Living Donor Liver Transplantation with Small Left Lobe Grafts: Prospective Validation of Utility of Splenectomy in Selected Recipients

BACKGROUND: We previously reported that the Model for End-stage Liver Disease (MELD) score and donor age are risk factors for small-for-size syndrome in adult living donor liver transplantation (LDLT) involving small grafts. Since April 2021, we have performed splenectomy as a portal inflow modulation in LDLT using small grafts according to the presence of risk factors. In this study, we evaluated the validity of our splenectomy strategies for optimizing graft outcomes. MATERIAL AND METHODS: We retrospectively reviewed patients who underwent primary LDLT using left lobe grafts with the middle hepatic vein from January 2005 to January 2024 at our institution. We also compared the graft outcomes between recipients who underwent LDLT beginning in April 2021 (current policy group) and those who underwent LDLT in the era when splenectomy as portal modulation was not indicated (previous policy group). RESULTS: In total, 173 consecutive LDLTs (current policy group: n=15) involving left lobe grafts were analyzed. Splenectomy was performed in 9 of 15 (60.0%) patients in the current policy group. All 15 patients in the current policy group remained alive for a median follow-up of 20.5 months. The rate of early allograft dysfunction was significantly lower, and the rate of small-for-size syndrome tended to be lower in the current policy group than in the previous policy group (13.3% vs 39.2%, P=0.047 and 20.0% vs 36.1%, P=0.211, respectively). CONCLUSIONS: LDLT with splenectomy for high-risk patients may expand the availability of small left lobe grafts and optimize graft outcomes.Annals of transplantation, 30, art. no. e946374; 2025journal articl

Successful granulocyte-macrophage colony-stimulating factor inhalation therapy for recurrent autoimmune pulmonary alveolar proteinosis after lung transplantation: A case report

Sargramostim, a recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) inhalation therapy, was recently approved for pharmaceutical use in Japan and shows promise as a treatment for autoimmune pulmonary alveolar proteinosis (APAP). For APAP patients with severe respiratory failure due to advanced lung fibrosis, lung transplantation is also a treatment option; however, APAP may recur after the procedure. Here, we report a case of successful sargramostim inhalation therapy for post-transplant APAP relapse in a patient who underwent living lung transplantation owing to severe fibrosis. Inhaled GM-CSF may be a useful treatment option for APAP recurrence in patients who have undergone lung transplantation.Respiratory Investigation, 63(1), pp.180-182; 2025journal articl

離島における移住者特性とコミュニティ形成に関する研究 長崎県福江島と鹿児島県奄美大島を対象に

This study analyzed migration trends to isolated islands, focusing on Fukue Island in Nagasaki Prefecture and Amami Oshima in Kagoshima Prefecture. These islands were selected due to significant differences in migration trends between the past 3 years (2018-2020) and the preceding 12 years (2009-2020). Findings reveal that most migrants were single-person households, with over half deciding to relocate within a year. While both islands attract migrants with their rich natural environments, Amami Oshima emphasized connections with local residents, whereas Fukue Island valued ties among migrants as well. Despite comprehensive migration support systems, 64% of migrants on Fukue and 83% on Amami Oshima did not utilize these resources, particularly freelancers, teleworkers, and entrepreneurs. Factors influencing settlement intentions included pre-move residence, decision-making time, timing of relocation, community engagement, and housing acquisition timing. Community dynamics played a key role, with Amami fostering resident interactions and Fukue hosting active migrant networks supported by key facilitators.長崎大学大学院工学研究科研究報告, 55(104), pp.45-52; 2025departmental bulletin pape

住まいに対する今後の意向と空き家化の関係性に関する研究 ―長崎市を通して―

This paper clarifies the causes of the occurrence of vacant dwellings and problems in the process of inheritance and other home succession processes by ascertaining the state of determination of future housing intentions from a questionnaire survey targeting residents of residential areas in Nagasaki City. Although the mandatory inheritance registration that began in April this year has been acknowledged, it has not triggered people to think about their future plans for their dwellings, and many households are unable to inherit or dispose of their dwellings even if they wanted to, and have not thought about their plans. Although there has been a change in awareness of inheritance, the problem continues to remain because the inheritance mechanism has not changed. In rural areas, the problem is that heirs are difficult to assemble due to people moving out of the locality and that they cannot manage their inheritance even if they do inherit. Another major factor was found to be the low marketability of land and houses that are not tangentially connected to a road, as well as the low price of such land and houses. While it is easier to schedule a plot with a road access, in nature-friendly zones, the trend is that plots without a road access are more likely to be scheduled. It is thought that the less convenient and secure people feel in their current living situation, the more they feel threatened by inheritance and sale, and the more they take the initiative in making plans. Less than half of the households have thought about how to utilise their houses after inheritance, and it is thought that this kind of inheritance leads to a lack of management and is a factor in the occurrence of vacant houses.長崎大学大学院工学研究科研究報告, 55(104), pp.23-29; 2025departmental bulletin pape

