担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1080/03610926.2023.2233152

Scopus

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

For square contingency tables with ordered categories, the marginal homogeneity model is represented by various expressions, and some extensions of the marginal homogeneity model were proposed. Herein we consider the marginal continuation-ratio to examine a new expression of the marginal homogeneity model. We also propose an extension of the marginal homogeneity model using the ratio of marginal continuation-ratios; namely, the marginal continuation odds ratio. The proposed model can be interpreted in various ways. Additionally, we propose a generalization of it, and decompose the marginal homogeneity model using the generalized model. Furthermore, we extend the models and decompositions into multi-way contingency tables.

DOI： 10.1007/s13571-020-00228-9

researchmap

その他リンク： https://link.springer.com/article/10.1007/s13571-020-00228-9/fulltext.html

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Informa UK Limited  

DOI： 10.1080/02664763.2019.1673325

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

Introduction: Atezolizumab plus bevacizumab combination therapy (atezo + bev) has been successfully developed as a standard of care for patients with unresectable hepatocellular carcinoma (HCC) and Child–Pugh A; however, there is no established treatment for those with Child–Pugh B. This study aimed to evaluate the safety and efficacy of atezo + bev in patients with advanced HCC and Child–Pugh B.Methods: This multicenter, open-label, single-arm, phase II study enrolled patients with advanced HCC and a Child–Pugh score of 7 or 8 who had not received prior systemic therapy. Patients were administered atezolizumab (1,200 mg) plus bevacizumab (15 mg/kg) every 3 weeks. The primary endpoint was the frequency of serious adverse events (SAEs), assuming a threshold SAE of 68.5%. A binomial test with a one-sided significance level of 2.5% was employed for the primary analysis.Results: Among the 31 patients enrolled between December 2021 and April 2023, we set 30 eligible patients as the population for the safety and efficacy analyses. The frequency of SAEs was 23.3% (95% confidence interval [CI] 9.9–42.3, p <0.0001). Objective response rates according to RECIST v1.1 and the modified RECIST were 40.0% and 46.7%, respectively. The median progression-free and overall survival were 240 days (95% CI 176–526 days) and 470 days (95% CI 256–576 days), respectively. The mean ±SD Child–Pugh scores were 7.2 ± 0.4 at the start of treatment, maintained 7.0 ± 1.0 and 7.0 ±1.2 at the third and sixth cycles, respectively, and was 7.6 ± 1.7 at the end of treatment. Conclusion: The atezo + bev regimen can be safely administered with demonstrable antitumor effects in patients with unresectable HCC and a Child–Pugh score 7 or 8. Additional studies are warranted to confirm the usefulness of atezo + bev in this patient group.

DOI： 10.1159/000551476

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jvc.2025.10.003

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Baishideng Publishing Group Inc.  

BACKGROUND

Pancreaticobiliary maljunction (PBM) is a congenital disease in which the pancreatic and bile ducts fuse outside the duodenal wall. Congenital biliary dilatation (CBD) involves PBM and dilatation of the extrahepatic bile duct. The lack of Oddi sphincter action at the confluence results in the retrograde flow of pancreatic juice into the bile duct, placing patients with CBD at high risk of biliary carcinoma. The standard treatment for CBD is complete extrahepatic bile duct resection (EHBR). Hepatolithiasis (HL), a late complication following CBD surgery, has a deleterious clinical impact; further research is necessary to elucidate its risk factors.

AIM

To clarify the clinical impact of and risk factors for HL after CBD surgery.

METHODS

A retrospective study was conducted with 223 CBD patients who underwent EHBR across three tertiary hospitals to investigate postoperative complications. An exploratory analysis was performed to identify factors associated with HL development. Risk factors were subsequently identified using least absolute shrinkage and selection operator (LASSO) analysis.

RESULTS

HL was observed in 15/223 (6.7%) patients. Two of those patients developed liver failure owing to biliary cirrhosis; one died, and the other received liver transplantation. Two patients required major hepatectomy. The majority of the remaining patients required repeated enteroscopic and/or percutaneous lithotomy procedures. LASSO analysis revealed older age at surgery as an independent risk factor for HL; the time-dependent receiver operating characteristic analysis at 6 years after surgery revealed a cutoff age of 31 years.

CONCLUSION

HL following CBD surgery has a markedly deleterious clinical impact. Advanced age at the time of CBD surgery was identified as an independent risk factor for HL.

DOI： 10.4240/wjgs.v18.i1.113350

researchmap

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

AIMS/INTRODUCTION: The MiniMed™ 780G® is effective for improving glycemic control; however, few studies have specifically examined the impact of upgrading from MiniMed™ 770G® to MiniMed™ 780G® in adults. We determined the effects of upgrading from MiniMed™ 770G® to MiniMed™ 780G® (780G) on glucose management, psychological distress, daily life quality, and sleep in type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS: In this single-center prospective study, we observed 21 adults who transitioned from the MiniMed™ 770G® to the 780G for 3 months. Glycemic outcomes, insulin delivery parameters, frequency of alarms, and sensor calibrations were assessed. Patient-reported outcomes were evaluated using the Problem Areas in Diabetes (PAID), the Diabetes Treatment Satisfaction Questionnaire status version, the Diabetes Therapy-Related Quality of Life, and the Pittsburgh Sleep Quality Index. RESULTS: Glycated hemoglobin (HbA1c) decreased (7.5 ± 1.3%-7.0 ± 0.8%, mean difference: -0.5%, 95% Confidence Interval (CI): -0.9 to -0.1; P = 0.018). Time in tight range (TITR) showed trends toward improvement (44.9 ± 15.5%-48.9 ± 15.5%, mean difference: 4.0%, 95% CI: -0.7 to 8.6; P = 0.090). Alarm frequency declined (11.9 ± 8.7-7.1 ± 5.5 times/day, mean difference: -4.8, 95% CI: -7.0 to -2.6; P = 0.0002), and calibration frequency decreased (3.6 ± 2.2-0.8 ± 0.6 times/day, mean difference: -2.8, 95% CI: -3.7 to -1.9; P < 0.0001). The PAID score improved, decreasing from 38.7 ± 19.9 to 31.7 ± 19.3 (mean difference: -7.0, 95% CI: -14.7 to 0.7; P = 0.074). CONCLUSIONS: Favorable changes in HbA1c, TITR, and PAID scores suggest potential glycemic and psychological benefits.

