The diagnosis of gallbladder (GB) lesions relies on imaging findings. Transpapillary cholangioscopy can potentially be used to diagnose GB lesions; however, the images obtained remain unclear. This study aimed to characterize the endoscopic findings of GB lesions. We examined the endoscopic features of GB lesions in 50 consecutive patients who underwent cholecystectomy. GB specimens were obtained immediately following cholecystectomy, opened on the side opposite the liver bed, and flushed with saline solution. Each lesion was assessed using a high-resolution endoscope equipped with white light and narrow-band imaging magnification. For elevated lesions, both the surface structure (classified as regular, irregular, or absent) and vascular structure (dilation, meandering, caliber change, non-uniformity, and loose vessel areas) were assessed. Twelve of the 50 patients had elevated lesions, including cholesterol polyp (n = 4), hyperplastic polyp (n = 1), xanthogranulomatous cholecystitis (n = 1), and GB carcinoma (n = 6). Advanced GB carcinoma, as opposed to T1 GB carcinoma, demonstrated a papillary surface with destructive areas and neovascularization on narrow-band imaging magnification. Endoscopic images of each GB lesion were characterized, and the differences between GB carcinomas and benign lesions were identified. This preliminary classification may contribute to innovative imaging diagnosis and targeted biopsy for diagnosing GB lesions under direct vision.

Stent placement is a standard option for palliative decompression in patients with malignant colorectal obstruction. Long-term stent placement is associated with perforation, migration, and stent occlusion. Perforation is associated with life expectancy. Several studies have shown that stents with a high axial force (AF), which is defined as the force required to maintain the stent straight after it has bent, are associated with a higher perforation rate. Therefore, we evaluated the long-term outcomes of using a very low AF stent (Niti-S Enteral Colonic Uncovered stent D-type) for palliative purposes.

Eighty-one consecutive patients with malignant colorectal obstruction in 33 medical institutions were evaluated. A stent with very low AF was placed using an endoscope system. We evaluated the adverse events (including perforation, migration, and stent occlusion), 1-year survival rate, and cumulative patency rate. Univariate analysis was conducted using Fisher's exact test. The overall survival and cumulative patency rates were assessed using the Kaplan-Meier method.

The 1-year cumulative survival rate was 37.8% after stent placement. The 3-month, 6-month, and 1-year cumulative patency rates after stenting were 93.6%, 84.2%, and 75.8%, respectively. The major adverse events included stent migration (6.2%), stent occlusion (9.9%), and perforation (2.5%). Chemotherapy was administered in 26 cases (32.1%) after stenting, and bevacizumab was administered in five cases. However, no cases of perforation occurred following bevacizumab administration.

Our results suggest that very low AF stents are safe and effective. Therefore, they may be a suitable option for applications, such as palliation. (UMIN 000011304).

Studies regarding the long-term outcomes of endoscopic submucosal dissection (ESD) performed in older patients with colorectal tumors are limited. Therefore, in this study, we aimed to analyze the long-term outcomes of older patients with colorectal tumors who underwent ESD and identify prognostic factors.

The data of patients aged ≥ 75 years who underwent ESD for colorectal tumors (adenoma and Tis/T1 colorectal cancer) at a single center were retrospectively analyzed. Prognostic factors for overall survival were analyzed using the Kaplan-Meier method and the Cox proportional hazard model.

Of the 156 patients included, 51 patients died during the follow-up period, among whom two deaths were due to colorectal cancer. The univariate analysis revealed that an age ≥83 years, Charlson Comorbidity Index ≥2, prognostic nutritional index <46, and neutrophil-to-lymphocyte ratio (NLR) ≥3 were associated with poor overall survival. The multivariate analysis identified Charlson Comorbidity Index ≥2 (hazard ratio: 2.26; 95% confidence interval (CI): 1.24-4.13; p = 0.0008) and NLR ≥3 (hazard ratio, 1.98; 95% CI: 1.02-3.81; p = 0.042) as independent prognostic factors.

CCI and NLR may be useful parameters for decision-making in older patients undergoing colorectal ESD.

This study aimed to evaluate the successful sequencing rate of Foundation One CDx (F1CDx) using small tissue samples obtained with a 22-gauge needle (22G) through endoscopic ultrasound-guided fine needle acquisition (EUS-TA) and to propose guidelines for tissue quantity evaluation criteria and proper slide preparation in clinical practice.

Between June 2019 and April 2024, 119 samples of 22G EUS-TA collected for F1CDx testing at Himeji Red Cross Hospital were retrospectively reviewed. Tissue adequacy was only assessed based on tumor cell percentage (≥20%). The procedure stopped when white tissue fragments reached 20 mm during macroscopic on-site evaluation. The specimens were prepared using both 'tissue preserving sectioning' to retain tissue within formalin-fixed paraffin-embedded blocks and the 'thin sectioning matched needle gauge and tissue length' method with calculation to ensure minimal unstained slides for the 1 mm3 sample volume criterion. Tissue area from HE slides and sample volume were measured, and F1CDx reports were analyzed.