Arterial Reconstruction Using the Right Gastroepiploic Artery in Living Donor Liver Transplantation: A Single-Center Experience

BACKGROUND: Recipient hepatic arteries are generally used for arterial reconstructions in living donor liver transplantation. When the hepatic arteries are not feasible, the right gastroepiploic artery is one of the options for arterial reconstructions. In this study, we evaluate the feasibility of using the right gastroepiploic artery and report the analyzed retrospective patient outcomes. MATERIAL AND METHODS: We included 324 patients who underwent primary living donor liver transplantation between August 1997 and December 2023. The rates of complications and surgical outcomes for different arteries used for reconstruction were compared between the groups. RESULTS: For primary arterial reconstruction, the right gastroepiploic artery was used in 18 patients. The incidence of arterial complications and biliary strictures was higher than in the remaining 306 patients (P=0.01 and P=0.21, respectively). The 1-year and 5-year graft survival rates were 83.3% and 77.8% in the right gastroepiploic artery group, and 83.7% and 70.1% in the hepatic artery group, respectively (P=0.58). Eleven patients underwent arterial re-reconstruction secondary to arterial complications. The right gastroepiploic artery was used for the first time in 7 of these patients because the hepatic arteries were not reusable. Arterial complications after arterial re-reconstruction occurred in 4 patients (36.4%). CONCLUSIONS: Arterial reconstruction using the right gastroepiploic artery was an effective option when the hepatic arteries were not suitable options, as it offered graft outcomes comparable to those of hepatic artery reconstruction, despite an increased risk of arterial and biliary complications.Annals of Transplantation, 30, art. no. e946135; 2025journal articl

災害公営住宅のコモンスペースと団地内活動がコミュニティ形成に与える影響 ―熊本地震の災害公営住宅を通して―

This study examines resident interactions and the role of community spaces in disaster housing seven years after the Kumamoto Earthquake. Disaster-related solitary deaths, particularly among elderly survivors in permanent housing, remain a critical issue. With limited support systems in place, social interactions are crucial for reducing isolation and preventing solitary deaths.The survey targeted 15 housing complexes in Kumamoto Prefecture, revealing that 67% of residents were elderly, mostly living alone. Many residents reported having no acquaintances when they moved in. While 33.8% of the complexes had community centers and 45.5% had plazas, the usage rates of these spaces were low. In community centers, 32% of residents reported never using them, though over 60% deemed them necessary, particularly for events. Housing complexes with integrated community centers had more frequent interactions compared to those with detached facilities.Similarly, while 53% of residents never used the plazas, over 60% considered them necessary. Plazas located along pedestrian routes fostered more interactions than those in isolated areas. Residents using community centers tended to have stronger social connections, especially when these centers were frequently used and well-integrated into the housing layout. Additionally, complexes with leaders elected voluntarily had higher levels of interaction compared to those with leaders chosen by a rotation system.The study underscores the importance of well-designed community spaces and regular events in facilitating interactions and preventing isolation. Future observational research will focus on particularly active complexes to further explore successful interaction strategies.長崎大学大学院工学研究科研究報告, 55(104), pp.59-64; 2025departmental bulletin pape

Recovery from inferior alveolar neurosensory changes after lower third molar extraction: A multicenter, retrospective study

Inferior alveolar (IA) neurosensory changes are complications that infrequently occur after third molar extraction. However, no adequate treatment has been established for IA neurosensory changes. The present study aimed to establish an effective treatment for IA neurosensory changes following lower third molar extraction. A total of 10,062 patients (12,776 teeth) who underwent lower third molar extractions were enrolled between April 2014 and June 2022. The medical records of the patients were reviewed, and relevant data were extracted. The prevalence of risk factors for recovery from IA neurosensory changes was analyzed. In total, 221 patients (224 teeth) developed IA neurosensory changes. Temporary and permanent IA neurosensory changes occurred in 1.75% and 0.71% of patients, respectively. The 1-, 3-, and 6-month cumulative recovery rates were 25.0%, 60.1%, and 71.1%, respectively. Univariate analysis revealed that age < 40 years (hazard ratio [HR], 2.02; P < .001), local anesthesia (HR, 1.45; P = .03), and postoperative administration of corticosteroids (HR, 1.63; P = .04) were significantly associated with high recovery rates. The cumulative recovery rate significantly improved with corticosteroid administration (P = .04). However, no significant differences were observed using the propensity score matching method. No significant differences were observed with or without vitamin B12 administration. These results suggest that postoperative administration of corticosteroids enables recovery from IA neurosensory changes after third molar extraction.Medicine, 104(1), art. no. e41227; 2025journal articl

