Faculty Profiles - MIYOSHI Kentaroh

Validity of using lobe-specific regional lymph node stations to assist navigation during lymph node dissection in early stage non-small cell lung cancer patients. Reviewed

Shinichiro Miyoshi, Kazuhiko Shien, Shinichi Toyooka, Kentaroh Miyoshi, Hiromasa Yamamoto, Seiichiro Sugimoto, Junichi Soh, Makio Hayama, Masaomi Yamane, Takahiro Oto

Surgery today 44 ( 11 ) 2028 - 36 2014.11

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

PURPOSE: The validity of our proposed lobe-specific regional lymph node stations (LSRLNS) was evaluated as a method for navigation during lymphadenectomy in patients with early stage non-small cell lung cancer (NSCLC). METHODS: A total of 725 NSCLC patients with c-T2N1M0 or less extensive disease who had undergone a curative operation with complete mediastinal lymph node dissection (MLND) were studied. The LSRLNS were #2, #3, #4 and #10 for the right upper lobe, #11i, #11s, #7 and #8 for the right lower lobe, #4, #5 and #6 for the left superior division, #11, #5 and #7 for the left lingular division and #11, #7 and #8 for the left lower lobe. RESULTS: If the LSRLNS were used for pathological examinations during surgery, 599 p-N0 and 39 p-N1 patients diagnosed with no metastasis would have been subjected to a selective MLND, while 20 p-N1 and 65 p-N2 patients who had a diagnosis of metastasis would have been navigated to a complete MLND. Two p-N2 patients with a diagnosis of no metastasis would have inappropriately undergone a selective MLND, resulting in the false negative rate at 0.3 %. CONCLUSION: Intra-operative pathological examination using our LSRLNS may accurately reveal the status of metastasis, and appropriately lead to a selective or complete MLND in patients with c-T2N1M0 or less extensive disease.

DOI： 10.1007/s00595-013-0772-5

肺移植前後のリハビリテーションに関する諸問題肺移植患者の理学療法と当院での現状

萩山明和, 築山尚司, 福田智美, 岩井賢司, 三好健太郎, 杉本誠一郎, 大藤剛宏

日本移植学会総会プログラム抄録集 50回 272 - 272 2014.8

Detection of airway ischaemic damage after lung transplantation by using autofluorescence imaging bronchoscopy. Reviewed International journal

Norichika Iga, Takahiro Oto, Masanori Okada, Masaaki Harada, Hitoshi Nishikawa, Kentaroh Miyoshi, Shinji Otani, Seiichiro Sugimoto, Masaomi Yamane, Shinichi Toyooka, Shinichiro Miyoshi

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 45 ( 3 ) 509 - 13 2014.3

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS INC

OBJECTIVES: Airway complications related to ischaemia are a major cause of morbidity after lung transplantation. Early detection of airway ischaemia and optimal management of the anastomotic site could reduce the risk of airway complications. Autofluorescence imaging (AFI) bronchoscopy has been increasingly recognized as an effective technique for detecting abnormal mucosal thickening. The aim of this study was to investigate whether AFI bronchoscopy can facilitate the detection of airway ischaemic damage in lung transplant patients. METHODS: Twenty Landrace pigs were used to create a tracheal autotransplantation model. A four-ring length of trachea was excised and implanted orthotopically. The tracheal autograft was observed on postoperative days 0, 2, 4 and 7 with AFI bronchoscopy. The extent and origin of graft autofluorescence were examined using histology and measured according to fluorescence intensity. RESULTS: The lesions on the tracheal autografts appeared as bright green fluorescence on AFI bronchoscopy. On confocal fluorescence microscopy, high-intensity green fluorescence was observed in the elastin fibre layer of the submucosa. The fluorescence intensity of elastin was significantly higher in the graft showing fluorescence than the graft that did not show fluorescence and that at the control site. CONCLUSIONS: Bright green fluorescence was seen in an elastin fibre layer in the submucosa, which was likely a result of epithelial sloughing. There is a close relationship between the bright green fluorescence pattern observed using AFI bronchoscopy and airway ischaemic damage. We conclude that AFI bronchoscopy may detect airway ischaemic damage after lung transplantation.

