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

BACKGROUND: The significance of pulmonary artery (PA) diameter in patients with non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) who undergo pulmonary resection has not been elucidated. METHODS: Data of 357 patients with NSCLC and COPD who underwent pulmonary resection were retrospectively reviewed. The main PA diameter, determined by preoperative computed tomography, relative to the body surface area (PBR), was used as an index of PA dilatation, and patients were divided into 2 groups using median values. The relationship between the PBR and short- and long-term outcomes was also analyzed. RESULTS: The mean age was 70.8 years, and 82% of the patients were men. The median main PA diameter was 24 mm (range, 17-43 mm), and the median PBR was 14.5 (range, 10.4-28.6). Lobectomy or more was performed in 276 patients (78%) and sublobar resection in 81 patients (22%). The postoperative complication rates did not differ between the low- and high-PBR groups (33% vs 32%, P = .91). The relapse-free survival (RFS) and overall survival (OS) rates of the low-PBR group were significantly better than those of the high-PBR group (5-year RFS: 76% vs 59%, P = .0003; 5-year OS: 88% vs 72%, P = .0010). A multivariable analysis identified high PBR as a poor prognostic factor for both RFS and OS. CONCLUSIONS: PA dilatation was associated with poor long-term outcomes and was an independent poor prognostic factor for both RFS and OS in NSCLC patients with COPD who underwent pulmonary resection.

DOI： 10.1016/j.atssr.2024.03.001

PubMed

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

BACKGROUND: Information regarding late recurrence after pulmonary resection for non-small cell lung cancer (NSCLC) is limited. This study aimed to analyze the risk factors for late recurrence after surgery for NSCLC in the current era. PATIENTS AND METHODS: We conducted a retrospective study of patients who underwent complete resection for pathological I-III NSCLC between 2006 and 2015. Late recurrence was defined as a recurrence that met the following conditions: (1) the patient underwent chest computed tomography (CT) at or after 54 months after surgery and recurrence was not detected at that time, and (2) recurrence that occurred more than 5 years after surgery. The factors influencing late recurrence, relapse-free survival (RFS), and overall survival (OS) after surgery were analyzed. RESULTS: A total of 1275 with 5-year relapse-free survival after surgery were enrolled in this study. The mean age of the patients was 66.4 years and 54% of the patients were men. The median interval between surgery and the latest follow-up examination was 98 months. In total, 35 patients (2.7%) experienced late recurrence and 138 patients have died thus far. The cumulative recurrence, RFS, and OS rates at 10 years were 3.9%, 84.9%, and 86.3%, respectively. A multivariate analysis revealed that pleural invasion was an independent risk factor for late recurrence. Pleural invasion was a poor prognostic factor for both RFS and OS. CONCLUSIONS: Pleural invasion was a predictor of late recurrence. Age > 67 years, preoperative serum carcinoembryonic antigen (CEA) > 5 ng/ml, non-adenocarcinoma, and pleural invasion were poor prognostic factors for RFS.

DOI： 10.1245/s10434-024-15279-9

PubMed

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

PURPOSE: To report aging-associated change rates in circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and macular ganglion cell-inner plexiform layer and complex thickness (MGCIPLT, MGCCT) in normal Japanese eyes and to compare the data in linear scaled visual field (VF) sensitivity of central 4 points of Humphrey Field Analyzer (HFA) 24-2 test (VF4TestPoints) to that in MGCIPLT in four 0.6-mm-diameter circles corresponding to the four central points of HFA 24-2 adjusted for retinal ganglion cell displacement (GCIPLT4TestPoints). STUDY DESIGN: Prospective observational study METHODS: HFA 24-2 tests and spectral-domain optical coherence tomography (SD-OCT) measurements of cpRNFLT, MGCIPLT, MGCCT and GCIPLT4TestPoints were performed every 3 months for 3 years in 73 eyes of 37 healthy Japanese with mean age of 50.4 years. The time changes of SD-OCT-measured parameters and VF4TestPoints were analyzed using a linear mixed model. RESULTS: The aging-associated change rates were -0.064 μm/year for MGCIPLT and and -0.095 for MGCCT (P=0.020 and 0.017), but could not be detected for cpRNFLT. They accelerated with aging at -0.009μm/year/year of age for MGCIPLT (P<0.001), at 0.011 for MGCCT (P<0.001) and at 0.013 for cpRNFLT(0.031). The aging-associated decline of -82.1 [1/Lambert]/year of VF4TestPoints corresponded to -0.095 μm/year of GCIPLT4TestPoints. CONCLUSION: We report that aging-associated change rates of cpRNFLT, MGCIPLT and MGCCT in normal Japanese eyes were found to be significantly accelerated along with aging. Relationship between VF sensitivity decline rates and SD-OCT measured GCIPLT decline rates during physiological aging in the corresponding parafoveal retinal areas are also documented.

DOI： 10.1007/s10384-024-01049-3

PubMed

Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)   Publisher：大阪大学大学院医学系研究科保健学専攻  

目的:在宅で障がい者を介護する高齢の介護者に関わる生活介護事業所職員におけるアドバンスケアプランニング(ACP)の認知度とその関連要因を調査した。方法:2022年8～10月に無記名郵送で、生活介護事業所職員を対象として調査した。従属変数は、ACPの認知の有無、独立変数は管理者か否か、年齢、性別、資格、ACP教育・研修の有無等とした。単変量解析でP<0.05の有意差であった12変数に対して、ロジスティック回帰分析を行った。結果:調査票を486事業所1,500名の対象者に配布し、69事業所141名から回収(回答率9.4%)した。職員全体で12.1%、施設管理者が16.1%、資格別では、介護福祉士13.6%、社会福祉士17.9%、精神保健福祉士38.5%、看護師20.0%がACPを認知していた。認知度の関連要因は「精神保健福祉士の資格」(OR7.8)「親亡き後の不安を把握」(OR14.9)等であった。結論:先行研究では、ACP認知度は7%で、本研究で、やや改善していたが、まだ低い状態であり、啓発が必要である。ACPを知っている職員は、管理職・医療・福祉の有資格者で、高齢の介護者に寄り添い、親亡き後の不安を把握していた。今後は、高齢の介護者支援でACPを活用する必要がある。(著者抄録)

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

BACKGROUND: One life event that requires extensive resilience and adaptation is parenting. However, resilience and perceived support in child-rearing vary, making the real-world situation unclear, even with postpartum checkups. OBJECTIVE: This study aimed to explore the psychosocial status of mothers during the child-rearing period from newborn to toddler, with a classifier based on data on the resilience and adaptation characteristics of mothers with newborns. METHODS: A web-based cross-sectional survey was conducted. Mothers with newborns aged approximately 1 month (newborn cohort) were analyzed to construct an explainable machine learning classifier to stratify parenting-related resilience and adaptation characteristics and identify vulnerable populations. Explainable k-means clustering was used because of its high explanatory power and applicability. The classifier was applied to mothers with infants aged 2 months to 1 year (infant cohort) and mothers with toddlers aged >1 year to 2 years (toddler cohort). Psychosocial status, including depressed mood assessed by the Edinburgh Postnatal Depression Scale (EPDS), bonding assessed by the Postpartum Bonding Questionnaire (PBQ), and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) between the classified groups, was compared. RESULTS: A total of 1559 participants completed the survey. They were split into 3 cohorts, comprising populations of various characteristics, including parenting difficulties and psychosocial measures. The classifier, which stratified participants into 5 groups, was generated from the self-reported scores of resilience and adaptation in the newborn cohort (n=310). The classifier identified that the group with the greatest difficulties in resilience and adaptation to a child's temperament and perceived support had higher incidences of problems with depressed mood (relative prevalence [RP] 5.87, 95% CI 2.77-12.45), bonding (RP 5.38, 95% CI 2.53-11.45), and sleep quality (RP 1.70, 95% CI 1.20-2.40) compared to the group with no difficulties in perceived support. In the infant cohort (n=619) and toddler cohort (n=461), the stratified group with the greatest difficulties had higher incidences of problems with depressed mood (RP 9.05, 95% CI 4.36-18.80 and RP 4.63, 95% CI 2.38-9.02, respectively), bonding (RP 1.63, 95% CI 1.29-2.06 and RP 3.19, 95% CI 2.03-5.01, respectively), and sleep quality (RP 8.09, 95% CI 4.62-16.37 and RP 1.72, 95% CI 1.23-2.42, respectively) compared to the group with no difficulties. CONCLUSIONS: The classifier, based on a combination of resilience and adaptation to the child's temperament and perceived support, was able identify psychosocial vulnerable groups in the newborn cohort, the start-up stage of childcare. Psychosocially vulnerable groups were also identified in qualitatively different infant and toddler cohorts, depending on their classifier. The vulnerable group identified in the infant cohort showed particularly high RP for depressed mood and poor sleep quality.

DOI： 10.2196/47372

PubMed

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

OBJECTIVES: Prolonged air leak (PAL) is a common complication of lung resection. Research on predictors of PAL using a digital drainage system (DDS) remains insufficient. In this study, we investigated the predictive factors of PAL to establish a novel early postoperative prediction model for PAL. METHODS: A retrospective cohort study and validation study were conducted. We examined patients who underwent lung resection with DDS at our institute. The relationship between the clinical factors and measurements of the DDS, including the difference between the set and measured intrapleural pressure (named: additional negative pressure [ANP]) at postoperative hour (POH) 3, with PAL was analyzed. RESULTS: A total of 494 patients were enrolled, 29 of whom had PAL. Percent forced expiratory volume in 1 s <60%, ANP <1 cmH2O, air leak flow >20 mL/min and pleural adhesion findings at surgery were independent predictors of PAL according to a multivariable analysis. The PAL rate was clearly stratified according to our novel risk scoring system, which simply notes the presence of the above four factors, that is, the rate increases when the score increases. The area under the curve (AUC) of the receiver operating characteristic (ROC) analysis for this scoring system was 0.818. Analysis of the validation cohort (n = 133) revealed that this scoring system showed a sufficient ability to predict PAL. CONCLUSIONS: ANP at POH 3 is an independent predictor of PAL. Thus, the risk-scoring system proposed in this study is useful for predicting PAL in the early postoperative period.

DOI： 10.1002/wjs.12007

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science (PLoS)  

Background

The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40–74 years with treated and untreated type 2 diabetes.

