Unlike transplantation of other solid organs, vascularized mouse lung transplantation has only recently been developed. In this protocol, we describe a detailed method for performing a vascularized and aerated mouse orthotopic lung transplant, which to date represents the most physiological mouse model of lung transplantation. The procedure is divided into two separate portions consisting of donor harvest followed by implantation using the cuff technique for bronchovascular anastomoses. After a training period spanning several months, the procedure can be successfully mastered and, in experienced hands, requires similar to 90 min to perform. After an initial learning curve, perioperative survival is close to 100%. As the donor hematopoietic cells in the transplanted lung are replaced by those of the host over time, thereby creating a 'chimeric lung,' this model represents a novel research tool for the study of transplantation biology as well as other disease processes, such as malignancies.

DOI： 10.1038/nprot.2008.218

Costimulatory Blockade-Mediated Lung Allograft Acceptance Is Abrogated by Overexpression of Bcl-2 in the Recipient

Okazaki, M., Sugimoto, S., Lai, J., Kornfeld, C.G., Hotchkiss, R.S., Richardson, S.B., Li, W., Kreisel, F.H., Huang, H.J., Patterson, G.A., Krupnick, A.S., Gelman, A.E., Kreisel, D.

Transplantation Proceedings 41 ( 1 ) 385 - 387 2009年

掲載種別：研究論文（学術雑誌）

Lung allografts are considered to be more immunogenic than other solid organs. Little is known about the effectiveness of immunosuppressive regimens after lung transplantation. Herein, we describe a novel model of murine vascularized orthotopic lung transplantation we used to study the effects of costimulatory blockade on lung rejection. Transplants were performed in the Balb → B6 strain combination. Recipients were either not immunosuppressed or received perioperative CD40/CD40L and CD28/B7 costimulatory blockade. Nonimmunosupressed Balb/c → B6 lung transplants had severe acute rejection 7 days after transplantation and CD8+ T cells outnumbered CD4+ T cells within the allografts. Alternatively, B6 recipients that received perioperative costimulatory blockade had minimal inflammation and there were nearly equal numbers of CD8+ and CD4+ T cells in these grafts. Approximately one third of graft-infiltrating CD4+ T cells expressed Foxp3. CD4+ T cells isolated from these grafts induced apoptosis of alloreactive CD8+ T cells that were stimulated with donor splenocytes in vitro. In contrast with wild-type B6 recipient mice, we observed severe rejection of Balb/c lungs 7 days after transplantation into Bcl-2 transgenic B6 recipients that had received costimulatory blockade. CD8+ T cells outnumbered CD4+ T cells in these immunosuppressed Bcl-2 transgenic recipients and, compared with immunosuppressed wild-type B6 recipients, a lower percentage of graft-infiltrating CD4+ T cells expressed Foxp3, and a higher percentage of graft-infiltrating CD8+ T cells expressed intereferon-γ. Thus, our results show that perioperative blockade of the CD40/CD40L and CD28/B7 costimulatory pathways markedly ameliorates acute rejection of lung allografts in wild type but not Bcl-2 transgenic recipients. © 2009 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2008.10.068

Monocyte Differentiation Is Controlled by MyD88 After Mouse Orthotopic Lung Transplantation

Sugimoto, S., Lin, X., Okazaki, M., Lai, J., Tietjens, J.R., Huang, H., Patterson, G.A., Krupnick, A.S., Kreisel, D., Gelman, A.E.

Transplantation Proceedings 41 ( 1 ) 388 - 390 2009年

掲載種別：研究論文（学術雑誌）

In lung grafts, ischemia-reperfusion signals rapidly induce the recruitment and differentiation of host monocytes into macrophages and dendritic cells. The nature of ischemia-reperfusion signals are antigen independent, but have been hypothesized to initiate Toll-like receptor (TLR) and interleukin (IL)-1R-mediated signaling pathways that are thought to potentiate alloimmune responses. We wondered whether MyD88, an adaptor molecule critical for both TLR and IL-1R-mediated inflammatory responses, regulated monocyte differentiation in a mouse model of vascularized orthotopic lung transplantation. Orthotopic left lung transplants were performed in the following syngeneic combinations: CD45.1+ B6 → CD45.2+ MyD88-/- and CD45.1+ B6 → CD45.2+ B6. One day later, recipient-derived dendritic cells and macrophage numbers were assessed in the bronchiolar lavage by FACS analysis. Compared with the bronchiolar lavage of wildtype recipients, MyD88-/- recipients had lower numbers of dendritic cells in lung graft airways that were of recipient origin. Lower numbers of newly differentiated lung graft dendritic cells was coincident with the appearance of higher numbers of undifferentiated monocytes in the lung airways of MyD88-/- recipients as compared with wild-type recipients. Moreover, adoptive transfer experiments demonstrated that MyD88-/- monocytes were poorer at differentiating into lung dendritic cells as compared with wild-type monocytes. Taken together, these data show that MyD88 regulates graft-infiltrating monocyte differentiation and suggests a mechanism by which TLR/IL-1R-signaling pathways control adaptive responses in lung allografts through controlling monocyte fate. © 2009 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2008.09.064