DOI： 10.1093/ejcts/ezt437

[The role of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in liposarcoma of the chest wall]. Reviewed

Haruchika Yamamoto, Seiichiro Sugimoto, Kentaroh Miyoshi, Hiromasa Yamamoto, Junichi Soh, Masaomi Yamane, Shinichi Toyooka, Takahiro Oto, Shinichiro Miyoshi

Kyobu geka. The Japanese journal of thoracic surgery 67 ( 1 ) 4 - 8 2014.1

Language：Japanese Publishing type：Research paper (scientific journal)

18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT)imaging is valuable in biopsy guidance, response assessment, grading, follow-up and prognostication for soft-tissue sarcoma. In liposarcoma, the maximum standardized uptake value (SUVmax) on PET/CT scan is correlated with the histological subtypes. We briefly review the role of FDG PET/CT in liposarcoma, and describe a case of chest wall liposarcoma treated based on the assessment with PET/CT. A 76-year-old man, with a 10-cm tumor at the thoracic outlet of the right chest wall, underwent the complete resection of the tumor according to the assessment with PET/CT that showed high FDG uptakeonly in the central area of the tumor with SUVmax of 5.89, but low uptake in the peripheral area. In accordance with the PET/CT findings, pathological examination revealed dedifferentiated liposarcoma in the central area and well-differentiated liposarcoma in the peripheral area. Pretherapy PET/CT should be performed for the appropriate treatment of liposarcoma.

微小乳頭状肺腺癌におけるEGFR、K-ras、EML4-ALKの変異の様式(EGFR, K-ras and EML4-ALK mutational profile of lung adenocarcinomas with micropapillary component)

多数の具体的達成・評価項目票使用による診療参加型臨床実習の導入

山根正修, 杉本誠一郎, 宗淳一, 万代康弘, 三好健太郎, 山本寛斉, 豊岡伸一, 大藤剛宏, 三好新一郎

医学教育 44 ( Suppl. ) 110 - 110 2013.7

古川公之, 宗淳一, 豊岡伸一, 枝園和彦, 三好健太郎, 山本寛斉, 杉本誠一郎, 山根正修, 大藤剛宏, 三好新一郎

肺癌 52 ( 5 ) 671 - 671 2012.10

まれなEGFR変異を有する肺腺癌の1例

木村紘爾, 山根正修, 豊岡伸一, 古川公之, 難波圭, 三好健太郎, 山本寛斉, 宗淳一, 大藤剛宏, 三好新一郎

肺癌 52 ( 5 ) 650 - 650 2012.10

Intrathoracic irrigation with arbekacin for methicillin-resistant Staphylococcus aureus empyema following lung resection. Reviewed International journal

Tsuyoshi Ueno, Shinichi Toyooka, Junichi Soh, Kentaroh Miyoshi, Seiichiro Sugimoto, Masaomi Yamane, Takahiro Oto, Shinichiro Miyoshi