Methods and results

This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40–74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR &gt;85 mL/min/1.73 m² or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40–59 and 60–74 years) and baseline eGFR levels (60–85, 30–59, and &lt;30 mL/min/1.73 m²). Covariates included sex, a history of heart disease, a history of stroke, a history of renal failure, anemia, low-density lipoprotein, systolic blood pressure, hemoglobin A1C, body mass index, antidiabetic medications, antihypertension drugs, lipid-lowering drugs, the oral adsorbent Kremezin, non-steroidal anti-inflammatory drugs, and drugs for the treatment of renal anemia. A rapid decline in eGFR was detected in approximately 1.3% of participants (7,683 cases). In the baseline eGFR &gt;30 subgroups (60–85 or 30–59 mL/min/1.73 m²), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60–74 age group and non-refreshing sleep in the 40–59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60–74 age group regardless of baseline eGFR levels. In the baseline eGFR &lt;30 mL/min/1.73 m² subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR.

Conclusions

We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease.

DOI： 10.1371/journal.pone.0295235

PubMed

Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/cas.15893

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

BACKGROUND: This study aimed to examine the effect of the HMGB1 peptide on Bronchopulmonary dysplasia (BPD)-related lung injury in a mouse model. RESULTS: HMGB1 peptide ameliorates lung injury by suppressing the release of inflammatory cytokines and decreasing soluble collagen levels in the lungs. Single-cell RNA sequencing showed that the peptide suppressed the hyperoxia-induced inflammatory signature in macrophages and the fibrotic signature in fibroblasts. These changes in the transcriptome were confirmed using protein assays. CONCLUSION: Systemic administration of HMGB1 peptide exerts anti-inflammatory and anti-fibrotic effects in a mouse model of BPD. This study provides a foundation for the development of new and effective therapies for BPD.

DOI： 10.1016/j.bbrc.2023.06.032

PubMed

Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

We aimed to clarify the differences in causes of death among patients with breast cancer according to age at diagnosis and years elapsed since diagnosis. Using data from the Osaka Cancer Registry and Vital Statistics databases, 40,690 female patients diagnosed with primary breast cancer between 1985 and 2006 were included in this study. The statistics on all deaths between 1985 to 2016 were collected, and the observation period was 10 years (2006–2016). Mortality hazards according to age at diagnosis and years elapsed since diagnosis were estimated using a flexible parametric estimation. Of the 40,690 patients, 13,676 (34%) died from all-cause death, and the 10-year survival rate was 65.74% (95% confidence interval: 65.28–66.21). The proportions of deaths were 10,531 (77%) from breast cancer, 1048 (8%) from other cancers, and 2097 (15%) from non-cancer causes. The mortality hazard for deaths from breast cancer was initially high and then declined, whereas that for deaths from other cancers and non-cancer causes was initially low and then increased. The more likely causes of death 5 years after breast cancer diagnosis were other cancers or non-cancer causes among patients aged ≥70 years.

DOI： 10.3390/healthcare11101409

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

This systematic review and meta-analysis aimed to review the optimal timing of delivery at term for neonates with prenatally diagnosed congenital diaphragmatic hernia (CDH). We reviewed the literature up to December 19, 2022 using MEDLINE and the Cochrane Library databases. The inclusion criteria were original articles, comparative studies of CDH neonates delivered at an early term (37-38 weeks of gestation) and at full term (39 weeks of gestation or later), and comparative studies investigating outcomes of CDH neonates. Six studies met the inclusion criteria, including 985 neonates delivered at an early term and 629 delivered at full term. The cumulative rate of survival to discharge showed no significant difference between CDH neonates delivered at an early term (395/515; 76.7%) or at full term (345/467; 73.9%) (risk ratio [RR] 1.01; 95% confidence interval [CI], 0.89-1.16; p = 0.85). Furthermore, the number of neonates requiring oxygen therapy at discharge was not significantly different between CDH neonates delivered at an early term (32/370; 8.6%) and at full term (14/154; 9.1%) (RR, 0.99; 95% CI, 0.36-2.70; p = 0.99). Therefore, the optimal timing of delivery at term for neonates with CDH remains unclear.

DOI： 10.1002/pd.6365

PubMed

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

OBJECTIVES: Colorectal cancer (CRC) is one of the major life-threatening complications in patients with Crohn's disease (CD). Previous studies of CD-associated CRC have involved only small numbers of patients, and no large series have been reported from Asia. The aim of this study was to clarify the prognosis and clinicopathological features of CD-CRC compared to sporadic CRC. METHODS: A large nationwide database was used to identify patients with CD-CRC (n=233) and sporadic CRC (n=129,783) over a 40-year period, from 1980 to 2020. Five-year overall survival (OS), recurrence-free survival (RFS), and clinicopathological characteristics were investigated. The prognosis of CD-CRC was further evaluated in groups divided by colon cancer (CC) and anorectal cancer (RC). Multivariable Cox regression analysis was used to adjust for confounding by unbalanced covariables. RESULTS: Compared to sporadic cases, patients with CD-CRC were younger; more often had RC, multiple lesions, and mucinous adenocarcinoma; and had lower R0 resection rates. Five-year OS was worse for CD-CRC than for sporadic CRC (53.99% vs. 71.17%, P<0.001). Multivariable Cox regression analysis revealed that CD was associated with significantly poorer survival (HR 2.36, 95% CI: 1.54-3.62, P<0.0001). Evaluation by tumor location showed significantly worse 5-year OS and RFS of CD-RC compared to sporadic RC. Recurrence was identified in 39.57% of CD-RC cases and was mostly local. CONCLUSION: Poor prognosis of CD-CRC is attributable primarily to RC and high local recurrence. Local control is indispensable to improving prognosis.

DOI： 10.14309/ajg.0000000000002269

PubMed

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

AIMS/INTRODUCTION: We aimed to clarify the effectiveness of the Diabetic Nephropathy Aggravation Prevention Program in Japan by comparing the diabetes-related medical visit behavior of individuals under the municipal national health insurance according to insurers' effort levels. MATERIALS AND METHODS: We assessed changes in medical visit behavior according to insurers' effort levels, "Full Efforts," "Some Efforts" and "No Effort," using longitudinal data from the National Database of Health Insurance Claims and Specific Health Checkups before 2015 and after 2018 regarding the national health insurance programs in Japan. We analyzed the effect of the Diabetic Nephropathy Aggravation Prevention Program using a generalized linear mixed model for 208,388 participants with diabetes. RESULTS: The additive effect on medical visit behavior was significantly higher for insurers with "Full Efforts" than for those with "No Effort;" the coefficient (log odds ratio) was 0.159 (95% confidence interval 0.063-0.256). The additive effects on medical visit behavior sizes for the people with hemoglobin A1c ≥7.0%, positive urinary protein and systolic blood pressure ≥140 mmHg were 0.508, 0.402 and 0.232, respectively, which were larger than the overall effect size (0.159) for insurers with "Full Efforts." CONCLUSIONS: Our findings showed that insurer efforts had an additive effect on the increase in the number of medical visits, suggesting that this national program could reduce the number of end-stage renal failures or dialysis in Japan.

DOI： 10.1111/jdi.14006

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JMIR Publications Inc.  

DOI： 10.2196/47372

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Survival information for Japanese patients with cancer is based only on survival status and the cause of death among these patients remains unclear. In this study, Osaka Cancer Registry data (1985–2014) and vital statistics data (1985–2016) were linked to create a database, permitting the extraction of data on the causes of death. In total, 522,566 subjects diagnosed with cancer between 1995 and 2011 were analyzed. Follow-up for vital status was conducted 5 and 10 years after cancer diagnosis. To evaluate the three causes of death (index cancer, non-index cancer, and non-cancer death), cause-specific hazard and cumulative incidence functions were estimated using a life table and Gray’s methods. The number of deaths owing to any of the causes in the observation period (median: 3.51 years, mean: 4.90 years) was 394,146. The 5- and 10-year cancer-specific survival rate was 48.56% and 39.92%, respectively. Immediately after cancer onset, the hazard of index cancer death was high. The proportion of non-index cancer deaths was high in patients with mouth and pharynx cancers. The hazard of index cancer death remained constant for breast and liver cancers. In prostate, breast, and laryngeal cancers with good prognosis, the hazard of non-index cancer and non-cancer death constantly increased.

DOI： 10.3390/healthcare11060835

PubMed

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

This retrospective study investigated the 3-year impact of the Great East Japan Earthquake (GEJE) of 2011 on deaths due to neoplasm, heart disease, stroke, pneumonia, and senility among older adults in the primarily affected prefectures compared with other prefectures, previous investigations having been more limited as regards mortality causes and geographic areas. Using death certificates issued between 2006 and 2015 (n = 7,383,253), mortality rates (MRs) and risk ratios (RRs) were calculated using a linear mixed model with the log-transformed MR as the response variable. The model included interactions between the area category and each year of death from 2010 to 2013. The RRs in the interaction significantly increased to 1.13, 1.17, and 1.28 for deaths due to stroke, pneumonia, and senility, respectively, in Miyagi Prefecture in 2011, but did not significantly increase for any of the other areas affected by the GEJE. Moreover, increased RRs were not reported for any of the other years. The risk of death increased in 2011; however, this was only significant for single-year impact. In 2013, decreased RRs of pneumonia in the Miyagi and Iwate prefectures and of senility in Fukushima Prefecture were observed. Overall, we did not find evidence of strong associations between the GEJE and mortality.

DOI： 10.3390/ijerph20065058

PubMed

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

The increasing number of patients undergoing dialysis due to diabetes mellitus (DM) is causing serious economic problems, and its reduction is an urgent policy issue in developed countries, including Japan. We aimed to assess the association between the annual rapid decline in renal function and health checkup measures, including blood pressure, to identify health guidance targets for preventing diabetic nephropathy (DN) and diabetic kidney disease (DKD) among individuals in a medical checkup system ("Tokuteikenshin" program) in 2018. This longitudinal analysis included 3,673,829 individuals who participated in the "Tokuteikenshin" program in 2018, had hemoglobin A1c (HbA1c) levels ≥5.6%, were available for follow-up, and underwent estimated glomerular filtration rate (eGFR) evaluation. We estimated the incidence of the relative annual decrease in eGFR ≥10% per 1000 person-years and odds ratios to evaluate the rapid decline in renal function and determine health guidance goals and their role in preventing DN and DKD. Overall, 20.83% of patients with DM had a rapid decline in renal function within the observation period. A rapid decline in renal function was associated with high systolic blood pressure, poor or strict DM control, increased urinary protein excretion, and decreased blood hemoglobin levels. The incidence of rapid decline in renal function is higher in DM, and appropriate systolic blood pressure and glycemic control are important to prevent the progression to DN or DKD. Our findings will be useful for researchers, clinicians, and other public health care members in establishing effective health guidance and guidelines for CKD prevention.