Native lung-sparing lobar transplantation for pulmonary emphysema 査読国際誌

Masaomi Yamane, Daisuke Okutani, Sciichiro Sugimoto, Shinichi Toyooka, Motoi Aoe, Megumi Okazaki, Yoshifumi Sano, Hiroshi Date

JOURNAL OF HEART AND LUNG TRANSPLANTATION 27 ( 9 ) 1046 - 1049 2008年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ELSEVIER SCIENCE INC

The living-donor lobar lung transplantation procedure has been developed clinically as an alternative approach for patients considered too ill to await cadaveric transplantation. With this procedure, 2 lobes are implanted in the recipient in place of whole right and left lungs, respectively. However, the shortage of graft volume can be a problem when compared with full-sized cadaveric grafts. In an attempt to solve this problem, we have developed a native lobe-preserving lobar transplant technique using a large animal model. We report a first successful case of a patient undergoing native lobe-preserving lobar lung transplantation for severe pulmonary emphysema.

DOI： 10.1016/j.healun.2008.05.025

The feasibility of diaphragmatic transplantation as potential therapy for treatment of respiratory failure associated with Duchenne muscular dystrophy: Acute canine model 査読国際誌

Alexander Sasha Krupnick, Andrew E. Gelman, Mikio Okazaki, Jiaming Lai, Nitin Das, Seiichiro Sugimoto, Thomas H. Tung, Steven B. Richardson, G. Alexander Patterson, Daniel Kreisel

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 135 ( 6 ) 1398 - U336 2008年6月

CD4(+) T lymphocytes are not necessary for the acute rejection of vascularized mouse lung transplants 査読国際誌

Andrew E. Gelman, Mikio Okazaki, Jiaming Lai, Christopher G. Kornfeld, Friederike H. Kreisel, Steven B. Richardson, Seiichiro Sugimoto, Jeremy R. Tietjens, G. Alexander Patterson, Alexander S. Krupnick, Daniel Kreisel

JOURNAL OF IMMUNOLOGY 180 ( 7 ) 4754 - 4762 2008年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：AMER ASSOC IMMUNOLOGISTS

Acute rejection continues to present a major obstacle to successful lung transplantation. Although CD4(+) T lymphocytes are critical for the rejection of some solid organ grafts, the role of CD4(+) T cells in the rejection of lung allografts is largely unknown. In this study, we demonstrate in a novel model of orthotopic vascularized mouse lung transplantation that acute rejection of lung allografts is independent of CD4(+) T cell-mediated allorecognition pathways. CD4(+) T cell-independent rejection occurs in the absence of donor-derived graft-resident hematopoietic APCs. Furthermore, blockade of the CD28/B7 costimulatory pathways attenuates acute lung allograft rejection in the absence of CD4(+) T cells, but does not delay acute rejection when CD4(+) T cells are present. Our results provide new mechanistic insight into the acute rejection of lung allografts and highlight the importance of identifying differences in pathways that regulate the rejection of various organs.

新しい生体肺移植術式:両側自己肺温存部分肺移植術 Bilateral native lung‐sparing lobar transplantation

杉本誠一郎, 伊達洋至, 杉本龍士郎, 山根正修, 豊岡伸一, 大藤剛宏, 青江基, 佐野由文

岡山医学会雑誌 119 ( 2 ) 107 - 112 2007年9月

記述言語：日本語出版者・発行元：岡山医学会

雑種成犬を用い、両側自己肺温存部分肺移植術を行った。ドナー犬の両肺ブロックから右グラフト(右中・下・縦隔葉)と左グラフト(左下葉)を分離し、レシピエント犬の解剖学的位置に移植した。手術は12例全例で成功した。急性期実験(〜180分)では、6頭全例が人工呼吸器下の3時間評価で良好な心肺機能を示し、3時間評価終了時の動脈血酸素分圧は589.0±14.4mmHg、平均肺動脈圧は35.8±3.9mmHgであった。慢性期実験(〜3週)は、6頭全例が気管内チューブを抜管でき、抜管後、レシピエントは正常の呼吸パターンを示した。5例(83%)は3週間生存した。胸部X線写真、肺動脈造影では、グラフトの拡張は良好で、動脈吻合部に狭窄を認めなかった。術後5日目に死亡した1例は肺静脈血栓症で、剖検時に止血部位の血栓形成を認めた。両側自己肺温存部分肺移植術は、脳死移植を待てず、かつ体格の大きい成人に対し、新たな選択肢になり得ることが示唆された。