Interactive cardiovascular and thoracic surgery 15 ( 3 ) 437 - 41 2012.9

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS

OBJECTIVES: Empyema is a well-known complication following lung resection. In particular, empyema caused by methicillin-resistant Staphylococcus aureus (MRSA) is difficult to treat. Here, we present our experience of MRSA empyema treated with local irrigation using arbekacin. METHODS: Six patients consisted of 4 males and 2 females with an average age of 65.7 years. They developed MRSA empyema following lung resection and were treated at our institution between 2007 and 2011. Cases comprised four primary and one metastatic lung cancer, and 1 patient was a living lung transplantation donor. The surgical procedure consisted of four lobectomies, one segmentectomy and one wedge resection. After diagnosis of MRSA empyema, anti-MRSA drugs were administered intravenously in all cases. In addition, arbekacin irrigation at a dose of 100 mg dissolved in saline was performed after irrigation with saline only. RESULTS: The average number of postoperative days for the diagnosis of MRSA empyema was 13 (range 4-19). The period of irrigation ranged from 6 to 46 days. Arbekacin irrigation did not induce nephrotoxicity or other complications, and no bacteria resistant to arbekacin was detected in the thoracic cavity. We re-operated on 1 case because he had pulmonary fistula and severe wound infection. At the time of removing the thoracic catheter, MRSA in the pleural effusion disappeared completely in 3 patients. The period until MRSA concentration in the pleural effusion became negative after starting arbekacin irrigation ranged from 4 to 9 days. In the remaining cases, in which MRSA did not disappear, the catheter was removed because of no inflammatory reaction after stopping irrigation and clamping the catheters. All patients were discharged from our institution without thoracic catheterization and no patients had relapsed during the follow-up period ranging from 6 to 44 months. CONCLUSIONS: Irrigation of the thoracic cavity with arbekacin proved to be an effective, safe and readily available method for treating MRSA empyema following lung resection.

DOI： 10.1093/icvts/ivs285

血清中microRNA34b/cメチル化同定による悪性胸膜中皮腫高感度スクリーニング法

村岡孝幸, 宗淳一, 豊岡伸一, 枝園和彦, 古川公之, 牧佑歩, 上野剛, 山本寛斉, 青江啓介, 藤本伸一, 岸本卓巳, 大槻剛巳, 三好健太郎, 杉本誠一郎, 山根正修, 大藤剛宏, 三好新一郎

日本呼吸器外科学会雑誌 26 ( 3 ) RS06 - 03 2012.4

Elevation of antidonor immunoglobulin M levels precedes acute lung transplant rejection. Reviewed International journal

Kentaroh Miyoshi, Yoshifumi Sano, Masaomi Yamane, Shinichi Toyooka, Takahiro Oto, Shinichiro Miyoshi

The Annals of thoracic surgery 92 ( 4 ) 1233 - 8 2011.10

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

BACKGROUND: No useful noninvasive biomarker exists for diagnosing acute rejection after lung transplantation (LTx). In this study, antidonor T-cell antibodies were monitored daily in living-donor lobar LTx recipients to determine whether they are correlated with the onset of steroid-responsive typical acute rejection. METHODS: Ten nonsensitized patients who underwent bilateral living-donor lobar LTxs donated from 2 persons were analyzed. In 5 patients, unilateral acute rejection developed during the first 14 days after LTx and responded to subsequent pulse steroid therapies. The other patients experienced no rejection episodes during the period. Immunoreactivity against T cells from each lobe of the donors was monitored daily by detecting antidonor immunoglobulin (Ig) M and IgG using flow cytometry crossmatching for 14 days after LTx. RESULTS: There was a remarkable increase in IgM levels against rejected grafts around the onset of acute rejection, but this increase was not observed against nonrejected grafts. The mean IgM levels against rejected grafts 14 days after transplantation was significantly higher than that against nonrejected grafts in the acute rejection group (p = 0.009) and the no rejection group (p = 0.010). In the acute rejection group, the IgM level against rejected grafts became significantly higher than those against nonrejected grafts 2 days before the clinical onset of acute rejection. These trends were statistically marginal or not detected for IgG levels. CONCLUSIONS: Significant immunoreactivity of IgM, but not IgG, preceded the clinical onset of acute rejection. Antidonor IgM monitoring can contribute to the early detection of steroid-responsive acute rejection.