DOI： 10.1038/s41440-023-01185-2

PubMed

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

AIM: Impacts of platelet counts at the time of liver biopsy on hepatocellular carcinoma (HCC) development in patients with nonalcoholic fatty liver disease (NAFLD) remain unknown. The aim of this study was to investigate the prognostic value of platelet counts in patients with biopsy-confirmed NAFLD using data from a multicenter study. METHODS: 1398 patients were included in this sub-analysis of the CLIONE (Clinical Outcome Nonalcoholic Fatty Liver Disease) in Asia study. Liver biopsy specimens were pathologically diagnosed, and histologically scored using the NASH Clinical Research Network system. Demographic, clinical, laboratory, and pathological data were collected. RESULTS: During a median follow-up period of 4.6 years (range, 0.3-21.6 years), which corresponds to 8,874 person-years, 37 patients developed HCC. Using a cutoff baseline platelet count of 192×109 /L, the lower platelet group had a higher HCC rate than the higher platelet group (6.7% vs. 0.4%; P<0.001). This cutoff value significantly stratified the event-free rate for HCC. Lower platelet counts were associated with an increased risk of HCC development. Relative to patients with platelet counts of 192×109 /L, patients with platelet counts of 100×109 /L had an unadjusted hazard ratio (HR) for HCC development of 7.37 (95% confidence interval [CI], 3.81-14.2) and an adjusted HR of 11.2 (95% CI, 3.81-32.7; P<0.001), adjusting for age, sex, and advanced fibrosis (Stage 3-4). CONCLUSIONS: Baseline platelet counts less than 192×109 /L and lower are associated with a higher risk of developing HCC in patients with biopsy-confirmed NAFLD and require active surveillance. This article is protected by copyright. All rights reserved.

DOI： 10.1111/hepr.13884

PubMed

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

We aimed to evaluate the response to definitive radiotherapy (RT) for cervical cancer based on histological subtypes and investigate prognostic factors in adenocarcinoma (AC). Of the 396 patients treated with definitive RT between January, 2010 and July, 2020, 327 patients met the inclusion criteria, including 275 with squamous cell carcinoma (SCC) and 52 with AC restaged based on the 2018 International Federation of Gynecology and Obstetrics staging system. Patient characteristics, response to RT, and prognoses of SCC and AC were evaluated. The complete response (CR) rates were 92.4% and 53.8% for SCC and AC, respectively (p &lt; 0.05). Three-year overall survival and progression-free survival (PFS) rates of SCC were significantly higher than those of AC (88.6% vs. 74.1%, p &lt; 0.05 and 76.3% vs. 59.3%, p &lt; 0.05, respectively). Among the AC population, univariate and multivariate analyses were performed to examine prognostic factors associated with non-complete response (CR). In the multivariate analysis, gastric-type adenocarcinoma (GAS) was associated with non-CR in AC (adjusted odds ratio, 12.2; 95% confidence interval 1.0-145.6; p &lt; 0.05). The 3-year PFS rate in patients with GAS was significantly lower than that in patients with other histological types of AC (44.4% vs. 66.7%, p &lt; 0.05). Definitive RT for cervical cancer was significantly less effective for AC than for SCC. GAS was the only independent prognostic factor associated with non-CR in AC.

DOI： 10.3390/cancers15010170

PubMed

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

BACKGROUND: Some cancer survivors develop second primary cancers. However, differences in prognosis between patients who have and have not had prior cancer have not been established. We examined and compared the prognoses of such patients. METHODS: Using the record-linked database of the population-based Cancer Registry of Osaka Prefecture and Vital Statistics in Japan, we identified patients aged ≥ 40 years who were diagnosed with stomach (n = 70,946), colorectal (n = 60,582), or lung (n = 58,016) cancers during 1995-2009. We defined these cancers as index cancers. Patients were classified into three groups according to history of prior cancer and interval between diagnosis of index and prior cancer: single (no prior cancer or interval of ≥10 years), synchronous (interval ≤3 months), and metachronous (interval 3 months to 10 years). The 5-year prognosis from index cancer diagnosis was investigated using the Kaplan-Meier method and log-rank test. RESULTS: 5-year prognoses of patients with synchronous stomach and colorectal cancers were significantly worse than that of patients with single primary, about 60 % of these patients' deaths being attributable to the prior cancer. In contrast, 5-year prognoses of patients with metachronous primaries were not significantly worse, except for men with colorectal cancer. The percentages of index cancer deaths were 1.7-4.3 times those for non-index cancer deaths. CONCLUSION: A prior cancer contributed to an inferior prognosis in patients with synchronous stomach and colorectal cancers. The prognoses of patients with metachronous primaries were more affected by the index than by the prior cancer, whereas most of them had similar or better prognoses than did patients with a single primary. This finding would help to relieve cancer survivors' anxiety about their development and prognosis of metachronous second primary cancer.

DOI： 10.1016/j.canep.2022.102218

PubMed

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

PURPOSE: This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). METHODS: A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. RESULTS: A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65-30.89], 11.14 (95% CI 5.19-23.89), and 10.28 (95% CI 3.38-31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. CONCLUSIONS: This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.

DOI： 10.1007/s00383-022-05232-w

PubMed

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

Objectives: Weight loss improves the liver pathophysiological status of nonalcoholic fatty liver disease (NAFLD) patients. However, there are few studies that investigate the accurate relationships between nutritional intake and disease progression in NAFLD patients. Methods: A total of 37 biopsy-confirmed NAFLD patients were enrolled in this study. Clinical and nutritional control data of 5074 persons were obtained from the National Institute of Health and Nutrition. Each NAFLD subject recorded dietary intake for seven consecutive days using a dietary questionnaire and photographs of each meal. A dietitian analyzed and quantified the nutritional data in each patient. We further analyzed the nutritional intake of NAFLD patients in three groups according to the following criteria: (1) liver fibrosis degree (advanced, early), (2) gender (male, female), and (3) body mass index (BMI) (high, low). Results: Excesses or deficiencies of multiple nutrients were found in NAFLD patients compared with control subjects. In addition, there were variations in nutritional intake. (1) The intake of vitamins A, B6, and E, pantothenic acid, soluble dietary fiber, and salt was lower in the advanced fibrosis group than in the early fibrosis group. (2) Fat intake was higher in male patients, and dietary fiber intake was lower in both male and female patients compared with control subjects. (3) Saturated fatty acid intake was higher, and copper and vitamin E intakes were lower in patients with high BMI than with low BMI. Conclusions: Our study demonstrates that differences were found in some nutrient intake of NAFLD patients and controls and according to the severity of the conditions (liver fibrosis degree, BMI).

DOI： 10.3390/nu14173453

PubMed

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

The frequency-doubling technology (FDT) screening test (FDT-C-20-1) has adopted in many recent population-based glaucoma surveys, but factors associated with false-positive (FP) responses to FDT-C-20-1 in normal eyes and false-negative (FN) responses in glaucoma eyes were not known. These factors were investigated in a population-based setting using the data from 3805 normal eyes (2381 subjects) and 272 eyes with definite glaucoma (215 subjects) in the Kumejima Study participants with reliable FDT-C-20-1 results. Considering the presence of at least one abnormal test point (P < 0.01) as abnormal, the specificity and sensitivity of FDT-C-20-1 for glaucoma were 91.8% (95% confidence interval, 91.1 ~ 92.5) and 56.3% (47.0 ~ 62.5), respectively. Multivariate linear mixed-model logistic regression analysis showed correlations with older age, worse visual acuity, greater β-peripapillary area (P < 0.001 for all comparisons) and more myopic refraction (P = 0.030) with the FP responses in normal eyes, and normal-tension glaucoma (P = 0.043), a better mean deviation value of Humphrey perimetry (P = 0.001), larger rim area (P = 0.041), and absence of disc hemorrhage (P = 0.015) with the FN responses in glaucoma eyes. In a population-based setting, abnormal responses to FDT-C-20-1 indicate the presence of a risk factor for glaucoma in normal eyes and risk factors for more rapid progression in glaucoma eyes.

DOI： 10.1038/s41598-022-15891-3

PubMed

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

PURPOSE: In the 5th edition of the World Health Organization classification, appendiceal goblet cell adenocarcinoma (GCA) is categorized separately from neuroendocrine tumors and other appendiceal adenocarcinomas. We clarified the clinicopathological characteristics of Japanese appendiceal GCA. METHODS: We designed a retrospective multicenter cohort study and retrieved the data of patients with appendiceal neoplasms and histologically diagnosed appendiceal goblet cell carcinoid (GCC) treated from January 2000 to December 2017 in Japan. The available GCC slides were reviewed and diagnosed with a new grading system of GCA. RESULTS: A total of 922 patients from 43 institutions were enrolled; of these, 32 cases were patients with GCC (3.5%), and 20 cases were ultimately analyzed. The 5-year survival rate was 61.4% (95% confidence interval: 27.4-83.2), and the median survival time was 93.1 months. For peritoneal metastasis, regional lymph node metastasis was a significant factor (p = 0.04), and Grade 3 was a potential factor (p = 0.07). No peritoneal metastasis was observed in either T1/2 patients (n = 2) or Grade 1 patients (n = 4). We were unable to detect any significant factors associated with regional lymph node metastasis. CONCLUSION: For peritoneal metastasis, regional lymph node metastasis was a significant factor, and Grade 3 was a potential factor.

DOI： 10.1007/s00595-022-02562-z

PubMed

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

PURPOSE: To evaluate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol and quantify the impact of each ERAS item on postoperative outcomes. METHODS: We used a generalized linear model to compare 289 colorectal cancer patients treated with the ERAS protocol between June, 2015 and April, 2021, with 99 colorectal cancer patients treated with the conventional colorectal surgery pathway between April, 2014 and June, 2015. RESULTS: The median length of hospital stay (LOHS) was significantly shorter in the ERAS group, at 9 days (range 3-104 days) vs. 14 days (range 4-44 days) (p < 0.001), but the complication rates (Clavien-Dindo grade 2 or more) were similar (16.6% vs. 22.2%; p = 0.227). However, in the ERAS group, the higher the compliance with ERAS items, the lower the complication rate and LOHS (both p < 0.001). Multiple regression analysis demonstrated that "Discontinuation of continuous intravenous infusion on POD1" and "Avoidance of fluid overload" were significantly associated with the LOHS (p < 0.001 and p = 0.008). CONCLUSION: The ERAS protocol is safe and effective for elective colorectal cancer surgery, and compliance with the ERAS protocol contributes to shorter LOHS and fewer complications. Items related to perioperative fluid management had a crucial impact on these outcomes.