DOI： 10.1111/jdi.70198

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

BACKGROUND: Pembrolizumab, an immune checkpoint inhibitor (ICI), has revolutionized the treatment of recurrent cervical cancer; however, its benefits are limited. This study investigated whether peripheral lymphocyte count (PLC) is a prognostic factor for ICI in patients with advanced or recurrent cervical cancer. METHODS: This retrospective study included 47 patients diagnosed with advanced or recurrent cervical cancer, who were treated with pembrolizumab at our hospital between September 2022 and December 2024. The primary outcome was progression-free survival (PFS). The PLC was measured using a blood test conducted immediately before the first administration of pembrolizumab. The optimal PLC cut-off value was determined by using the first quartile point of the PLC distribution. Based on this cut-off value, the patients were allocated into two groups: a normal PLC group (PLChigh) and low PLC group (PLClow). The impact of PLC on PFS was assessed using a Cox proportional hazards regression model using inverse probability of treatment weighting method based on the propensity score, as well as the log-rank test. RESULTS: The median age of the participants was 55 years (interquartile range, 34–84 years). The most common histological type was squamous cell carcinoma (60% of cases). The cut-off value for PLC was set at 710/µL based on the first quartile point. Twelve patients had PLClow (26%) and 35 had PLChigh (74%). Low PLC was significantly associated with shorter PFS (hazard ratio [HR], 2.91, 95% confidence interval [CI], 1.23–6.91, p = 0.013). In the sensitivity analysis, low PLC was also significantly associated with shorter PFS (HR, 4.10; 95% CI, 1.81–9.29, p < 0.001). CONCLUSIONS: PLC may have potential as a prognostic marker for immunochemotherapy in patients with advanced or recurrent cervical cancer. Pre-treatment assessment of PLC could be helpful in identifying patients at risk of poor outcomes and in supporting clinical decision-making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-025-15173-x.

DOI： 10.1186/s12885-025-15173-x

PubMed

researchmap

その他リンク： https://link.springer.com/article/10.1186/s12885-025-15173-x/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

ABSTRACT

Objectives

To examine the real-world effectiveness and safety of peficitinib (PEF) and abatacept (ABT) in patients with rheumatoid arthritis (RA).

Methods

In this multicentre, retrospective cohort study, we examined patients who were administered PEF or ABT between July 2019 and July 2022. The primary endpoint was the 1-year retention rate of PEF or ABT. The primary analyses were performed using treatment persistence, disease activity measurements, and safety parameters. The inverse probability of treatment weighting (IPTW) was used to adjust for confounding variables.

Results

A total of 219 patients were enrolled, with 64 receiving PEF and 155 receiving ABT. The 1-year retention rates were 42.8% in the PEF group and 61.0% in the ABT group after IPTW (P = .0083). Two years following the initiation of treatment, the composite disease activity measures showed comparable improvement in both groups after IPTW. Treatment discontinuation occurred primarily because of an inadequate therapeutic response (PEF: 41.3%, ABT: 28.1%) and adverse reactions (PEF: 11.1%, ABT: 3.8%).

Conclusions

PEF treatment resulted in lower retention rates compared with ABT, whereas both medications demonstrated effectiveness in controlling disease activity for patients who were able to continue treatment. Our findings contribute to informed decision-making in RA treatment in actual clinical practice.

DOI： 10.1093/mr/roaf094

researchmap

その他リンク： https://academic.oup.com/mr/article-pdf/36/2/196/64612960/roaf094.pdf

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

OBJECTIVE: This study investigated whether lean body mass could predict the incidence of dose-limiting toxicity and chemotherapy-induced peripheral neuropathy in patients with endometrial cancer treated with carboplatin-paclitaxel. METHODS: This retrospective study included patients with endometrial cancer who underwent carboplatin-paclitaxel after primary surgery. Lean body mass was calculated using an approximation formula based on abdominal computed tomography images. A multivariable analysis was conducted using a logistic regression model to explore the factors associated with the incidence of chemotherapy-induced peripheral neuropathy and dose-limiting toxicity, with age, body mass index, paclitaxel dose per lean body mass, and carboplatin dose per lean body mass as covariates. Subsequently, the cutoff value for the paclitaxel dose per lean body mass was determined based on the first quartile and receiver operating characteristic curve analysis, dividing the participants into high-dose and low-dose groups. Differences in the incidence of chemotherapy-induced peripheral neuropathy and dose-limiting toxicity between the 2 groups were examined. RESULTS: The study included 98 patients, with 35 (35.7%) and 31 (31.6%) experiencing chemotherapy-induced peripheral neuropathy and dose-limiting toxicity, respectively. The multivariable analysis showed that paclitaxel dose per lean body mass was significantly associated with the incidence of chemotherapy-induced peripheral neuropathy (OR 2.58, 95% CI 1.08 to 6.19) but was not significantly associated with the incidence of dose-limiting toxicity. The cutoff value for the paclitaxel dose per lean body mass was determined to be 8.12 mg/kg. The high-dose group showed a significantly higher incidence of chemotherapy-induced peripheral neuropathy (high-dose group, 52.0%; low-dose group 30.1%, p = .049) and a higher incidence of dose-limiting toxicity (high-dose group, 52.0%; low-dose group, 24.7%, p = .011) than the low-dose group. CONCLUSIONS: Paclitaxel dose per lean body mass may predict the incidence of chemotherapy-induced peripheral neuropathy in patients with endometrial cancer undergoing carboplatin-paclitaxel and could be suitable for dosage modulation of paclitaxel.

DOI： 10.1016/j.ijgc.2025.102108

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JMIR Publications Inc.  

BACKGROUND: The mental health of children and adolescents is a growing public health concern, with increasing rates of depression and anxiety impacting their emotional, social, and academic well-being. In Japan, access to timely psychiatric care is limited, leading to extended waiting periods that can range from 3 months to a year. Artificial intelligence (AI)-driven chatbots, such as emol (Emol Inc) that integrates acceptance and commitment therapy, show potential as digital solutions to support young patients during these waiting times. The AI chatbot emol was selected based on a comprehensive review of Japanese mental health technology apps, including in-person evaluations with company representatives. OBJECTIVE: This exploratory parallel-group randomized controlled trial examined the feasibility of using an AI chatbot emol with pediatric and adolescent individuals on psychiatric waiting lists. METHODS: Participants aged 12-18 years were recruited from 4 hospitals in Kanagawa Prefecture and randomly assigned to either an intervention group, receiving 8 weekly chatbot sessions, or a control group, receiving standard mental health information. The primary outcome was the change in scores on the 9-item Patient Health Questionnaire from pre- to postintervention. Secondary assessments, such as voice and writing pressure analysis, provided additional engagement metrics, with data collected at baseline, during the intervention, and at week 9. RESULTS: Of the 96 eligible individuals on psychiatric waiting lists, 8 expressed interest and 3 provided initial consent. However, all participants subsequently withdrew or were excluded, resulting in no evaluable data for analysis. Low engagement may have been influenced by the perceived irrelevance of digital tools, complex protocols, and privacy concerns. CONCLUSIONS: Significant barriers to engagement suggest that digital interventions may need simpler protocols and trusted environments to improve feasibility. Future studies could test these interventions in supportive settings, like schools or community centers, to enhance accessibility and participation among youth.