Of 119 samples, 108 (90.8%) were suitable for F1CDx. Excluding the cases not submitted for testing, in the 45 cases where F1CDx was done using 22G EUS-TA samples, eight (17.8%) had a sum of tissue area tissue of 25 mm2 or greater in the HE-stained sample. However, all cases met the F1CDx 1 mm3 volume criterion by submitting > 30 unstained slides per sample. As a result, 43 of 45 cases (95.6%) were successfully analyzable.

The 22G EUS-TA needle is an effective tool for providing the sufficient tissue volume required for F1CDx.

With the aging population, there is a growing need for treating multiple myeloma (MM) in elderly patients; however, real-world studies of them are quite limited.

We retrospectively analyzed 519 patients diagnosed between 1997 and 2020 in the Kansai Myeloma Forum database to evaluate the efficacy and safety of novel agents available for 80 years and older patients with MM. Patients were divided into groups according to the treatment year: up to 2010 (Group 1), 2011-2015 (Group 2), and 2016-2020 (Group 3).

The median age and number of treatment lines were 83 years (range, 80-96) and 2, respectively. The median time to next treatment (TTNT) was 7.8 months. The TTNT for Group 3 was significantly shorter (3.8 months) than in other groups (p < 0.001). Median progression free survival and overall survival (OS) were 24.4 and 43.7 months, respectively, and did not differ significantly between 3 groups based on pairwise comparisons. In Group 3, the 1-year cumulative incidence of adverse events (AEs), progression or death, and planned treatment leading to treatment discontinuation was 37.7%, 29.4%, and 15.6%, respectively. In addition, the median time until discontinuation due to AEs has been shortened in recent years.

Our findings suggest that AEs threaten the continued treatment of very elderly patients receiving novel agents, with careful management needed to extend the TTNT.

Honey bees are important pollinators in both agriculture and ecosystems, and their health is essential for sustainable human development. Although only two bacteria, Paenibacillus larvae and Melissococcus plutonius, have been identified as bacterial pathogens in honey bee brood for over 100 years, we found three additional Paenibacillus strains (Paenibacillus sp. J27TS7, Paenibacillus azoreducens J34TS1, and Paenibacillus melissococcoides J46TS7) in honey that harmed honey bee brood development. In particular, Paenibacillus sp. J27TS7 was highly virulent in bee larvae (the median lethal dose [LD50] = 12.7 spores/larva) and was comparable to P. larvae (LD50 = 2.3-11.5 spores/larva). Paenibacillus azoreducens J34TS1 showed the second-highest virulence (LD50 = 45.9 spores/larva), and P. melissococcoides J46TS7 was the least virulent (LD50 = 469.0 spores/larva). However, P. melissococcoides was most frequently detected in Japanese honey among the three species, with the highest concentration being 1.8 × 106 spores/mL honey, suggesting its wide distribution in Japanese apiaries. The novel pathogenic Paenibacillus species were categorized into the fast killer (Paenibacillus sp. J27TS7), medium-fast killer (P. melissococcoides), and slow killer (P. azoreducens) like P. larvae strains in terms of the time to kill infected brood; however, histopathological and genome analyses indicated that their pathogenic mechanisms were different from those of P. larvae strains. Moreover, P. melissococcoides showed differences in virulence depending on the lineage of the strain. These findings represent the first discovery of honey bee brood pathogens in more than 100 years and indicate the need to look beyond known pathogens for a comprehensive understanding of honey bee diseases.

Haemophilus influenzae (H. influenzae) and Moraxella catarrhalis (M. catarrhalis) are associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD); however, their role in the pathogenesis of COPD is unknown. We retrospectively analysed the clinical data of patients with AECOPD (modified British Medical Research Council scale score, Global Initiative for Chronic Obstructive Lung Disease [GOLD] classification, pre-admission antibiotic and inhalant usage, sputum culture and epidemic influenza virus antigen test) for association with admission frequency. Among 169 eligible patients, pathogens were and were not detected in 64 and 105, respectively. The GOLD classification grade was higher in the non-detection group with a prior antimicrobial administration rate of 21.9% than in the detection group. H. influenzae and M. catarrhalis, each identified in 24.6% of the total number of detected pathogens, were the most common infectious bacteria. The GOLD classification grade was higher in the re-hospitalisation group than in the one-time hospitalisation group (p < 0.01). Regarding type of pathogen, M. catarrhalis infection (n = 16) was more common in the re-hospitalisation group. History of M. catarrhalis, H. influenzae infection and GOLD grade ≥ III were risk factors for re-hospitalisation, with odds ratios of 92.7 (95% confidence interval [CI]: 3.68-2340.0, p < 0.01), 20.1 (CI: 1.48-274.0, p < 0.05) and 9.83 (CI: 2.33-41.4, p < 0.01), respectively. These bacterial infections and severe airway limitation were associated with increased AECOPD frequency. Routine microbial monitoring may be useful for AECOPD prevention, reducing medical burden and improving prognosis.

Sufficient attention has not been given to machine learning (ML) models using longitudinal data for investigating important predictors of new onset of hypertension. We investigated the predictive ability of several ML models for the development of hypertension.