DOI： 10.1007/s00595-022-02568-7

PubMed

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

BACKGROUND: Previous randomized trials have assessed the effectiveness of triclosan-coated sutures in fascia closure after midline laparotomy in preventing surgical site infections (SSIs); however, available evidence remain inconclusive. We aimed to evaluate the effectiveness of triclosan-coated sutures in abdominal fascia closure to prevent postoperative SSIs. STUDY DESIGN: This study was a multicenter prospective trial conducted within 24 Japanese secondary and tertiary care centers and a propensity score (PS)-matched analysis. Patients 20 years of age or older who underwent elective surgery for colorectal cancer (CRC) were included. Between July 2016 and July 2019, 2,207 patients were prospectively enrolled into the triclosan-coated sutures or uncoated sutures groups. The per-protocol population comprised 2,195 patients. The PS matching was performed for 1,579 patients: 926 patients in the coated group and 653 patients in the uncoated group. The abdominal fascia after midline laparotomy was closed with triclosan-coated or uncoated sutures depending on group. The primary endpoint was the incidence of an SSI. Secondary endpoints were length of hospital stay and surgical complication rates. RESULTS: The recorded SSI rates were 4.2% in the triclosan-coated group and 6.74% in the uncoated suture group (p = 0.028). There were no serious adverse events in the groups. The final logistic regression model showed that several variables affected the occurrence of SSI. Our meta-analysis included six phase-III trials, and our study evaluated 4,797 patients. The results show a significant superiority of triclosan-coated sutures over uncoated suture material. CONCLUSION: Triclosan-coated sutures reduce the incidence of SSI after elective CRC surgery.

DOI： 10.1097/XCS.0000000000000167

PubMed

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

OBJECTIVES: The surgical Apgar score (SAS) is a simple score that predicts postoperative complications based on three intraoperative valuables. The present study evaluated the association between the SAS and postoperative outcomes in non-small-cell lung cancer (NSCLC) patients who underwent surgery. METHODS: A total of 585 patients who underwent lung resection were enrolled in the present study. We calculated the SAS of each patient and investigated its influence on the short- and long-term outcomes. RESULTS: Postoperative complications of any grade were detected in 164 cases (28%). The morbidity rate increased with decreasing SAS. When all the patients were divided into 2 groups (SAS <7 vs ≥ 7), postoperative complications were observed more frequently in the SAS <7 than in the SAS ≥7 group (41% vs 25%, P < 0.001). In the multivariate analysis, the SAS was an independent risk factor for postoperative complications (odds ratio: 1.64 [1.03-2.61], P = 0.036). In terms of long-term outcomes, the 5-year disease-free survival 54.1% vs 73.2%, P < 0.001) and overall survival (73.8% vs 83.0%, P = 0.031) were significantly worse in the SAS <7 group than in the SAS ≥7 group. In a multivariate analysis, however, the SAS was not found to be an independent prognostic factor for either disease-free survival (hazard ratio: 1.39 [0.97-2.00], P = 0.075) or overall survival (hazard ratio: 0.90 [0.57-1.42], P = 0.642). CONCLUSIONS: The SAS reflected preoperative and intraoperative characteristics and was able to stratify the morbidity rate, suggesting it to be a useful predictor of short-term outcomes in NSCLC patients who undergo surgery. CLINICAL REGISTRATION NUMBER: The study protocol was approved by the Ethics Review Board for Clinical Studies at Osaka University (control number 18237).

DOI： 10.1093/icvts/ivac150

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPANDIDOS PUBL LTD  

Postoperative carcinoembryonic antigen (post-CEA) has recently been reported to be a reliable prognostic factor for colon cancer. However, most clinicians decide whether or not to conduct adjuvant chemotherapy (AC) for stage II colon cancer according to major guidelines, which do not include post-CEA in their high-risk criteria. The present study aimed to assess post-CEA in stage II colon cancer for which the significance of AC is unknown. The present study analyzed 199 consecutive patients with stage II colon cancer who underwent curative surgery between January 2007 and December 2016. The CEA value was considered high when it was >= 5.0 ng/ml. The prognostic value of high post-CEA values was assessed. Overall, 19 patients exhibited high post-CEA levels. Kaplan-Meier survival curve analysis demonstrated that patients with high post-CEA levels had significantly worse relapse-free survival (RFS) and overall survival (OS) than those with normal post-CEA [RFS, 63.5 (high post-CEA) vs. 88.0% (normal post-CEA), P=0.003; OS, 76.5 (high post-CEA) vs. 96.8% (normal post-CEA), P<0.001]. Multivariate analysis demonstrated that high post-CEA remained a significant independent risk factor for worse RFS [hazard ratio (HR), 3.98; P=0.006]. The same was also demonstrated for patients without AC (HR, 5.43; P=0.008). To the best of our knowledge, the present study was the first to demonstrate that high post-CEA levels may be an indicator of high-risk stage II colon cancer, even for patients without AC. These results highlight the need for a multicenter prospective study.

DOI： 10.3892/ol.2022.13287

Web of Science

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

PURPOSE: Due to its rarity and biological heterogeneity, guidelines for primary appendiceal tumor (PAT) are based on scarce evidence, resulting in no strong recommendations. The present study explored prognosis-related factors, including the timing of lymph node dissection (LND), in PAT patients after curative resection (CR) to determine the optimal surgical therapies. METHODS: We retrospectively collected and analyzed data from 404 patients with PATs who underwent CR at 43 tertiary hospitals from 2000 to 2017. This manuscript is based on revised manuscript during review process. Please, change the bold characters to normal characters in the manuscript. RESULTS: After propensity score matching, there were no marked differences in the recurrence-free survival (RFS) or overall survival (OS) between the primary and secondary LND groups (P = 0.993 and 0.728). A multivariate analysis showed that lymph node metastasis (LNM) was an independent factor for the RFS (hazard ratio [HR] 2.59; 95% confidence interval [CI] 1.09-6.13; P = 0.031) and OS (HR 4.70; 95% CI 1.40-15.76; P = 0.012). There were significant associations between the LNM rates and tumor depth (P < 0.0001) and the histological type (P = 0.006). There was no LNM in patients with low-grade appendiceal mucinous neoplasm (LAMN) or well-differentiated mucinous adenocarcinoma (G1) or patients with any Tis or T1 PATs. CONCLUSIONS: LNM was an independent prognostic predictor in PATs after CR with LND. Tumor depth and histological type were not prognostic predictors but were LNM predictors. Secondary LND based on the pathological findings of resected specimens is considered an acceptable surgical management without a worse prognosis than primary LND, and it may be omitted in LAMN+G1 or in any Tis and T1 PATs.

DOI： 10.1007/s11605-021-05070-6

PubMed

Language：Japanese   Publisher：(公社)日本看護科学学会  

目的:術後尿道カテーテルを留置している患者の膀胱内尿量を連続測定し尿流出状況の実態を明らかにする.方法:泌尿器・消化器・内分泌手術後に尿道カテーテルを留置している患者を対象に,手術後から翌朝まで膀胱用超音波画像診断装置を装着し,膀胱内尿量を1分毎に連続測定した.なお膀胱内尿量100ml以上を「尿流出停滞」と定義した.結果:患者23名中16名を分析対象とした.そのうち「尿流出停滞」を認めた患者は7名(43.8%)であった.膀胱内尿量最高値は中央値(四分位範囲)78(51,143)mlで,範囲は34～193mlであった.尿流出停滞を認めた患者7名の尿流出停滞時間は中央値(四分位範囲)24(2,48)分で,範囲は2～61分であった.結論:術後尿道カテーテル留置中患者の半数近く(43.8%)に一時的な尿流出停滞を認め,停滞時の最高膀胱内尿量は193mlであった.(著者抄録)

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

BACKGROUND: Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. METHODS: We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥40 mm was performed. RESULTS: We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter <40 mm, and two of them progressed to complex cysts during follow-up; however, when the diameter was limited to <35 mm, no cases showed progression to complex cyst. Fifteen of the simple cysts were ≥40 mm; three progressed to complex cysts, and two of them were confirmed to be ovarian necrosis. In four patients who underwent IUA, the ovaries could be preserved. CONCLUSIONS: IUA is a promising therapy for preserving ovaries with simple cysts ≥40 mm in diameter; however, the indications for fetal surgery and the appropriate timing of intervention require further study.

DOI： 10.3390/diagnostics11122224

PubMed

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

Aim: Early detection of surgical site infection (SSI) allows for appropriate management after Crohn's disease (CD) surgery. The aim of this study was to evaluate the usefulness of bacterial culture of postoperative drainage fluid after CD surgery. Methods: This study included 110 patients with CD who underwent surgery with bowel resection between January 2010 and March 2020 at Osaka University Hospital. Patients with only perianal surgery or incomplete records were excluded. Risk factors for SSI were evaluated in the context of clinical findings, including bacterial culture of postoperative drainage fluid, and bacterial species related to SSI were also examined. Results: Of 110 patients, 18 (16.4%) developed SSI. Organ/space SSI developed in six, and a positive bacterial culture of drainage fluid (D-Posi) was found in five (83.3%). Of 104 patients without organ/space SSI, 31 (29.8%) were D-Posi (P = .027). Similarly, 68.8% with incisional SSI were D-Posi, whereas 26.6% without incisional SSI were D-Posi (P = .0021). Multivariate analysis revealed that D-Posi was an independent risk factor in both organ/space and incisional SSI. Bacterial examination showed that Pseudomonas aeruginosa and Enterococcus faecalis were significantly detected in patients with SSI. Conclusion: This study suggests the usefulness of postoperative drainage fluid bacterial culture for early diagnosis of SSI after CD surgery.

DOI： 10.1002/ags3.12530

PubMed

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ags3.12530

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

Background and Aim In Japan, the actual number of stoma constructions and stoma closures is not known. The aim of this study was to conduct a survey to determine the number of gastrointestinal stoma constructions and closures in Japan. Methods Enrolled participants comprised patients undergoing selected gastrointestinal surgeries who were recorded in the National Clinical Database. This database uses the "Common Items for Gastrointestinal Surgeons." These procedures were formulated by the Japanese Society of Gastroenterological Surgery during 2013-2018. Results According to the National Clinical Database, a total of 154,323 gastrointestinal stomas were constructed between January 1, 2013 and December 31, 2018. By procedure, there were 78,723 cases of stoma construction, 39,653 of abdominoperineal resection, 2470 total pelvic exenteration procedures, and 33,572 Hartmann's procedures. The ratio of stoma closures to stoma constructions increased annually in patients under 70 y of age but not in older patients. Approximately 35% of total colectomies, 60% of proctocolectomies, and 20% of low anterior resections were accompanied by stoma construction. The number of patients with rectal cancer who underwent colostomy increased gradually during the study period and the number who underwent stoma construction increased among older patients. Conclusion The number of cases of gastrointestinal stoma construction has increased gradually in Japan, and the proportion of older patients is increasing each year. The purposes and surgical techniques for stoma construction are diverse and are expected to increase in Japan, a super-aged society.