DOI： 10.2196/70960

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s00520-025-09751-9

researchmap

その他リンク： https://link.springer.com/article/10.1007/s00520-025-09751-9/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Public Library of Science (PLoS)  

Background

Enteral nutrition is preferable over parenteral nutrition for critically ill patients, but is often discontinued due to enteral feeding intolerance. Diarrhea is one of the most common causes of the discontinuation of enteral nutrition and may be attributed to the composition of enteral formulas. Dietary fiber attenuates diarrhea by normalizing the intestinal microbiota, providing energy for colonic epithelial cells, and exerting a thickening effect on intestinal contents. We herein conducted a randomized controlled trial (RCT) to test the hypothesis that the administration of an enteral formula containing low-methoxy pectin, a type of dietary fiber, more effectively ameliorates diarrhea in critically ill adult patients than a similar composition without pectin.

Methods

A protocol for planning a multicenter, parallel-group, open-label RCT is described herein. Enrolled patients are those ≥18 years of age with the indication of enteral nutrition by gastric access. Overall, 200 patients will be randomized into an intervention group administered an enteral formula containing low-methoxy pectin and a control group administered an enteral formula with similar components, but without pectin at a ratio of 1:1. Each enteral formula will be administered for 3 days or longer. There are no restrictions on other treatments. The primary outcome is the incidence of diarrhea as defined by Bristol Scale 5, 6, or 7. Secondary outcomes include the rate of EN failure, the survival rate, the lengths of ICU and hospital stays, and nutritional endpoints.

Discussion

The present study examines the effects of a low-methoxy pectin-containing enteral formula on enteral feeding intolerance, including diarrhea, in critically ill patients. The results obtained may provide new considerations regarding the selection of enteral formulas for critically ill patients.

Trial registration

jRCTs031230684 registered on 08 Mar 2024, https://jrct.niph.go.jp/en-latest-detail/jRCTs031230684.

DOI： 10.1371/journal.pone.0326582

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

Background

Mitral valve repair (MVR) has emerged as a novel surgical intervention for dogs with myxomatous mitral valve disease (MMVD). However, no objective risk assessment method has been established for these cases.

Objectives

The primary aim of this study was to develop and evaluate preoperative prediction models for 30-day postoperative mortality in dogs undergoing MVR. The secondary aim was to assess the association between short-term predictive risk and long-term mortality following MVR.

Animals

A total of 2089 client-owned dogs with MMVD that underwent MVR between 2016 and 2023 were included.

Methods

This was a single-center retrospective cohort study. Preoperative variables including demographic data, routine blood test results, diagnostic imaging examination data, and medication history were selected as predictor candidates. Prediction models for 30-day all-cause mortality were developed using these variables and shrinkage estimation methods, and the model performances were evaluated. The association between the predicted probabilities and 2-year cumulative all-cause mortality was assessed using Cox proportional hazards analysis.

Results

The 30-day all-cause mortality rate after MVR was 4.9% (102/2089). The best preoperative prediction model for 30-day all-cause death demonstrated low-to-moderate discrimination abilities (c-statistics, 0.654) and good calibration performance (slope = 1.003; intercept = 0.007; Eavg = 0.002) in internal validation. The quartile grouping of the predicted 30-day all-cause mortality risk was associated with 2-year mortality.

Conclusions and Clinical Importance

The preoperative prediction model for short-term mortality in dogs undergoing MVR demonstrated acceptable predictive performance. The prediction model may provide an objective preoperative risk assessment in dogs undergoing MVR at this center.

DOI： 10.1111/jvim.70152

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ibneur.2025.03.011

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JMIR Publications Inc.  

BACKGROUND: Virtual reality (VR) technology is emerging as a tool in mental health care, providing a safe space for social interaction and therapeutic engagement. A social VR-based television program broadcast on Japanese public television offers a virtual environment where adolescents with mental health challenges can engage in peer support using alien avatars, reducing barriers to communication and encouraging emotional expression. OBJECTIVE: This case series aimed to document the psychological trajectories of adolescents with psychiatric disorders participating in a social VR-based television program. METHODS: A single-center case series was conducted with 3 adolescents with psychiatric disorders (aged 15, 18, and 19 years) who participated in the social VR-based television program. The study focused on examining patient-reported outcomes (PROs), including psychological measures and qualitative experiences, and clinical observations across program participation and broadcast viewing. Psychological measures, including the Japanese versions of the 3-item Short-Form University of California, Los Angeles Loneliness Scale (UCLA-LS3-J SF-3), the 14-item Resilience Scale, short form (RS-14), and the 9-item Patient Health Questionnaire (PHQ-9), were assessed at 3 time points: baseline, prebroadcast, and postbroadcast. Qualitative analysis of participant dialogue explored themes of self-disclosure, emotional expression, and social dynamics. RESULTS: Participants showed improvements in loneliness, resilience, and depressive symptoms after participating in the social VR-based program, as indicated by psychological measures and PROs. Qualitative analysis suggested that the structured facilitation embedded in the program enabled participants to express positive and negative emotions, promoting self-reflection and mutual support. CONCLUSIONS: This case series suggests that structured social VR programs can provide a supportive platform for emotional exploration and psychological growth among adolescents with psychiatric disorders. The combination of avatar-based interaThis case series suggests that structured social VR-based programs can provide a supportive platform for emotional exploration and psychological growth among adolescents with psychiatric disorders. The combination of avatar-based interaction and therapeutic facilitation may offer a novel approach to engaging young people in mental health care, particularly during waiting periods for traditional psychiatric services.ction and therapeutic facilitation may offer a novel approach to engaging young people in mental health care, particularly during waiting periods for traditional psychiatric services.