運営状況からみる空き家活用団体の継続性に関する考察 （その２）

Japan’s vacant housing rate reached 13.8% in 2023, with numbers doubling since 1993. To tackle this issue, the Ministry of Land, Infrastructure, Transport, and Tourism launched programs like the Vacant House Regeneration Promotion Project. This study examines the sustainability of organizations utilizing vacant houses, focusing on leadership, financial management, and professional collaboration. Of 140 organizations analyzed, 46% remain active, with associations and foundations showing higher sustainability than NPOs due to their ability to train external resources. Leadership transitions occurred in 67% of organizations, but half lack a clear successor plan, with most leaders aged over 70.Financially, organizations rely heavily on subsidies, while business income plays a secondary role. However, long-term profitability awareness is low, as most prioritize short-term results. Collaboration with professionals, especially in construction, law, and finance, emerged as vital for sustainability. Key success factors include internal expertise, administrative support, and member lignment, while new member recruitment was underemphasized. To ensure sustainability, organizations must strengthen expertise, improve financial strategies, and plan for leadership succession. Enhanced support from local governments and a focus on professional partnerships can further stabilize operations and effectively address Japan’s growing vacant housing problem.長崎大学大学院工学研究科研究報告, 55(104), pp.53-58; 2025departmental bulletin pape

オープンガーデンを通した高齢者のコミュニティ形成に関する研究

In this paper, the purpose of this paper is to clarify the relationship between the holding of community activities called open gardens and the reduction of isolation among the elderly, using the Japan version of CCRC "Minagi no Mori" as the site of the open garden. In addition, we will identify the issues and consider the effects that the organizers feel of publishing the gardens managed by the group in the open garden pamphlet. Minagi no Mori was established as a Japanese version of CCRC, so there are many elderly residents, and a certain degree of community had been formed through club activities before the open garden was held. Through the open garden, there were cases where relationships were further deepened through talking about flowers, and many people expressed a desire for future events. The proportion of people who did not have relationships at various levels of intimacy has decreased, and the activities have been supported, expanding and deepening relationships. Therefore, we believe that open gardens are effective as one way for residents to interact with each other and prevent loneliness among the elderly. While there is room for improvement in the decrease in garden owners, incorporating gardens managed by groups has led to an increase in open garden participants and improved and revitalized local scenery. Therefore, we believe that introducing gardens managed by groups along with private gardens at open gardens will lead to revitalization of interactions within groups as well as with local residents.長崎大学大学院工学研究科研究報告, 55(104), pp.30-37; 2025departmental bulletin pape

Core Outcome Set development for LEPtospirosis trials (COS-LEP): a study protocol to develop a core outcome set for the evaluation of clinical therapeutic interventions for human leptospirosis

Background: Leptospirosis is a zoonotic bacterial infection occurring worldwide. It is of particular public health concern due to its global distribution, epidemic potential and high mortality without appropriate treatment. The method for the management of leptospirosis, particularly in severe disease, is clouded by methodological inconsistency and a lack of standardized outcome measures. The study this protocol details aims to develop a core outcome set (COS) for leptospirosis research. A COS is a set of outcomes with international consensus as a minimum for reporting in future studies focusing on leptospirosis. Establishing a COS will contribute to harmonizing Leptospirosis treatment research and will be instrumental in constructing a high-quality evidence base to feed into a planned future rigorous international clinical trial on leptospirosis. Methods: The COS-LEP study will employ a COS development methodology standardized by the COMET initiative framework. This includes (1) a systematic review of available quantitative and qualitative literature reporting therapeutic response and safety outcomes and measures; (2) focused interviews with healthcare professional and people treated for leptospirosis exploring outcomes of interests using qualitative methodology; (3) narrowing the choice of outcomes by international consensus using a Delphi survey process; and (4) undertaking a hybrid consensus meeting with key stakeholders to build the final COS. Discussion: This protocol describes the method to develop the first core outcome set for use in human leptospirosis studies. This will not only be a key feature in the design of a future definitive randomized controlled trial, but also provide a structure for clinicians and researchers collecting treatment cohort data in the various settings where leptospirosis is a public health issue.Trials, 26 (1), art. no. 6; 2025journal articl