DOI： 10.1002/ags3.12521

Web of Science

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ags3.12521

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

OBJECTIVE: To evaluate the optimal timing of neonates with prenatally diagnosed congenital diaphragmatic hernia (CDH). METHODS: Data from a retrospective cohort study conducted by the Japanese CDH Study Group between 2011 and 2018 were divided into two groups according to delivery timing: 36-37 and 38-41 weeks of gestation (wg). Death before 90 days as the primary outcome and the duration of hospitalization, oxygen therapy and tube feeding at discharge as the secondary outcomes were analyzed with generalized linear model applying inverse probability of treatment weighting method. We also performed layered analysis according to stomach position. RESULT: Among 493 neonates with prenatally diagnosed, isolated and left CDH, 237 were born at 38-41wg. The duration of hospitalization was significantly shorter in those born at 38-41wg, especially among those with stomach malposition, and the other outcomes showed no difference. CONCLUSIONS: Delivery at 38-41wg could be beneficial for those with high grade stomach position.

DOI： 10.1038/s41372-021-01118-2

PubMed

Other Link： https://www.nature.com/articles/s41372-021-01118-2

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

BACKGROUND: It is highly controversial whether a lymphadenectomy for treating distant lymph nodes, such as the para-aortic lymph node, provides clinical benefit in colorectal cancer (CRC). This study aimed to investigate the benefit of a lymphadenectomy for para-aortic lymph node metastasis (PALM) in CRC, by evaluating the extent of dissection. METHODS: This retrospective cohort study included 28 consecutive patients with pathologically positive PALMs in CRC that underwent lymphadenectomies from October 2001 to March 2018 at our institute. We analyzed the rates of 3-year recurrence-free survival (RFS), postoperative complications, and peri-operative death. We examined RFS in two groups with different operation types. One group received radical resections (radical group), defined as a systematic dissection of para-aortic lymph nodes, which removed the area under the renal vein and above the aortic bifurcation. The other group (targeted group) received targeted dissections, which removed specific swollen para-aortic lymph nodes. RESULTS: The radical group had a significantly better RFS than the targeted group. In addition, females had significantly better RFS prognoses than males. Univariate and multivariate Cox regression analyses identified two clinical factors significantly associated with RFS: sex (P = 0.0100) and surgical procedure (P = 0.0033). Postoperative complications after PALM resections occurred in 35.7% of patients. There was no postoperative mortality. CONCLUSION: Our study suggested that a radical lymphadenectomy for treating PALMs in CRC could be performed safely and could prolong the RFS. More studies are necessary to strengthen the evidence in support of this conclusion.

DOI： 10.1007/s00384-021-03961-3

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：(一社)ITヘルスケア学会  

背景:音声認識システムの開発が進んでおり、音声認識を看護記録システムに導入することで記録業務の効率化が期待されている。臨床研究では記録システムとしてのユーザビリティや話し言葉の識別精度の検討が始められている。音声認識技術を看護記録作成に活用をする場合、話し言葉と書き言葉の違いがボトルネックとなる可能性がある。そこで、本研究では外回り看護師の発話と看護記録で用いられる用語の対応関係を調査した。方法:3件の婦人科腹腔鏡手術から、看護師の口述と看護記録のデータを取得し、形態素解析を行った。形態素の内容の比較は名詞に着目して行い、看護記録から収集された名詞の形態素をカテゴリーとサブカテゴリーに分類し、各カテゴリーに対応する口述の形態素を抽出し比較を行った。結果・考察:口述と看護記録のデータそれぞれから9,220件と552件の形態素が分析のため抽出され、そのうち2,370件と450件は名詞の形態素であった。看護記録の名詞の形態素のうち26.2%は口述から同一の形態素が抽出され、63.2%は口述では同じ意味・内容を示す別の用語に言い換えが行われていた。また、看護記録の形態素のうち10.5%は、口述には含まれていなかった。本研究では、多くの口述と記録の用語に対応関係を認めており、看護師の口述から看護記録作成を行うためのキーワードの抽出を行える可能性が示唆された。しかし、口述と記録で用いられる用語の差異を認めることから、記録の音声認識支援を行うためには、口述と記録の用語の関連付けを充実させる必要があると考えられる。(著者抄録)

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI  

In recent years, the use of information and communication technology (ICT) has meant that learning is no longer limited to the school. In order to achieve Sustainable Development Goal (SDG) goal 4, that is, to ensure quality education for all, to make educational resources and online learning are indispensable, and to access these resources anytime, anywhere through the Internet. In addition, the global pandemic of COVID-19 has made online education more necessary than ever before. Where and how ICT is used may have an impact on the components of motivation, such as self-efficacy and persistence. In this study, we quantified the impact of ICT utilization on the two components of self-efficacy and persistence. The effects of ICT use on both components were analyzed from the data taken from the 2018 Program for International Student Assessment (PISA) administered to 15-year old students. The results revealed that students who frequently utilized ICT for the purpose of out-of-school learning, particularly for activities related to school projects, exhibited significantly higher levels of self-efficacy and persistence. The frequency of ICT usage for in-school learning revealed no effect on any of the two above components. In addition, utilization of ICT for recreational purposes outside of school showed significantly lower values in the area of persistence. These results indicate that it is important to set tasks that provide a continuum of ICT use, both in and out of school, in order to motivate learners. This has important implications for the design of learning in online education. Furthermore, it suggests that teachers should design exploratory type lessons that focus on strengthening students' desire to learn outside of class.

DOI： 10.3390/su13116463

Web of Science

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

PURPOSE: To study how mild-to-moderate myopia and aging affect visual field sensitivity (VF-S) in normal eyes correcting for effects of each. DESIGN: Combined cross-sectional and cohort study. METHODS: Two normal groups, cross-sectional group (n=703; 1,051 eyes; mean age, 52.6 years) and longitudinal group (n=44; 83 eyes; mean age, 52.3 years; follow-up, 4.2 years; VF tests, 12) were included. In the cross-sectional group, the mean VF-S of the entire field and three disc portion-oriented subfields of the Humphrey Field Analyzer 24-2 program were correlated with subjects' age, axial length (AL), disc, rim and β-peripapillary area and disc ovality and torsion, using linear mixed-regression models. Their time changes in the longitudinal group were correlated with time, subjects' age and AL using linear mixed-regression models. RESULTS: In the cross-sectional group, the VF-S correlated negatively with age (-0.081 decibel [dB]/year (P<0.001), which was more negative (P=0.020) in the midperipheral than central subfield, and with AL (P=0.049) without inter-subfield differences. In the longitudinal group, no changes in the ocular media were significant and the VF-S declined by 0.074 dB/year (P=0.007), which accelerated with higher age (P<0.002) and baseline VF-S (P<0.001) without inter-subfield differences. The AL showed little effects on the VF-S longitudinal changes. CONCLUSION: In normal eyes with mild-to-moderate myopia, the VF-S was lower subfield-independently with longer AL, while the AL had little effects on the aging-associated VF-S reduction. The VF-S decreased with aging with inter-subfield differences. The aging-associated VF-S reduction accelerated with higher age, to which the ocular media changes were unrelated.

DOI： 10.1016/j.ajo.2021.04.027

PubMed

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

OBJECTIVES: With improvements in the outcome of treatment for non-small-cell lung cancer (NSCLC), other diseases may account for a high death rate after surgery in patients with stage I NSCLC. In the present study, we analysed the associations between the clinical factors and non-cancer death after surgery in these patients. METHODS: The records of 514 patients with stage I NSCLC who underwent surgery were retrospectively reviewed; a proportional hazards model for the subdistribution of a competing risk was conducted to define the risk factors for non-cancer death. RESULTS: The mean patient age was 67 years. A total of 367 patients (71%) underwent bilobectomy or lobectomy while 147 (29%) underwent sublobar resection. The pathological stage was IA in 386 (75%) and IB in 128 (25%) patients. Three patients (0.6%) died within 90 days after surgery, and 108 (21%) experienced postoperative complications. Until the time of writing this report, 83 patients had died during the follow-up. The cause of death was primary lung cancer in 38 (46%) patients and other diseases in 45 (54%) patients, including non-cancer causes in 29 patients, such as pneumonia, cardiac death and cerebral stroke. According to a multivariable competing risk analysis for non-cancer death age (≥70 years), sex (male), body mass index (BMI <18.5), postoperative complications and % forced expiratory volume in 1 s (<80) were identified as risk factors for postoperative non-cancer death. CONCLUSIONS: Advanced age (≥70 years), male sex, low BMI (<18.5), postoperative complications and low preoperative % forced expiratory volume in 1 s (<80) were found to be the risk factors for postoperative non-cancer death after surgery in patients with stage I NSCLC.

DOI： 10.1093/ejcts/ezaa333

PubMed

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

INTRODUCTION: Recently, "low-grade appendiceal mucinous neoplasms" (LAMNs) have been proposed as one subtype of appendiceal mucinous neoplasms, characterized by a villous or flat proliferation of mucinous epithelium with low-grade cytologic atypia. The aim of this study was to clarify the clinicopathological characteristics of LAMN. METHODS: In this multi-institutional cohort study, we retrospectively analyzed the clinicopathological characteristics in appendiceal neoplasms patients who underwent treatment from 2000 to 2017. RESULTS: In total, 922 patients were enrolled, with 279 (30.3%) cases of LAMN, and 93 (10.1%) cases of non-LAMN disease. In comparison with patients with non-LAMN disease, those with LAMN had significantly lower levels of CA19-9 (p = 0.045), a lower frequency of T4 tumors (p < 0.0001), a lower frequency of lymph node metastasis (p < 0.0001), and a lower frequency of distant metastasis (p < 0.0001). Survival analysis revealed that patients with LAMN had a significantly better prognosis than did those with non-LAMN disease (p < 0.001). Among the patients with distant metastasis, those with LAMN had a significantly better prognosis than did those with non-LAMN disease (p = 0.0020), but among the patients without distant metastasis, the difference between the 2 groups was not significant (p = 0.26). However, among patients who underwent complete resection, the difference in prognosis between the 2 groups was not significant (p = 0.10). CONCLUSIONS: A multicenter retrospective study revealed that the clinicopathological characteristics of LAMN was different from those of non-LAMN.