DOI： 10.2196/74401

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s00595-025-03020-2

researchmap

その他リンク： https://link.springer.com/article/10.1007/s00595-025-03020-2/fulltext.html

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

The Fukushima Daiichi Nuclear Disaster (FDND) occurred in 2011, which occurred after the Great East Japan Earthquake. However, how the incidence of radiation-induced malformations in Fukushima has been affected by FDND remains to be elucidated. To address this, we analyzed birth data from Fukushima and other areas in Japan from the International Clearinghouse for Birth Defects Surveillance and Research Japan Center, including information on birth defects between January 2010 and December 2022. Among the registered birth defects, microcephaly, microphthalmia, and neural tube defects were classified as radiation-induced malformations. Our study included 90 433 births in Fukushima, accounting for 52.6% of all births. Among these, birth defects were observed in 1376 (1.52%) births, of which 28 (0.031%) were diagnosed with radiation-induced malformations. With regard to other areas in Japan, 1 323 391 births, which accounted for 10.9% of all births, were registered; births with birth defects and radiation-induced malformations were observed in 37 490 (3.67%) and 889 (0.067%), respectively. Because sampling bias was suspected, we compared the rates of radiation-induced malformations in Fukushima and other areas in Japan by adjusting the incidence in Fukushima with the incidences of ventricular septal defects in both areas. However, there was no statistically significant difference between them. Our results, which covered the largest number of births in Fukushima, did not find a significant increase in the incidence of radiation-induced malformations in Fukushima since FDND.

DOI： 10.1111/cga.70013

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

Background

Patients with heart failure (HF) are at an increased risk of developing pneumonia, leading to a high mortality. A decrease in muscle strength due to aging or concomitant disease may contribute to the development of pneumonia in older adults. We sought to investigate the relationship between low muscle strength and pneumonia incidence in older patients hospitalized for worsening HF.

Methods

We carried out a subanalysis of the FRAGILE-HF, a prospective multicenter observational study, including 1 266 consecutive older (≥65 years) patients hospitalized with HF (mean age 80.2 ± 7.8 years; 57.4% male; left ventricular ejection fraction 46% ± 17%) and information of incident pneumonia observed after discharge. Patients were followed up for 2 years post-discharge.

Results

A total of 88 patients (7.0%) developed pneumonia after discharge, with an incidence of 42.7 per 1 000 person-years. A total of 893 patients with low muscle strength, defined as handgrip strength &amp;lt;28 kg for men and &amp;lt;18 kg for women according to international criteria, were more likely to develop pneumonia than those with normal muscle strength (p &amp;lt; .001; log-rank test). Low muscle strength was a significant predictor of incident pneumonia (adjusted hazard ratio with 95% confidence interval: 2.65 [1.31–5.35], p = .007). Furthermore, the mortality rates were 43.2% in patients who developed pneumonia and 19.3% in those who did not, indicating a heightened risk of death following the onset of pneumonia (adjusted hazard ratio: 4.25 [2.91–6.19], p &amp;lt; .001).

Conclusions

In older patients hospitalized for HF, low muscle strength was associated with incident pneumonia after discharge.

DOI： 10.1093/gerona/glae266

researchmap

その他リンク： https://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/glae266/61200234/glae266.pdf

掲載種別：研究論文（学術雑誌）   出版者・発行元：Association for Research in Vision and Ophthalmology (ARVO)  

DOI： 10.1167/iovs.65.12.25

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jos.2024.08.005

researchmap

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

Abstract

Background

The efficacy and safety of conversion surgery (CS) after FOLFIRINOX or gemcitabine plus nab‐paclitaxel (GnP) chemotherapy in patients with initially unresectable pancreatic cancer (PC) remains unclear.

Methods

This multicenter retrospective cohort study enrolled patients, between 2014 and 2018, with initially locally advanced or metastatic PC who were considered candidates for CS following FOLFIRINOX or GnP chemotherapy. They were classified into surgery (207 patients [194 resection and 13 exploratory laparotomy only]) and continued chemotherapy (10 patients, control) groups. The primary endpoint was overall survival (OS) from the day of diagnosis of potentially curative resection on imaging studies, with an expected hazard ratio (HR) of 0.7.

Results

OS in the surgery group was longer than that in the control group (HR, 0.47; 95% confidence interval [CI]: 0.24–0.93). The median OS was 34.4 (95% CI: 27.9–43.4) and 19.8 (95% CI: 14.9–31.1) months in the surgery and control groups, respectively. The Clavien‐Dindo grade ≥ IIIa postoperative complication and in‐hospital mortality rates were 19.6% and 0.5%, respectively. Multivariate analysis revealed that preoperative chemotherapy duration was not associated with OS.

Conclusions

CS, following a favorable response to FOLFIRINOX or GnP chemotherapy, improved initially unresectable PC prognosis (specifically, OS), regardless of the chemotherapy duration.

DOI： 10.1002/jhbp.12066

researchmap

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

Objective

The association between sarcopenia and prognosis in patients with platinum-resistant recurrent ovarian cancer remains unclear. This study investigated whether sarcopenia is a prognostic factor in patients with platinum-resistant recurrent ovarian cancer.

Methods

A total of 52 patients diagnosed with platinum-resistant recurrent ovarian cancer who had undergone non-platinum chemotherapy at our institution formed our study population. Body composition and clinicopathological data of these patients were collected retrospectively. Abdominal computed tomography (CT) scans obtained at the time of platinum-resistant recurrent ovarian cancer diagnosis were used to measure the cross-sectional area of skeletal muscles at L3 level. These values were corrected for height to calculate the skeletal muscle index, and accordingly sarcopenia was defined. Overall survival was defined as the primary outcome of the study. The impact of sarcopenia on overall survival was assessed using Cox proportional hazards regression models with inverse probability weighting of treatment based on propensity scores and log-rank tests.

Results

The median patient age was 63 years (IQR: 53–71). The most common International Federation of Gynecology and Obstetrics (FIGO) 2018 stage was stage III (50%) and the most common histology was serous or adenocarcinoma (67.3%). The optimal cut-off value of skeletal muscle index was 35.6 cm²/m², which was calculated using the data of 21 patients with sarcopenia and 31 without sarcopenia. Sarcopenia was significantly associated with shorter overall survival (HR 1.93; 95% CI 1.06–3.49; p=0.03). Subgroup analysis based on patient attributes and prognostic factors suggested a consistent prognostic impact of sarcopenia. Sarcopenia was identified as a significant risk factor, particularly in patients who had higher CA125 levels (HR, 2.47; 95% CI, 1.07 to 5.69; p=0.034) and a higher neutrophil-to-lymphocyte ratio (HR, 2.92; 95% CI, 1.02 to 8.31; p=0.045).