DOI： 10.1016/j.athoracsur.2011.04.090

Early effects of the ex vivo evaluation system on graft function after swine lung transplantation. Reviewed International journal

Shinji Otani, Takahiro Oto, Tomokazu Kakishita, Kentaroh Miyoshi, Shiro Hori, Masaomi Yamane, Shinichi Toyooka, Shinichiro Miyoshi

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 40 ( 4 ) 956 - 61 2011.10

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE BV

OBJECTIVES: Ex vivo lung evaluation (ex vivo) has been developed as a useful method by which to assess lungs from donation-after-cardiac death (DCD) donors prior to transplant. However, the safety of the ex vivo circulation itself with respect to grafts has not been fully investigated. The aim of this study is to evaluate the effects of the ex vivo circuit using a swine lung transplant model. METHODS: Lungs with or without 2-h warm ischemia were used. To assess post-transplant graft function, the left lung was transplanted after 2-h ex vivo or cold preservation; blood gas analysis of the left pulmonary vein (partial pressure of oxygen, PO(2)) was performed during the 6-h post-transplant follow-up period. Data were compared between the ex vivo (+) and ex vivo (-) groups. RESULTS: Partial pressure of oxygen/ inspired oxygen fraction (PO(2)/FiO(2)) in the ex vivo (-) group was significantly greater than that in the ex vivo (+) group until 3h after transplant. The PO(2)/FiO(2) levels in both groups then increased and became similar at 6 h after transplant, regardless of whether ischemic or non-ischemic lungs (p<0.001 and p=0.004, respectively) were used. CONCLUSIONS: Negative effects of the ex vivo system were limited and seen only in the immediate post-transplant period. Therefore, in DCD swine lung transplantation, the ex vivo system appears to be safe.

DOI： 10.1016/j.ejcts.2010.12.071

A novel technique for identification of the lung intersegmental plane using dye injection into the segmental pulmonary artery. Reviewed International journal

Seiichiro Sugimoto, Takahiro Oto, Kentaroh Miyoshi, Shinichiro Miyoshi

The Journal of thoracic and cardiovascular surgery 141 ( 5 ) 1325 - 7 2011.5

Effect of donor pre-mortem hypoxia and hypotension on graft function and start of warm ischemia in donation after cardiac death lung transplantation. Reviewed International journal

Kentaroh Miyoshi, Takahiro Oto, Shinji Otani, Shin Tanaka, Masaaki Harada, Tomokazu Kakishita, Shiro Hori, Naohisa Waki, Masaomi Yamane, Shinichiro Miyoshi

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 30 ( 4 ) 445 - 51 2011.4

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

BACKGROUND: The start of warm ischemic time (WIT) of donor lungs in donation after cardiac death (DCD) is not clearly defined. We investigated the effect of donor pre-mortem hypotension and hypoxia to determine which physiologic factor is the determinant of WIT onset in controlled DCD lung transplantation. METHODS: Twenty mechanically-ventilated donor pigs were placed in 4 groups (n = 5 each) and exposed to each of the pseudo-agonal conditions for 60 minutes: (1) control group, no intervention and optimum ventilation, followed by cardiac arrest; (2) hypotension (HT) group, controlled cardiac tamponade reducing systolic blood pressure to <50 mm Hg, followed by cardiac arrest; (3) hypoventilation (HV) group, ventilation with room air at 5 breaths/min, followed by cardiac arrest; (4) non-circulation (NC) group, initial cardiac arrest, followed by a 60-minute standoff time. The lung graft was retrieved and the left lung was transplanted to the recipient. Graft function was evaluated for 4 hours after contralateral pulmonary artery ligation. The reperfusion injury was evaluated based on tissue cytokine expression, wet weight-to-dry weight ratio, and histology at the end of the reperfusion period. RESULTS: Impaired post-transplant graft function was seen in the HV group, which had significantly poorer oxygenation during the reperfusion period than the other groups (p < 0.001). The HV group also had higher tissue levels of interleukin-8 (p < 0.05), a higher wet weight-to-dry weight ratio (p < 0.05), and histologic findings of graft tissue injury than the control group. The difference in these parameters among the control, HT, and NC groups was not significant. CONCLUSIONS: Only pre-mortem hypoxia provoked by hypoventilation significantly impaired lung graft function in DCD lung transplantation. Ventilatory rather than circulatory deterioration can trigger the onset of warm ischemia.