DOI： 10.1159/000513973

PubMed

Language：Japanese   Publisher：Japanese Society for Palliative Medicine  

<p>Purpose: This study aimed to implement an end-of-life care simulation that was assessed at one facility (University A) on nursing university students in a different educational environment (University B), and assess the simulation through a review. Method: After the simulation, participants were asked to freely comment on the review sheet and the contents were analyzed. There were 12 participants. Results: Comments on the review sheet were summarized in 13 categories: self-understanding of nursing, realization of one's positive view regarding nursing, acquisition of knowledge regarding communication, acquisition of knowledge regarding end-of-life, gaining learning opportunities, realization of effects from debriefing, positive change one experiences regarding nursing, acquisition of knowledge regarding nursing, realization of reality, assessment of teachers' involvement, assessment of implementation method, assessment of the atmosphere of the venue, and assessment of experiences. Conclusion: Participants of the simulation can be expected to gain a similar learning experience regardless of the learning environment.</p>

DOI： 10.2512/jspm.16.59

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

This study aimed to determine the association between umbilical cord leucine-rich alpha-2 glycoprotein (LRG) and fetal infection and investigate the underlying mechanism of LRG elevation in fetuses. We retrospectively reviewed the medical records of patients who delivered at Osaka University Hospital between 2012 and 2017 and selected those with histologically confirmed chorioamnionitis (CAM), which is a common pregnancy complication that may cause neonatal infection. The participants were divided into two groups: CAM with fetal infection (CAM-f[+] group, n = 14) and CAM without fetal infection (CAM-f[-] group, n = 31). Fetal infection was defined by the histological evidence of funisitis. We also selected 50 cases without clinical signs of CAM to serve as the control. LRG concentrations in sera obtained from the umbilical cord were unaffected by gestational age at delivery, neonatal birth weight, nor the presence of noninfectious obstetric complications (all, p > 0.05). Meanwhile, the LRG levels (median, Interquartile range [IQR]) were significantly higher in the CAM-f(+) group (10.37 [5.21-13.7] μg/ml) than in the CAM-f(-) (3.61 [2.71-4.65] μg/ml) or control group (3.39 [2.81-3.93] μg/ml; p < 0.01). The area under the receiver operating characteristic (ROC) curve of LRG for recognizing fetal infection was 0.92 (optimal cutoff, 5.08 μg/ml; sensitivity, 86%; specificity, 88%). In a mouse CAM model established by lipopolysaccharide administration, the fetal LRG protein in sera and LRG mRNA in the liver were significantly higher than those in phosphate-buffered saline (PBS)-administered control mice (p < 0.01). In vitro experiments using a fetal liver-derived cell line (WRL68) showed that the expression of LRG mRNA was significantly increased after interleukin (IL)-6, IL-1β, and tumor necrosis factor- alpha (TNF-α) stimulation (p < 0.01); the induction was considerably stronger following IL-6 and TNF-α stimulation (p < 0.01). In conclusion, LRG is an effective biomarker of fetal infection, and fetal hepatocytes stimulated with inflammatory cytokines may be the primary source of LRG production in utero.

DOI： 10.1371/journal.pone.0242076

PubMed

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

BACKGROUND: Appendiceal tumor has recently been treated differently from colorectal cancer. However, obtaining knowledge of this disease is difficult because of its rareness. OBJECTIVE: This study aimed to investigate the clinicopathological characteristics of appendiceal tumors in a Japanese cohort. DESIGN: This was a nationwide multi-institution retrospective observational study. SETTING: This study was conducted at the participating tertiary referral hospitals. PATIENTS: Patients with appendiceal tumor who were diagnosed between 2000 and 2017 were included. MAIN OUTCOME MEASURES: The primary outcome measured was the total survivability. RESULTS: A total of 922 patients from the 43 facilities that participated were identified. Of these, 114 patients were diagnosed with cancer other than adenocarcinomas. The remaining 760 patients, with the exception of 48 patients with unknown survival data, were eligible for the final cohort analysis. Of these 760 patients, 515 (67.8%) had mucinous adenocarcinomas and 245 (32.2%) had nonmucinous adenocarcinomas. Within the mucinous adenocarcinoma group, 267 patients (35.1%) were diagnosed as having low-grade appendiceal mucinous neoplasm. The 5-year survival rate of mucinous adenocarcinoma (83.1%) was superior to that of nonmucinous adenocarcinoma (62.0%; p < 0.01). Regarding mucinous adenocarcinoma, multivariate analysis revealed that high differentiation grade (American Joint Committee on Cancer grade 2/3), distant metastases, and R2 operation were significantly associated with a higher 5-year mortality rate. The 5-year survival rate was significantly better for low-grade appendiceal mucinous neoplasms (93.3%) than for other mucinous adenocarcinomas (72.1%; p < 0.01). LIMITATIONS: This study was limited by its retrospective study design. CONCLUSIONS: We cumulatively investigated appendiceal tumors in a multicenter retrospective study; this is the first such report from Asia. Grouping the grades as per the American Joint Committee on Cancer was useful as a prognostic indicator of appendiceal mucinous adenocarcinomas, including low-grade appendiceal mucinous neoplasm. See Video Abstract at http://links.lww.com/DCR/B282. ANÁLISIS DE LAS CARACTERÍSTICAS CLINICOPATOLÓGICAS DE LOS TUMORES APENDICULARES EN JAPÓN: UN ESTUDIO CLÍNICO RETROSPECTIVO COLABORATIVO MULTICÉNTRICO: UNA ENCUESTA NACIONAL JAPONESA: El tumor apendicular recientemente se ha tratado de manera diferente al cáncer colorrectal. Sin embargo, obtener conocimiento de esta enfermedad es difícil debido a su rareza.Este estudio tuvo como objetivo investigar las características clinicopatológicas de los tumores apendiculares en una cohorte Japonesa.Este fue un estudio observacional retrospectivo de múltiples instituciones a nivel nacional.Este estudio se realizó en los hospitales de referencia terciarios participantes.se incluyeron pacientes con tumor apendicular que fueron diagnosticados entre el 2000 y 2017.El resultado primario medido fue la supervivencia total.Se identificaron un total de 922 pacientes de las 43 instalaciones que participaron. De estos, 114 pacientes fueron diagnosticados con cáncer distinto de adenocarcinomas. Los 760 pacientes restantes, excepto 48 pacientes con datos de supervivencia desconocidos, fueron elegibles para el análisis de cohorte final. De estos 760 pacientes, 515 (67,8%) tenían adenocarcinomas mucinosos y 245 (32,2%) tenían adenocarcinomas no mucinosos. Dentro del grupo de adenocarcinoma mucinoso, 267 pacientes (35,1%) fueron diagnosticados con neoplasia mucínica apendicular de bajo grado (LAMN). La tasa de supervivencia a 5 años del adenocarcinoma mucinoso (83.1%) fue superior a la del adenocarcinoma no mucinoso (62,0%) (p <0,01). Con respecto al adenocarcinoma mucinoso, el análisis multivariado reveló que el alto grado de diferenciación (Comité Estadounidense Conjunto sobre el Cáncer grado 2/3), las metástasis a distancia y la operación R2 se asociaron significativamente con una mayor tasa de mortalidad a 5 años. La tasa de supervivencia a 5 años fue significativamente mejor para las neoplasias mucinosas apendiculares de bajo grado (93.3%) que para otros adenocarcinomas mucinosos (72,1%) (p <0,01).Este estudio fue limitado por su diseño de estudio retrospectivo.Investigamos acumulativamente los tumores apendiculares en un estudio retrospectivo multicéntrico y este es el primer informe de este tipo de Asia. Agrupar los grados según el Comité Estadounidense Conjunto sobre el Cáncer fue útil como indicador pronóstico de los adenocarcinomas mucinosos apendiculares, incluida la neoplasia mucínica apendicular de bajo grado. Consulte Video Resumen en http://links.lww.com/DCR/B282. (Traducción-Dr. Yesenia Rojas-Khalil).

DOI： 10.1097/DCR.0000000000001676

PubMed

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

BACKGROUND: The feasibility of laparoscopic surgery for primary appendiceal tumors compared to that of open surgery has not been demonstrated to date because primary appendiceal tumors are rare. This study aimed to compare the long-term outcomes between laparoscopic and open surgeries for primary appendiceal tumors. METHODS: In this multicenter retrospective cohort study, the data of patients who had been histologically diagnosed with primary appendiceal tumors at 43 tertiary hospitals in Japan between 2000 and 2017 were analyzed. In total, 922 patients were assessed, and 679 cases were eligible for analysis. Using propensity scores, the baseline characteristics were matched for 114 open surgery cases and 114 laparoscopic surgery cases. The primary endpoints were recurrence-free survival (excluding patients with stage IV disease with distant metastasis) and overall survival. RESULTS: The rate of conversion from laparoscopic to open surgery was 1.5%. The 5-year recurrence-free survival rates were 80.4% (95% confidence interval: 71.0-89.7) and 78.2% (95% confidence interval: 69.0-87.3) in the laparoscopic and open surgery groups, respectively, with no significant difference (p = 0.57). No significant difference was observed in the 5-year overall survival rates between the laparoscopic [83.5% (95% confidence interval: 74.4-92.7)] and open surgery [72.7% (95% confidence interval: 62.3-83.0); p = 0.09] groups. In multivariate analysis, laparoscopic surgery was not identified as an independent prognostic factor for overall survival [hazard ratio: 0.49 (95% confidence interval: 0.23-1.06), p = 0.0707]. CONCLUSIONS: Laparoscopic surgery is comparable to open surgery and can be considered a treatment option for primary appendiceal tumors.

DOI： 10.1007/s00464-020-08046-w

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

© 2020, The Author(s). Objectives: This study investigated the relationship between oral high-risk HPV (HR HPV) infection and sexual behavior in Japanese medical professionals. Materials and methods: We collected oral specimens and a self–administered questionnaire from 234 men and 171 women. Results: The oral HR HPV infection prevalence was 4.7% (95% confidence interval [CI]: 3.0–7.2]) overall, 7.3% (95% CI: 4.6–11.3) for men, and 1.2% (95% CI: 0.3–4.2) for women. The number of sex partners had a significant influence on this prevalence, with variation by type of sexual behavior. The prevalence of oral HR HPV infection was significantly higher (p < 0.0001) among those with more than 20 lifetime overall sex partners (23.8%, 95% CI: 13.5–38.5) or oral sex partners (25.0%, 95% CI: 14.2–40.2). In terms of the number of vaginal sex partners, the prevalence was approximately the same for those with 6–10 (8.3%, 95% CI: 3.9–17.0), 11–20 (11.1%, 95% CI: 5.2–22.2), or more than 20 (11.5%, 95% CI: 4.0–29.0) partners (p = 0.0043). Furthermore, dividing the number of vaginal and oral sex partners into four categories (both>5, only vaginal>5, only oral>5, and both≤5), the infection prevalence was significantly higher when both vaginal and oral sex partners were more than five (12.5%, 95% CI: 7.7–19.6). The prevalence was also higher for those who had more oral than vaginal partners, compared with other groups (13.5%, 95% CI: 6.7–25.3). Conclusions and clinical relevance: Oral HR HPV infection in Japan seems to be influenced by sexual behavior, and preventive health efforts such as vaccination and health education should be implemented.