Conclusion

Sarcopenia significantly shortened the overall survival of patients with platinum-resistant recurrent ovarian cancer.

DOI： 10.1136/ijgc-2024-005323

researchmap

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

Abstract

Aim

Intracorporeal anastomosis (IA) is becoming increasingly popular and replacing extracorporeal anastomosis (EA) for reconstruction in laparoscopic and robotic surgery for right‐sided colon cancer (LSRCC). Intracorporeal overlap anastomosis (IOA) is the most widely used IA technique. This study aimed to examine the safety of IOA by investigating its short‐term results during the implementation phase.

Methods

This multicenter prospective cohort study was conducted by the Kanagawa Yokohama Colorectal Cancer (KYCC) Study Group. Patients with stage 1–3 colon cancer who planned to undergo LSRCC with IOA reconstruction were eligible. The incidence of anastomotic leakage (AL) of Clavien–Dindo (C–D) grade ≥3 was evaluated as the primary endpoint, and other surgical outcomes and postoperative complications of C–D grades ≥2 were the secondary endpoints.

Results

A total of 127 patients were enrolled, of whom 120 were finally analyzed. The incidence of C–D grade ≥2 complications was 8.3%. The incidence of C–D grade ≥3 AL was 0.8%. This trend was lower than that reported in previous randomized controlled trials (RCTs) and acceptable. Additionally, 1.7% of the patients developed abdominal abscesses, and no cases of anastomotic stenosis were observed. The median operative time was 257 min, and the reconstruction procedure required 32 min. Stapler closure of the enterotomy and facility experience of more than 30 cases were associated with a shorter reconstruction time during IOA.

Conclusion

IOA is feasible and can be safely performed during the implementation phase in patients undergoing LSRCC.

DOI： 10.1002/ags3.12831

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The optimal administration of inotrope after cardiac surgery is unknown. This study aimed to investigate the impact of postoperative inotrope on clinical outcomes in adult elective cardiac surgery patients. Data from the Blood Pressure and Relative Optimal Target after Heart Surgery in Epidemiologic Registry study were analyzed, employing propensity score considering the hospital of admission. The primary outcome was the length of hospital stay evaluated using quantile regression. Secondary outcomes were kidney injury progression, renal replacement therapy, atrial fibrillation, mortality, mechanical ventilation duration, and length of intensive care unit (ICU) stay. Among 870 patients from 14 ICUs in Japan, 535 received inotropes within 24 h of ICU admission, with usage rates ranging from 40 to 100% among facilities. After propensity score matching, 218 patients were included in each group. The inotrope group had a significantly longer hospital stay compared to the control group (16 days vs. 14 days; median difference 1.78 [95% confidence interval [CI] 0.31-3.24]; p = 0.018). However, no significant differences were observed in the secondary outcomes, except for mechanical ventilation duration. The results of the sensitivity analysis using a mixed-effects quantile regression analysis considering the hospital of admission for length of hospital stay in the original cohort were consistent with the results of the propensity analyses (median difference in days, 2.35 [95% CI, 0.35-4.36]; p = 0.022). The use of inotropes within 24 h of ICU admission in adult elective cardiac surgery patients was associated with an extended hospitalization period of approximately 2 days, without offering any prognostic benefit. Clinical trial registration: UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm , UMIN000037074.

DOI： 10.1007/s00380-023-02349-3

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Previous studies have shown that interpregnancy weight fluctuations impact perinatal outcomes. In order to examine this in Japanese women, we analyzed the data of 2,861 women in their first and second pregnancies who delivered singletons between 2000 and 2022. We compared the second pregnancy perinatal outcomes of women whose interpregnancy body mass index (BMI) change was -1 to 1 unit with those of women whose BMI change was < -1 or ≥ 1 unit. An interpregnancy BMI change ≥ 1 unit was associated with an increased risk of developing gestational diabetes mellitus (adjusted odds ratio [aOR], 1.51; 95% confidence interval [CI], 1.18-1.95) and delivering a large for gestational age neonate (aOR, 1.67; 95% CI, 1.15-2.42) but a decreased risk of preterm birth (aOR, 0.66; 95% CI, 0.46-0.95). An interpregnancy BMI change < -1 unit was associated with a decreased risk of developing gestational diabetes mellitus (aOR, 0.51; 95% CI, 0.31-0.85). In a subgroup analysis of three groups divided according to prepregnancy BMI, interpregnancy BMI changes ≥ 1 unit in women with a BMI of < 18.5 kg/m2 before their first pregnancy were associated with a remarkable risk reduction of developing preterm birth (aOR, 0.30; 95% CI, 0.11-0.81). Interpregnancy BMI changes < -1 unit in women with a BMI of ≥ 25 kg/m2 before their first pregnancy were associated with a remarkable risk reduction of developing gestational diabetes mellitus (aOR, 0.33; 95% CI, 0.12-0.88). Weight gain during interpregnancy period was related to an increased risk of gestational diabetes mellitus and delivery of a large-for-gestational-age neonate, whereas weight loss was related to a decreased risk of developing gestational diabetes mellitus. These results indicate the importance of interpregnancy weight control as part of preconception care; therefore, women considering additional pregnancies should be educated on the importance of maintaining a healthy weight.

DOI： 10.1371/journal.pone.0299794

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Chronic intestinal pseudo-obstruction (CIPO) is a rare intractable disease with limited treatment options. Small intestinal bacterial overgrowth (SIBO) often co-occurs with several diseases, including CIPO. While rifaximin (RFX) is effective in treating SIBO, its efficacy for CIPO remains unclear. Here, we aimed to investigate the efficacy and safety of RFX in adult patients with CIPO. Twelve patients were randomly assigned to receive RFX (400 mg three times daily, n=8) or a placebo (PBO, n=4) for 4 weeks. The global symptom score for abdominal bloating (GSS-bloating) and an original whole gastrointestinal symptoms score (O-WGSS) were collected, and a glucose hydrogen breath test (GHBT) and abdominal computed tomography (CT) were performed. No significant differences were observed in the primary endpoint. GSS-bloating improved by 75% and 25% in the PBO and RFX groups, respectively, and O-WGSS improved by 25% in both groups. No significant differences were observed in secondary and other endpoints, including the SIBO eradication rate in the GHBT and small intestinal volume on CT. In a post hoc analysis of SIBO-positive patients with CIPO (4/4 and 4/8 in the PBO and RFX groups), SIBO was eradicated in 25% and 75% of the patients (PBO and RFX groups, respectively) at the end of treatment, indicating a high eradication rate in the RFX group. Furthermore, the small intestinal gas volume decreased in the RFX group, and no severe adverse events occurred. Although no significant improvements were observed in subjective indicators, RFX may be beneficial in alleviating SIBO and reducing the small intestinal gas volume in SIBO-positive patients with CIPO.