DOI： 10.4044/joma.119.107

Bilateral native lung-sparing lobar transplantation in a canine model 査読国際誌

Seiichiro Sugimoto, Hiroshi Date, Ryujiro Sugimoto, Motoi Aoe, Yoshifumi Sano

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 132 ( 5 ) 1213 - 1218 2006年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：MOSBY, INC

Objective: Bilateral living-donor lobar lung transplantation has become an accepted approach in response to the cadaveric lung donor shortage. Because only one lobe is implanted in each chest cavity, this procedure is usually confined to patients of small size. The purpose of this study was to develop a technique of bilateral native lung - sparing lobar transplantation that can be applied to large adult patients.
Methods: Bilateral native lung - sparing lobar transplantation was performed in 12 pairs of dogs. In donor animals the right middle, lower, and cardiac lobes were separated as a right graft, and the left lower lobe was separated as a left graft. In recipient animals these 2 grafts were implanted in the natural anatomic position with sparing native right upper, left upper, and middle lobes. In an acute study (n = 6), transplanted graft function was assessed for 3 hours after ligation of the pulmonary artery branches to the native spared lobes. In a chronic study (n = 6) the immunosuppressed recipients were observed for 3 weeks to assess the quality of bronchial healing and long-term pulmonary function.
Results: Morphologic adaptation of the 2 grafts was found to be excellent. All 6 animals in the acute study showed excellent pulmonary function. Five of 6 animals in the chronic study survived for 3 weeks, with excellent pulmonary function and satisfactory bronchial healing.
Conclusion: Bilateral native lung - sparing lobar transplantation was technically possible and associated with excellent pulmonary function and good bronchial healing in a canine experimental model.

DOI： 10.1016/j.jtcvs.2006.07.012

Post-mortem administration of urokinase in canine lung transplantation from non-heart-beating donors 査読国際誌

Ryujiro Sugimoto, Hiroshi Date, Seiichiro Sugimoto, Mikio Okazaki, Keiju Aokage, Hidetoshi Inokawa, Motoi Aoe, Yoshifumi Sano

JOURNAL OF HEART AND LUNG TRANSPLANTATION 25 ( 9 ) 1148 - 1153 2006年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ELSEVIER SCIENCE INC

Background: We previously reported that post-mortem heparinization by closed-chest cardiac massage within 30 minutes after cardiac arrest is beneficial in lung transplantation (LTx) from non-heart-beating donors (NHBDs) by preventing formation of microthrombi. In this study, we evaluated the effects of post-mortem administration of urokinase 60 minutes after cardiac arrest.
Methods: Left LTx was performed in 12 pairs of mongrel dogs. Donors were sacrificed and left at room temperature for 2 hours. In Group I (n = 6), heparin sodium (1,000 U/kg) was administered intravenously 60 minutes after cardiac arrest, then closed-chest cardiac massage was performed for 1 minute to distribute the heparin. In Group 2 (n = 6), the donors were treated as in Group 1, except, in addition to heparin sodium, urokinase (120,000 U) was administered intravenously before and at the end of cardiac massage. After 2 hours of cardiac arrest, donor lungs were flushed with low-potassium dextran glucose solution. After left LTx, the right pulmonary artery was ligated, and recipients were followed up for 3 hours. Uni- and multivariate repeat analyses were performed to obtain statistical data.
Results: Group 2 had significantly better arterial oxygen tension, lower pulmonary vascular resistance and lower wet/dry weight ratio of the transplanted lung than Group 1. D-dimer level during the warm ischemia was significantly lower in Group 2 than in Group 1.
Conclusions: Post-mortem administration of urokinase along with heparin is beneficial in LTx from NHBDs by fibrinolytic action on already formed pulmonary microthrombi in the cadaver donor lungs.

DOI： 10.1016/j.healun.2006.07.005

Intraatrial extension of thyroid cancer: A case report 査読

S Sugimoto, H Doihara, Y Ogasawara, M Aoe, S Sano, N Shimizu

ACTA MEDICA OKAYAMA 60 ( 2 ) 135 - 140 2006年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：OKAYAMA UNIV MED SCHOOL

A 61-year-old man, who was diagnosed with superior vena cava syndrome by papillary thyroid carcinoma, was referred to our hospital. A bulky thyroid tumor with tracheal invasion extended from the left neck to the right atrium without distant metastases. The risk of sudden death due to airway occlusion, tumor embolism or obstruction of the tricuspid valve led us to elect surgery. Extended resection of thyroid cancer was performed with cardiopulmonary bypass. Peritoneal dissemination was found via laparotomy. A histologrical diagnosis of anaplastic carcinoma arising from transformation of papillary carcinoma was made. After the operation, bilateral ureteral occlusion by peritoneal dissemination and multiple lung metastases were detected. The patient died with acute renal failure on postoperative day 12. Intraatrial extension of thyroid cancer is rare, and only 12 cases have been reported in the literature. We present a case of thyroid cancer with intruatrial extension.

DOI： 10.18926/AMO/30734

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7
8
9
10
11