DOI： 10.1007/s10389-020-01337-5

Scopus

Other Link： http://link.springer.com/article/10.1007/s10389-020-01337-5/fulltext.html

Language：Japanese   Publisher：(NPO)日本緩和医療学会  

【目的】終末期ケアシミュレーションへの参加がレジリエンスに与える影響を評価した.【方法】参加学生61名を無作為に2群に割り付け,教育群に終末期ケアシミュレーションを実施した.ベースラインと教育終了後時点の両群のレジリエンスを測定した.【結果】ベースラインは両群に有意な差はなかったが,教育終了後時点は総合得点,I am・I have・I will/do因子得点が対照群よりも教育群で有意に高かった.教育群では総合得点,I am・I have・I will/do因子得点が,対照群ではI am因子得点のみがベースラインよりも教育終了後時点で有意に高かった.【結論】終末期ケアシミュレーションへの参加が,レジリエンス,とくに他者との信頼関係を築きネットワークを広げる力,自分自身で目標を定めそれに向かって伸びていく力を高める.(著者抄録)

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

© 2020 Objectives: Human papillomavirus (HPV) infection drives carcinogenesis in the oropharynx. No standard sampling or HPV detection methods for evaluating oropharyngeal HPV infection exist. The prevalence of oral HPV infection in Japan is unknown. Materials and methods: We examined 435 healthy Japanese individuals to address whether adding tonsillar washing to oral gargling would improve HPV detection. We compared HPV assessment using GENOSEARCH HPV31 versus nested PCR and direct sequencing. Associations between HPV infection and demographic and behavioral characteristics were examined. Results: Most participants who were HPV-positive based on oral gargles were also HPV-positive based on tonsillar washings: 11 (64.7%) of 17 on nested PCR and 12 (70.6%) of 17 on GENOSEARCH HPV31. Although HPV infection was more prevalent in oral gargles followed by tonsillar washings than in oral gargles alone, the difference was not statistically significant (nested PCR, 4.8% vs. 3.9%, P = 0.46; GENOSEARCH HPV31, 5.3% vs. 3.9%, P = 0.33). The overall agreement between nested PCR and GENOSEARCH HPV31 was 98.6%, with 76.0% positive agreement. The overall prevalence of oral HPV infection in Japan was 5.7% (95% confidence interval, 3.9–8.3%). Men had a significantly higher prevalence of oral HPV infection than women (8.3% vs. 2.6%, P = 0.02). Infection increased with number of lifetime sexual partners (P < 0.001 for trend). Conclusion: The oropharynx is probably the major source of HPV-infected cells in oral gargles. Oral gargling could be a standard sampling method for evaluating oropharyngeal HPV infection. GENOSEARCH HPV31 could be an option for oral HPV detection.

DOI： 10.1016/j.oraloncology.2020.104669

Scopus

PubMed

Publishing type：Research paper (scientific journal)   Publisher：Japanese Society for Palliative Medicine  

DOI： 10.2512/jspm.15.153

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

Regenerative medicine has continued to progress for lung biology and lung diseases. Efforts have focused on a variety of different applications for pluripotent stem cells. Several groups have reported successful methods for inducing differentiation of induced pluripotent stem cells (iPSCs) into the airway epithelium such as alveolar epithelium type II (ATII). However, differentiation efficiency varies among reports and improvements are needed. In the present paper, we propose a novel method for elimination of residual undifferentiated murine iPSCs using JQ1, a potent inhibitor of bromodomain (BRD) and extraterminal domain (BET) family proteins, for efficient differentiation into ATII. First, the murine iPSC line 20D-17 was induced to differentiate into ATII over a period of 26 days (days 0-26) using previously reported embryoid body seeding and stepwise differentiation methods. mRNA expressions of differentiation markers including surfactant protein C (Sftpc) were confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR) results, and 17% of the cells were shown positive for prosurfactant protein C (proSPC) in flow cytometry analysis. Next, those cells were cultured three-dimensionally in Matrigel for an additional 14 days (days 26-40), during which JQ1 was added for 4 days (days 28-32) to remove residual undifferentiated iPSCs. As a result, on day 40, the mRNA expression level of Sftpc in the three-dimensional culture was maintained at the same level as on day 26 and shown to be further increased by the addition of JQ1, with 39% of the cells found to express proSPC, showing that differentiation efficiency could be further increased. Three-dimensional culture with BRD4 inhibition by JQ1 improved the differentiation induction efficiency to ATII by removing residual undifferentiated murine iPSCs during the differentiation induction process.

DOI： 10.1155/2019/1271682

PubMed

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

Aim: Visceral obesity (VO) reportedly has a stronger association with complications after colorectal surgery than does body mass index. Here, we retrospectively assessed VO as a risk factor for postoperative ileus (POI) after colorectal resection in patients with colorectal cancer. Methods: This study included 417 consecutive patients with colorectal cancer who underwent elective surgery at our institute from January 2010 to December 2012. Visceral fat area (VFA) was calculated by image analysis software. VO was defined as VFA ≥100 cm2. We assessed 49 factors, including VO, comorbidities, surgical procedure, and postoperative complications. Data were analyzed using a propensity score-matching strategy. Results: Postoperative ileus occurred in 18 patients (4.3%) from the entire cohort, and in 14 (5.5%) of the 256 matched patients. Multivariate analysis (n = 417 patients) showed that significant risk factors for POI included VO (OR 7.9, 95% confidence interval [CI] 1.9-32.1, P = .004), open surgery (OR 6.4, 95% CI 1.6-26.7, P = .010), and pelvic/intra-abdominal abscess (OR 11.0, 95% CI 1.1-110.2, P = .041). Propensity score matching showed two independent risk factors in the multivariate analysis: VO (OR 6.2, 95% CI 1.3-30.4, P = .025) and open surgery (OR 9.1, 95% CI 2.0-40.5, P = .004). Conclusion: Visceral obesity may be an independent risk factor for POI in patients with colorectal cancer.

DOI： 10.1002/ags3.12291

PubMed

Language：English   Publisher：Japanese Society of Wound, Ostomy and Continense Management  

<b>Background</b>: As the population ages, the number of operations for ostomy construction and the need for stoma management increases. On the other hand, the length of hospitalization has been shortened, but it is difficult for nurses to decide which skills to train patients in for their independence in stoma management during hospitalization.<br> <b>Objectives</b>: The degree of independence of the three items of stoma management, changing, emptying, and ordering the ostomy pouch, was surveyed by self-reported questionnaires to clarify the relationship of independence with the current age and stoma duration in Japan.<br> <b>Methods</b>: In total, 3,000 ostomates from the client list of 14 ostomy appliance sales agents throughout Japan were invited to the study. To investigate the relationship, the independence of the three stoma management items was analyzed by Chi-square and Cochran-Armitage trend tests according to duration and current age group.<br> <b>Results</b>: In total, 1,086 participants（36%）, including 640 men and 436 women, were recruited. Of the participants, 72% were independent in changing the ostomy pouch, 93% in emptying, and 77% in ordering. The proportions of those independent in stoma management were lower for changing and ordering, consistent with the shortness of stoma duration and age of the ostomates; however, almost the same proportion was observed for emptying among ages.<br> <b>Conclusions</b>: For hospitalized elderly ostomates, emptying of the ostomy pouch is a basic skill, whereas long-term support is needed for changing and ordering the ostomy pouch.

DOI： 10.32201/jpnwocm.23.3_305

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

The T3 subdivision has been reported to predict prognosis in rectal cancer. However, few studies describe a correlation between T3 subdivision and prognosis in colon cancer. The current study aimed validate the correlation between the invasion distance (ID) beyond the muscularis propria and prognosis in colorectal cancer. The present retrospective study included 148 consecutive patients with pathologically confirmed T3 colorectal cancer, who underwent resection between January 2008 and October 2012. T3 stage was subdivided based on ID: T3a, ID<1 mm; T3b, ID=1-5 mm; and T3c, ID>5 mm. Statistical analyses were performed to evaluate correlations between T3 subdivision groups (T3a + T3b versus T3c) and clinicopathological factors. Compared with the T3a + T3b group, the T3c group exhibited worse 3-year RFS (P=0.003) and 5-year CSS (P=0.006). Multivariate analysis demonstrated that 3-year RFS was significantly correlated with sex (P=0.03) and ID (P=0.02), and 5-year CSS was significantly correlated with lymphoid dissection number (P=0.02) and ID (P=0.03). A ROC curve was constructed using ID values and recurrence data, and the area under the curve was 0.63. These data revealed that ID beyond the muscularis propria was significantly associated with prognosis in T3 colorectal cancer.

DOI： 10.3892/ol.2019.10913

PubMed

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

BACKGROUND: We assessed the feasibility and safety of single-site laparoscopic surgery for patients with colorectal cancer who required perioperative heparinization. METHODS: This retrospective study reviewed the medical records of 390 patients who underwent single-site laparoscopic surgery for colorectal cancer from January 2010 to December 2016. Antithrombotic drugs were stopped preoperatively and heparin was administered according to the operative risk of each patient, based on consultation with the cardiologist physician or neurosurgeon. Propensity score modeling was utilized to adjust for baseline characteristics. RESULTS: Of 390 patients, 29 were treated with standard bridging intravenous heparin therapy. Propensity matching identified 119 patients: 22 patients in the heparinization group and 97 in the control group. The matched groups were not significantly different in operation times, bleeding volumes, or conversion rate. The mean postoperative hospital stay was 17.9 days in the heparinization group and 9.5 days in the control group (p = 0.034). Postoperative bleeding was observed in 4 patients (18.2%) in the heparinization group and 11 patients (11.4%) in the control group (p = 0.646), while other complications were similar in the two study groups (p = 0.502). Of these other complications, thromboembolic events were observed in two patients in the heparinization group and one patient in the control group. CONCLUSIONS: We found that single-site laparoscopic surgery for colorectal cancer with heparinization was feasible and safe. Heparinization did not increase the risk of postoperative bleeding complications, but postoperative hospital stay was prolonged.