DOI： 10.12938/bmfh.2023-080

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: Fully covered self-expandable metallic stents (SEMS) are laser-cut (L) or braided (B); however, which is more effective for distal malignant biliary obstruction (DMBO) has been unclear. We compared the clinical outcomes of using L- type and B-type stents because we believe that recurrent biliary obstruction (RBO) is less likely to occur with L-type stents. METHODS: Patients diagnosed with unresectable DMBO were randomly assigned to groups L and B in a stratified block fashion, and outcomes were compared. The primary outcome was the rate of RBO within 1 year; secondary outcomes were adverse events, clinical success rate, time to RBO (TRBO), and overall survival. RESULTS: Of the 60 enrolled participants, 56 (group L: 27, group B: 29) were included. The rates of RBO within 1 year were 44.4% and 17.2% in groups L and B, respectively (odds ratio 2.57 [95% confidence interval {CI}: 1.045-6.353]). Early adverse events, which improved with conservative treatment, included pancreatitis (n=4) in group L and pancreatitis (n=3) and cholecystitis (n=1) in group B (p=0.913). The median TRBO (220 days [95% CI: 56-272] versus 418 days [95% CI: 232-454]) was significantly longer in group B than in group L (log-rank test, p=0.0118). The median overall survival (L: 158 days, B: 204 days) after stenting was not significantly different between the groups (p=0.8544). CONCLUSIONS: In the setting of DMBO, braided (B)-type stents are associated with less recurrent obstruction than laser-cut-type (L) stents, although there was no difference in safety.

DOI： 10.1016/j.gie.2023.11.057

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

In Japan, rubella antibodies are measured in all pregnant women in order to detect subclinical infection. The study aimed to assess the validity of measuring rubella antibodies to detect subclinical rubella among pregnant women in Japan. This single-center, retrospective study measured rubella hemagglutination inhibition (HI) titers and rubella-specific IgM antibody index values (IgM-values). IgM-values were measured by enzyme immunoassay, and IgM-values > 1.2 were considered positive. Of 14965 pregnant women who were included, 186 (1.2%) were IgM-positive. Only one patient was clinically diagnosed with rubella (HI titer, 1:2048; IgM-value, 10) and developed a fever and skin rash. She decided to terminate her pregnancy without a repeat blood test. Of the IgM-positive patients, 136 (73.1%) had rubella HI titers of < 1:256. The correlation coefficient of rubella HI titers and IgM-values was weakly positive (0.2527; p < 0.0001). This study showed that the single combination of rubella HI and rubella-specific IgM measurements alone did not detect subclinical rubella. Creating awareness among pregnant women by informing them that almost all rubella-specific IgM-positive individuals without symptoms are not acutely infected could decrease their anxiety and prevent unnecessary termination of pregnancies.

DOI： 10.7883/yoken.JJID.2023.222

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Subcutaneous implantable cardioverter defibrillators (S-ICDs) are occasionally used in combination with other cardiac implantable electronic devices (CIEDs). However, whether the incidence of inappropriate shock increases in patients with S-ICDs and concomitant CIEDs remains unclear. This study aimed to investigate the association between the concomitant use of CIEDs and the incidence of inappropriate shock in patients with current-generation S-ICDs. METHODS: A total of 127 consecutive patients received an S-ICD. Patients were assigned to two groups depending on concomitant use of CIEDs at the time of S-ICD implantation: patients without other CIEDs (non-combined group, 106 patients) and patients with other CIEDs (combined group, 21 patients). CIEDs included pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy pacemakers, and cardiac resynchronization therapy defibrillators. The primary outcome was inappropriate shock, defined as a shock other than ventricular arrhythmia. Hazard ratios and 95% confidence intervals were calculated using a time-varying Cox proportional hazards model which was adjusted for age because age differed between the groups and could be a confounder. RESULTS: During a median follow-up period of 2.2 years (interquartile range, 1.0-3.4 years), inappropriate shock events occurred in 17 (16%) and five (19%) patients of the non-combined and combined groups, respectively. While the age-adjusted hazard ratio for inappropriate shock was 24% higher in the combined than in the non-combined group (hazard ratio = 1.24, 95% confidence interval, 0.39-3.97), this difference was insignificant (p = .71). CONCLUSION: The incidence of inappropriate shock did not differ between patients with and without concomitant use of CIEDs, suggesting that S-ICDs could potentially be combined with other CIEDs without increasing the number of inappropriate shocks. Further studies are warranted to confirm the safety and feasibility of concomitant use of S-ICDs and CIEDs.

DOI： 10.1111/pace.14887

PubMed

researchmap

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

Abstract

Aims/Introduction

This study evaluated the effects of the Medtronic MiniMed 770G hybrid closed‐loop system on glycemic control and psychological aspects in persons with type 1 diabetes mellitus.

Materials and Methods

This 3‐month prospective observational study included 22 participants with type 1 diabetes mellitus who used the Medtronic MiniMed 640G predictive low‐glucose suspend system and were switched to the 770G system. Time in the range of 70–180 mg/dL and glycated hemoglobin levels were evaluated; satisfaction, emotional distress and quality of life were assessed using self‐reported questionnaires, including the Diabetes Treatment Satisfaction Questionnaire Status, Problem Area in Diabetes and Diabetes Therapy‐Related Quality of Life.

Results

Time in the range of 70–180 mg/dL increased (63.5 ± 13.4 to 73.0 ± 10.9% [mean ± standard deviation], P = 0.0010), and time above the range of 181–250 mg/dL decreased (26.9 ± 8.9 to 19.6 ± 7.1%, P &lt; 0.0005). Glycated hemoglobin levels decreased (7.7 ± 1.0 to 7.2 ± 0.8%, P = 0.0021). The percentage of participants with time below the range of 54–69 mg/dL &lt;4% of readings increased from 91% to 100% (P &lt; 0.0005). No significant changes were detected in the satisfaction, emotional distress and quality of life levels, but increased sensor calibration might be related to worsened emotional distress and quality of life.