DOI： 10.1016/j.healun.2010.11.010

Suppression of inflammatory cytokines during ex vivo lung perfusion with an adsorbent membrane. Reviewed International journal

Tomokazu Kakishita, Takahiro Oto, Shiro Hori, Kentaroh Miyoshi, Shinji Otani, Sumiharu Yamamoto, Naohisa Waki, Osamu Yoshida, Mikio Okazaki, Masaomi Yamane, Shinichi Toyooka, Yoshifumi Sano, Shinichiro Miyoshi

The Annals of thoracic surgery 89 ( 6 ) 1773 - 9 2010.6

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

BACKGROUND: Lung grafts can be perfused ex vivo for 2 hours without edema formation; however, prolonged ex vivo lung perfusion (EVLP) eventually induces lung injury. This study evaluated the change in proinflammatory cytokines of the perfusate during EVLP and investigated the effect of cytokine removal using an adsorbent membrane. METHODS: Porcine heart-lung blocks were harvested after electrically induced cardiac arrest and underwent 12-hour EVLP with an adsorbent membrane (membrane group: n = 5) and without an adsorbent membrane (control group: n = 6). RESULTS: In the control group, both tumor necrosis factor-alpha and interleukin 8 levels were elevated in the perfusate 2 hours after perfusion. Although tumor necrosis factor-alpha and interleukin 8 levels were significantly lower in the membrane group than in the control group during the EVLP period, there was no significant difference in oxygenation, pulmonary vascular resistance, edema formation, or myeloperoxidase activity between the two groups. CONCLUSIONS: Tumor necrosis factor-alpha and interleukin 8 levels of the perfusate were elevated during EVLP. Although adverse effects of these inflammatory cytokines were anticipated, removal of inflammatory cytokines by the adsorbent membrane did not improve lung function during prolonged EVLP. Factors other than the cytokines may play a major role in causing lung injury during EVLP. Further research is needed to investigate the real mechanism of lung graft injury during prolonged EVLP and to establish longer EVLP duration for graft treatment. This strategy could contribute to the salvage of potentially damaged lungs, especially from cardiac death donors, and to expansion of the donor pool.

DOI： 10.1016/j.athoracsur.2010.02.077

肺移植後急性拒絶反応と抗ドナー特異的抗体価の推移急性拒絶発症を予見できるか

三好健太郎, 佐野由文, 岡崎幹生, 山根正修, 豊岡伸一, 大藤剛宏, 三好新一郎

日本呼吸器外科学会雑誌 24 ( 3 ) 416 - 416 2010.4

Extracorporeal membrane oxygenation bridging to living-donor lobar lung transplantation. Reviewed International journal

Kentaroh Miyoshi, Takahiro Oto, Mikio Okazaki, Masaomi Yamane, Shinichi Toyooka, Keiji Goto, Yoshifumi Sano, Shunji Sano, Shinichiro Miyoshi

The Annals of thoracic surgery 88 ( 5 ) e56-7 - E57 2009.11

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

A 21-year-old man with pulmonary fibrosis and a 27-year-old woman with idiopathic pulmonary hypertension, who were in pulmonary hypertensive crisis, were successfully treated by using venoarterial extracorporeal membrane oxygenation, followed by living-donor lobar lung transplantation. In both of the patients, bridging time of extracorporeal membrane oxygenation to lung transplantation was 2 days, and both could be weaned from cardiopulmonary support immediately after transplantation in the operating room. No major complications were seen, including primary graft dysfunction. The cardiopulmonary functions of these patients markedly improved after living-donor lobar lung transplantation.

DOI： 10.1016/j.athoracsur.2009.07.089