DOI： 10.1245/s10434-019-07794-x

PubMed

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

BACKGROUND: A recent study demonstrated remarkable discrepancy between the relapse-free survival (RFS) and overall survival (OS) after pulmonary metastasectomy (PM) in the current era. As the RFS may not be a suitable parameter after PM, a more suitable parameter is needed for PM as a surrogate marker for OS. METHODS: A total of 134 consecutive patients who underwent PM were retrospectively analyzed. In the present study, we introduced a new endpoint, time to local treatment failure (TLTF). This endpoint was defined as the time interval between the first PM and the first untreatable recurrence by local treatment with curative intent or death due to any cause. We analyzed the correlation between the RFS and OS and between the TLTF and OS to validate whether or not the TLTF is a better parameter than the RFS after PM. RESULTS: Thus far, 78 patients have experienced relapse. Of these, 37 patients (47%) underwent local therapy with curative intent, 29 of whom are alive without local treatment failure. The 5-year OS, RFS and TLTF were 70.9%, 36.5%, and 57.6%, respectively. The concordance proportions for the RFS and OS and for the TLTF and OS were 0.634 and 0.851 for all patients, respectively. The Spearman's rank correlation coefficient for the RFS and OS was 0.639, while that for the TLTF and OS was 0.875. CONCLUSIONS: The TLTF may be a good surrogate parameter for the OS after PM in the current era.

DOI： 10.1007/s00268-019-05071-2

PubMed

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

BACKGROUND: Nursing students have limited opportunities to experience end-of-life care, so it is difficult for them to learn how to deliver it empirically. The use of simulations with standardized patients may be a way to provide realistic experience of end-of-life care for nursing students. OBJECTIVES: The aim of this study was to evaluate the effectiveness of end-of-life care simulations with standardized patients in improving the knowledge, skill performance and self-confidence of undergraduate nursing students. DESIGN: Randomized controlled study. SETTING: Japanese university nursing school. PARTICIPANTS: Thirty-eight students in the third year of the Bachelor's degree in nursing (simulation group = 20, control group = 18). METHODS: After randomization to a simulation or control group, participants in the simulation group participated in an end-of-life care simulation with standardized patients. The primary outcome of a change in the knowledge score was assessed using a knowledge questionnaire, skill performance by completing Objective Structured Clinical Evaluations, and self-confidence related to end-of-life care by self-reported questionnaires. RESULTS: The simulation group improved significantly in knowledge, skill performance in physical assessment and psychological care, and self-confidence related to end-of-life care. The results of the two-way analysis of variance showed a significant interaction between groups and time (p = 0.000). Analysis of the simple main effect showed a significant difference (p = 0.000) between groups after the end-of-life care simulation and a significant difference (p = 0.000) over time in the simulation group. There were large effects on knowledge improvement (η2 = 0.372), physical assessment (η2 = 0.619), psychological care skill performance (η2 = 0.588), and self-confidence in both physical assessment (η2 = 0.410) and psychological care (η2 = 0.722). CONCLUSIONS: End-of-life care simulation with standardized patients would be an effective strategy to train nursing students, who have limited opportunities to experience end-of-life care.

DOI： 10.1016/j.nedt.2019.01.005

PubMed

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

BACKGROUND: Although fat accumulation in human organs is associated with a variety of diseases, there is little evidence about the effect of a fatty pancreas on the development of subclinical chronic pancreatitis over the clinical course. METHODS: We conducted a prospective cohort study from 2008 to 2014 of patients who underwent a medical checkup consultation for fat accumulated in the pancreas. Patients included in the analysis were divided into a non-fatty pancreas group (n = 9710) and fatty pancreas group (n = 223). The primary end point was the odds ratio (OR) for chronic pancreatitis associated with fatty pancreas, which was diagnosed using ultrasonography. We used a multiple logistic regression model to estimate the OR and the corresponding 95% confidence interval (CI). RESULTS: Ninety-two people were diagnosed with chronic pancreatitis, including both presumptive and definitive diagnoses. Twelve people were diagnosed with chronic pancreatitis by ultrasonography among the 223 patients with fatty pancreas, and 80 patients among 9710 were diagnosed with non-fatty pancreas. The crude OR was 6.85 (95% CI 3.68, 12.75), and the multiple adjusted OR was 3.96 (95% CI 2.04, 7.66). CONCLUSIONS: Fat accumulation in the pancreas could be a risk factor for developing subclinical chronic pancreatitis.

DOI： 10.1186/s12199-019-0763-2

PubMed

Language：Japanese   Publisher：(NPO)日本緩和医療学会  

DOI： 10.2512/jspm.13.181

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

There are few recent data on trends in childhood cancer incidence using population-based cancer registries in Japan.
This study comprised 6110 reported cases of patients aged 0-14 years who were diagnosed as having primary cancer between 1993 and 2009. We chose cancer registries of seven prefectures, according to the international cancer registry standard of fewer than 10% death certificate only cases among cancer registries in Japan. We analyzed population-based cancer registration data in the seven prefectures between 1993 and 2009. We calculated childhood cancer incidence, age-specific incidence, crude incidence rate, age-adjusted incidence rate, confidence intervals and annual change for each prefecture and classified the data into 12 diagnostic groups, according to the International Classification of Childhood Cancer (ICCC).
According to sex-specific incidence, males accounted for slightly more cases than females. Children 0-3 years old accounted for 41.1% of patients. Leukemia accounted for 36.0% of cancers, followed by central nervous system tumors with 15.0%, according to the ICCC. The crude incidence rate did not change substantially, remaining at an average 8-11 per 100 000 population. In addition, the age-adjusted incidence rate remained constant with an average 2 per 100 000 population.
Using population-based cancer registry data, age-specific incidence and 12 diagnostic groups according to the ICCC showed characteristics of childhood cancers. The incidence rate of childhood cancers has been nearly stable in Japan over the past 15 years.

DOI： 10.1093/jjco/hyx041

Web of Science

PubMed

Language：Japanese   Publisher：日本重症心身障害学会  

J-GLOBAL

J-GLOBAL

J-GLOBAL

Language：English  

DOI： 10.1097/XCS.0000000000000308

PubMed

The authors regret that the statement in the Funding section was incorrect and thus have corrected it as follows: Error, This work was supported by JSPS KAKENHI Grant Number JP16H02681; Correction, This work was supported by JSPS KAKENHI Grant Number JP16H02681 and Research Grants of Princess Takamatsu Cancer Research Fund. The authors would like to apologise for any inconvenience caused.

DOI： 10.1016/j.oraloncology.2021.105478

Scopus

PubMed

The article contains an error in the data acquisition. The correct information is shown below. Authorship contribution statement Data acquisition: H. Cho, Y. Tokita, M. Fujii, H. Ishihara. Manuscript review: Y. Ohno, H. Inohara. The original version has been corrected.

DOI： 10.1007/s10389-020-01410-z

Scopus

J-GLOBAL

Language：English  

In the original article, Yuichiro Doki's first and last names are transposed. The author's name is correct as reflected here.

DOI： 10.1245/s10434-019-07839-1

PubMed

Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

Language：English  

Language：Japanese   Publisher：(公社)日本看護科学学会  

Language：Japanese   Publisher：(公社)日本看護科学学会  

Language：Japanese   Publisher：日本公衆衛生学会  

Language：Japanese   Publisher：(公社)日本看護科学学会  

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)  

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Event date： 2022.7

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大規模総合病院の外来では、待ち時間が長いことがしばしば問題となる。待ち時間が長時間化している実態と、その要因を明らかにするためには、診療過程における時間経過を調査する必要がある。従来のタイムスタディで行われる、手作業による観察、記録という方法は、日常的に実施することが困難である。電子カルテのデータから時間経過を把握できれば、有効な手段となる。しかし、電子カルテには細かいイベントの時間経過が記録されていない。本研究では、眼科外来の視力検査を対象に、電子カルテに記録された時刻情報から、患者や検査担当者の行動の前後関係に基づき、視力検査の開始時刻を推定し、待ち時間を把握する方法を試みた。(著者抄録)

Event date： 2022

Event date： 2021.12

Language：Japanese  

Event date： 2021.12

Language：Japanese  

Event date： 2021.12

Language：Japanese  

Event date： 2021.6

Language：Japanese   Presentation type：Oral presentation (general)  

Event date： 2021.4

Language：Japanese  

Event date： 2021

Event date： 2021

Event date： 2020.12

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Event date： 2019.11

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Event date： 2019.11

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Event date： 2019.10

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Event date： 2019.10

Language：English  

背景:高齢化により高齢者へのストーマ造設手術が増加している。入院期間が短縮化するなかで高齢ストーマ保有者が入院中に技術を習得することは困難なことがある。目的:ストーマ保有者の年齢群とストーマ保有年数ごとにストーマ装具注文、排泄物処理、および装具注文の自立の実態を明確にすることである。方法:ストーマ装具交換、排泄物処理、装具注文におけるストーマ保有者の自立を問う自記式質問紙による横断的研究である。 2017年4月から2018年3月にストーマ保有者3000人に調査用紙を送付した。得られたデータはストーマ保有期間と年齢群についてχ2検定とCochran-Armitageの傾向検定を用いて分析した。結果:男性640人、女性436人を含む1,086人の参加者(36%)から回答が得られた。全体ではストーマ装具交換においては72%が自立していた。さらに、93%がストーマ装具からの排泄物処理ができていた。77%のストーマ保有者がストーマ装具の注文ができた。現在の年齢群で自立の割合をみると、高齢者では装具交換と装具注文の自立の割合が低く、排泄物処理ではほとんど同じ割合が示された。結語:高齢ストーマ保有者はストーマ保有時間が短い人でも排泄物処理は自立割合が高かった。入院中に排泄物処理の技術を習得することが生活の自立に重要である。また、装具交換や装具注文には長期的支援が重要である。(著者抄録)

Event date： 2019.7

Language：English  

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Event date： 2019.7

Event date： 2019.5

Language：Japanese  

Event date： 2019.4

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Event date： 2019.3

Language：Japanese  

Event date： 2018.12

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Event date： 2018.12

Language：Japanese  

Event date： 2018.12

Language：Japanese  

Language：English   Presentation type：Oral presentation (general)  

Language：English  

Language：English  

Language：English  

Language：English  

Language：English   Presentation type：Oral presentation (general)  

Language：Japanese  

Language：Japanese   Presentation type：Oral presentation (general)  

Language：Japanese  

Language：Japanese   Presentation type：Oral presentation (general)  

Language：Japanese  

Language：English  

Language：Japanese  

Language：Japanese  

Language：English   Presentation type：Oral presentation (general)  

Language：Japanese   Presentation type：Oral presentation (general)  

Language：Japanese   Presentation type：Oral presentation (general)  

Language：Japanese   Presentation type：Oral presentation (general)  

Language：Japanese   Presentation type：Oral presentation (general)  

Language：English  

Language：English  

Language：Japanese  

Language：Japanese  

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Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：English  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：English   Presentation type：Oral presentation (general)  

Language：Japanese  

Language：Japanese   Presentation type：Oral presentation (general)  

Language：English   Presentation type：Oral presentation (general)  

Language：English   Presentation type：Oral presentation (general)  

Language：English   Presentation type：Oral presentation (general)  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

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Language：Japanese  

Language：Japanese