Conclusions

The hybrid closed‐loop system decreased hyperglycemia and minimized hypoglycemia, but did not improve psychological aspects compared with the predictive low‐glucose suspend system, probably because sensor calibration was increased.

DOI： 10.1111/jdi.14103

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Renin suppression in primary aldosteronism indicates mineralocorticoid receptor activation via excessive aldosterone secretion, inducing renal damage. We investigated whether the reversal of renin suppression after the initiation of mineralocorticoid receptor antagonist therapy was associated with long-term renal outcomes in medically treated patients with primary aldosteronism. METHODS: This retrospective cohort study included 318 patients with primary aldosteronism treated with mineralocorticoid receptor antagonist between 2008 and 2020 at the Yokohama Rosai Hospital in Japan. The posttreatment renin status was defined as unsuppressed (ie, reversal of renin suppression) when individual plasma renin activity after the initiation of mineralocorticoid receptor antagonist (post-plasma renin activity) was ≥1.0 ng/(mL h); otherwise, it was defined as suppressed. We analyzed the association of posttreatment renin status with subsequent longitudinal estimated glomerular filtration rate changes using linear mixed-effects models for repeated measurements, adjusting for potential confounders. RESULTS: The posttreatment renin status of 119 patients was unsuppressed (median post-plasma renin activity, 1.7 ng/[mL h]) and that of 199 patients was suppressed (median post-PRA, 0.5 ng/[mL h]). Through the median follow-up period of 3.1 years, the decline in estimated glomerular filtration rate was milder among patients with the unsuppressed posttreatment renin (-0.46 [95% CI, -0.63 to -0.28] mL/min per 1.73 m2 per year) than those with suppressed posttreatment renin (-1.41 [95% CI, -1.56 to -1.27] mL/min per 1.73 m2 per year; difference, 0.96 [95% CI, 0.72-1.20] mL/min per 1.73 m2 per year). CONCLUSIONS: Our findings may highlight the importance of reversing renin suppression with optimal mineralocorticoid receptor antagonist titration in medically treated primary aldosteronism, which could mitigate adverse renal outcomes.

DOI： 10.1161/HYPERTENSIONAHA.123.21096

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.nut.2022.111966

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

Background

Loneliness is a global issue, and primary care physicians play an important role in assessing and intervening with loneliness. This study aimed to examine the association between having a usual source of care (USC) or a good quality of primary care, and loneliness.

Methods

This cross-sectional study was conducted in Japan in 2022. A total of 6,000 residents were randomly sampled from the general population, aged 20–74 years. The outcome was the total score of the University of California, Los Angeles (UCLA) 3-item loneliness scale. The exposure included USC and the Person-Centered Primary Care Measure (PCPCM), which assesses the quality of primary care. We conducted a linear regression analysis to adjust for age, sex, educational status, annual household income, self-rated health, living status (whether alone or not), and the existence of physical health problems.

Results

Of the 6,000 residents, 1,277 responded to the survey. The median score of the UCLA 3-item loneliness scale was 6.0 and the mean total score of the PCPCM was 2.62. Of the 1,277 individuals, 713 (55.8%) had USC. Having USC was significantly associated with lower scores on the UCLA 3-item loneliness scale; the coefficient was −0.34 (95% confidence interval (CI): −0.57 to −0.12). Also, the total PCPCM score was significantly associated with lower loneliness scores; the coefficient was −0.56 (P &amp;lt; 0.001, 95% CI: −0.78 to −0.35).

Conclusions

Having USC and a better quality primary care were associated with a lower loneliness score. The quality of primary care could be a factor to mitigate patient loneliness.

DOI： 10.1093/fampra/cmad049

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are extensively used in the treatment of non-small cell lung cancer (NSCLC); hence, equal access to them is important. Therefore, this study aimed to identify regional differences in the prescription of EGFR-TKIs and the factors contributing to these differences. In this ecological study, we collected data using the National Database Open Data and the National Cancer Registry. The standardized claim ratio (SCR) was used as an indicator of the number of EGFR-TKI prescriptions. Additionally, we examined the association between SCR and various factors to identify the factors associated with this difference. The average SCR for the top three provinces was 153.4, while the average for the bottom three provinces was 61.6. Multivariate analysis used for evaluating the association of SCR with variables revealed that the number of designated cancer hospitals and radiation therapies were independent factors associated with the SCR of EGFR-TKIs. There were significant regional differences in the prescriptions of EGFR-TKIs in Japan based on the number of coordinated designated cancer hospitals and the number of patients receiving radiotherapy alone. These findings emphasize the need to implement policies to increase the number of hospitals to reduce regional differences.

DOI： 10.1038/s41598-023-31856-6

researchmap

その他リンク： https://www.nature.com/articles/s41598-023-31856-6

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s10157-023-02342-0

researchmap

その他リンク： https://link.springer.com/article/10.1007/s10157-023-02342-0/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

Placental abruption (PA) with intrauterine fetal death (IUFD) is associated with a high risk of postpartum hemorrhage (PPH) resulting from severe disseminated intravascular coagulation (DIC). Therefore, blood products that are sufficient for coagulation factor replacement must be prepared, and delivery should occur at referral medical institutions that are equipped with sufficient blood products and emergency transfusion protocols. We retrospectively reviewed the records of patients with PA and IUFD (PA-IUFD) to identify possible factors that may indicate the need for early blood transfusion and investigated whether the Japanese scoring system for PPH can be applied in such cases.

Methods

We used a database of 16,058 pregnant patients who delivered at Yokohama City University Medical Center between January 2000 and February 2016. Thirty-three patients were diagnosed with PA-IUFD before delivery and categorized into two groups–blood transfusion and non-transfusion–to compare the maternal characteristics and pregnancy outcomes.

Results

In patients with PA-IUFD, the transfusion group exhibited significantly more blood loss; lower fibrinogen levels and platelet counts; higher levels of fibrin degradation products (FDP), D-dimer, and prothrombin time; and a tendency for tachycardia on admission, compared to the non-transfusion group. Many patients in the transfusion group had normal fibrinogen levels on admission but later displayed markedly decreased fibrinogen levels. The Japan Society of Obstetrics and Gynecology (JSOG) DIC score was significantly higher in the transfusion than in the non-transfusion group.

Conclusions

In PA-IUFD, the fibrinogen level, platelet count, D-dimer, FDP, heart rate, and JSOG DIC score on admission may indicate the need for blood transfusion. However, even with normal fibrinogen levels on admission, continuous monitoring is indispensable for identifying progressive fibrinogen reductions in patients with PA-IUFD.

DOI： 10.1186/s12884-022-05187-9

researchmap

その他リンク： https://link.springer.com/article/10.1186/s12884-022-05187-9/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

A 2-step approach, Fibrosis-4 index (FIB-4) followed by vibration-controlled transient elastography (VCTE), has been proposed to predict advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We aimed to develop a novel 3-step approach for predicting advanced fibrosis. We enrolled 284 biopsy-confirmed NAFLD patients from two tertiary care centers and developed subgroups (n = 190), including 3.7% of patients with advanced fibrosis, assuming a primary care setting. In the 3-step approach, patients with intermediate-to-high FIB-4 in the first step underwent an enhanced liver fibrosis test or measurement of type IV collagen 7S domain as the second step, and VCTE was performed if the second step value was higher than the cutoff. In 284 cases, a tertiary care cohort with 36.3% advanced fibrosis, the 3-step approach showed significantly higher specificity and positive predictive value than the 2-step approach. In the subgroup with 3.7% advanced fibrosis, the 3-step approach significantly reduced the referral rate to specialists, the number of high-risk patients (i.e., liver biopsy candidates), and healthcare costs by 12.5% to 15.8%. The 3-step approach may improve the diagnostic performance to predict advanced fibrosis in NAFLD, which could lower rates of referrals to specialists, liver biopsies, and medical costs.

DOI： 10.1038/s41598-022-22767-z

researchmap

その他リンク： https://www.nature.com/articles/s41598-022-22767-z

掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ  

Objectives

Continuity of care is a core dimension of primary care, and better continuity is associated with better patient outcomes. Therefore, care fragmentation can be an indicator to assess the quality of primary care, especially in countries without formal gatekeeping system, such as Japan. Thus, this study aimed to describe care fragmentation among older adults in an ageing city in Japan.

Design

Cross-sectional study.

Setting

The most populated basic municipality in Japan.

Participants

Older adults aged 75 years and older.

Interventions

This study used a health claims database, including older adults who visited medical facilities at least four times a year in an urban city in Japan. The Fragmentation of Care Index (FCI) was used as an indicator of fragmentation. The FCI was developed from the Continuity of Care Index and is based on the total number of visits, different institutions visited and proportion of visits to each institution. We employed Tobit regression analysis to examine the association between the FCI and age, sex, type of insurance and most frequently visited facility.

Results

The total number of participants was 413 600. The median age of the study population was 81 years, and 41.6% were men. The study population visited an average of 3.42 clinics/hospitals, and the maximum number of visited institutions was 20. The proportion of patients with FCI &gt;0 was 85.0%, with a mean of 0.583. Multivariable analysis showed that patients receiving public assistance had a lower FCI compared with patients not receiving public assistance, with a coefficient of 0.137.

Conclusions

To our knowledge, this is the first study to demonstrate care fragmentation in Japan. Over 80% of the participants visited two or more medical facilities, and their mean FCI was 0.583. The FCI could be a basic indicator for assessing the quality of primary care.

DOI： 10.1136/bmjopen-2022-061921

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.14309/ctg.0000000000000503

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Asverin® (tipepidine hibenzate) has been used as an antitussive for > 50 years in Japan. Studies revealed that tipepidine modulates monoamine levels, by inhibiting G-protein-activated inwardly rectifying potassium (GIRK) channels, expecting the potential therapeutic effects of tipepidine for attention-deficit/hyperactivity disorder (ADHD) in recent years. In this study, TS-141, a sustained-release tablet of tipepidine, was developed for the treatment of ADHD through a drug repositioning approach. METHODS: The sustained-release profile of TS-141 in healthy adults was investigated, and tipepidine exposure in the plasma after the TS-141 administration was compared to that of Asverin in the phase I study. Phase II study was conducted to examine the effects of TS-141 30 (once a day), 60 (once a day), 120 mg (60 mg twice a day), or placebo, that is within the exposure in the maximum dosage of Asverin, in children and adolescents with ADHD, and was designed as an 8-week treatment, randomized, parallel group, double-blind, placebo-controlled trial recruiting 6-17-year-old children and adolescents diagnosed with ADHD. A total of 216 patients were randomized according to the CYP2D6 phenotype. The primary end-point was ADHD Rating Scale IV-J changes. Furthermore, effects of CYP2D6 phenotype on the efficacy in the subgroup analysis were investigated. RESULTS: TS-141 had the sustained-release profile, and the CYP2D6 phenotype had effects on the plasma exposure of tipepidine. ADHD RS-IV-J scores in all TS-141 dosages decreased from their baseline scores; however, no significant difference was observed in ADHD RS-IV-J score changes between the placebo and TS-141-administered groups. In patients with intermediate metabolizer CYP2D6, ADHD RS-IV-J score changes in the 120 mg group tended to be larger than that in the placebo group. CONCLUSIONS: ADHD RS-IV-J changes on TS-141 may depend on the interaction between the TS-141 dose and CYP2D6 phenotype, suggesting that further clinical trials should be conducted with careful consideration of polymorphism. Drug repositioning approach of TS-141 was attempted at the same dose as that of antitussive; however, dose setting according to the indication was necessary. TRIAL REGISTRATION: Phase I study: JapicCTI-205235 (Registered 25 March 2020), Phase II study: JapicCTI-163244 (Registered 9 May 2016), https://www.clinicaltrials.jp/cti-user/trial/Show.jsp.

DOI： 10.1186/s12888-020-02932-2

PubMed

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SUT Journal of Mathematics - Tokyo University of Science  

DOI： 10.55937/sut/1570041313

researchmap

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

DOI： 10.3844/jmssp.2011.314.318

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語  

researchmap

記述言語：日本語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（指名）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

会議種別：口頭発表（一般）  

researchmap

会議種別：口頭発表（一般）  

researchmap

会議種別：口頭発表（一般）  

researchmap

会議種別：口頭発表（一般）  

researchmap

会議種別：ポスター発表  

researchmap

会議種別：ポスター発表  

researchmap

会議種別：ポスター発表  

researchmap

会議種別：ポスター発表  

researchmap

会議種別：口頭発表（一般）  

researchmap

会議種別：口頭発表（一般）  

researchmap