A total of 15 965 Japanese participants (men/women: 9,466/6,499, mean age: 45 years) who received annual health examinations were randomly divided into a training group (70%, n = 11,175) and a test group (30%, n = 4,790). The predictive abilities of 58 candidates including fatty liver index (FLI), which is calculated by using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, were investigated by statistics analogous to the area under the curve (AUC) in receiver operating characteristic curve analyses using ML models including logistic regression, random forest, naïve Bayes, extreme gradient boosting and artificial neural network.

During a 10-year period (mean period: 6.1 years), 2,132 subjects (19.1%) in the training group and 917 subjects (19.1%) in the test group had new onset of hypertension. Among the 58 parameters, systolic blood pressure, age and FLI were identified as important candidates by random forest feature selection with 10-fold cross-validation. The AUCs of ML models were 0.765-0.825, and discriminatory capacity was significantly improved in the artificial neural network model compared to that in the logistic regression model.

The development of hypertension can be simply and accurately predicted by each ML model using systolic blood pressure, age and FLI as selected features. By building multiple ML models, more practical prediction might be possible.

This study aimed to evaluate the accuracy and reliability of posterior tibial slope (PTS) measurements obtained from radiographs and CT. PTS, particularly its differences in medial and lateral measurements, plays a crucial role in knee alignment, and inconsistencies in measurement techniques across different imaging modalities have raised concerns about accuracy.

This retrospective study included data from 98 Japanese patients legs and 324 Chinese patients legs. PTS was measured on long-leg and short-leg radiographs and CT. Two independent surgeons assessed the measurements, and the inter- and intra-observer reliability were evaluated. The primary outcome was the comparison of medial and lateral PTS measurements, while the secondary aim was to assess the impact of tibial length on measurement accuracy.

The study revealed that lateral PTS was consistently smaller than medial PTS, with an average difference of 1.2°-1.9°. Shorter leg radiographs tend to underestimate PTS compared to full-length tibial measurements. The correlation between measurements from short and long leg radiographs showed that PTS measurements were more prone to errors, which may be due to anatomical factors such as tibial bowing. Inter- and intra-observer reliability were good for medial PTS but poor to moderate for lateral PTS, especially when using radiographs.

For accurate measurement of both medial and lateral PTS, surgeons should consider using additional examination methods such as CT and MRI. If PTS is to be measured on radiographs, the focus should be on the medial PTS, as it tends to provide more reliable results.

This study evaluated whether penicillin MICs can predict piperacillin susceptibility in Enterococcus faecalis. Among 427 strains, 10 were resistant to piperacillin. Even strains with penicillin MICs of 4-8 µg/mL may exhibit resistance. These findings suggest that even penicillin MICs within the susceptible range may indicate piperacillin resistance, challenging CLSI guidelines.

Intramedullary nailing (IMN) for femoral trochanteric fractures (FTF) is the primary surgical intervention. Excessive lag screw sliding (ES) of the femoral neck screw sometimes occurs. This multicenter investigation sought to 1) determine the prevalence of ES, 2) evaluate the relationship between ES and postoperative complications, and 3) identify the factors of ES in elderly patients with FTF undergoing IMN.

From 2016 to 2020, 1448 patients with FTF were treated using a short IMN across 11 institutions (TRON group). Upon applying exclusion criteria, 519 patients (127 men, 392 women; mean age, 84.4 years) were included. The postoperative sliding distance was measured immediately after surgery and at final follow-up. A sliding distance of ≥8 mm categorized patients as having ES. We identify the factors contributing to ES using the logistic regression analysis, with a p < 0.05 as statistical significance.

ES was observed in 116 patients (22.4 %). Patients with ES had a higher incidence of postoperative cut-out and peri-implant fracture. Logistic regression analysis showed that achieving optimal reduction in both AP and lateral views (odds ratio (OR) 0.48, p = 0.0012) and the use of a double screw system or twin screws with integrated locking mechanism significantly reduced the risk of ES (OR 0.27, 0.17; p = 0.0027, <0.001).

The incidence rate of ES was 22.4 %. ES was associated with a higher risk of postoperative complications. The surgeons should aim for optimal reduction and use a double screw or twin screws with an integrated interlocking mechanism as the implant of choice.

The presence of full-thickness cartilage in the lateral compartment on valgus stress radiography is a criterion for medial mobile-bearing unicompartmental knee arthroplasty (UKA). However, the appropriateness of medial UKA is uncertain when preoperative MRI shows extrusion of the lateral meniscus. We therefore assessed how preoperative MRI-detected lateral meniscus extrusion affects mid-term functional outcomes after mobile-bearing UKA.

We retrospectively reviewed the records of our patients that underwent mobile-bearing medial UKA between January 2017 and December 2019. Crema's classification system was used to assess MRI of the lateral meniscus, categorizing patients as either grade 0 or ≥ grade 1. We preoperatively evaluated patient-reported outcomes using the Oxford knee score and Knee Society functional score, and then again at the latest follow-up. We also measured range of motion pre- and postoperatively. We compared preoperative individual data with outcome data obtained for at least three years.

The lateral meniscus extrusion group included 19 knees, and the remainder included 98 knees. Clinical outcomes were similar between these groups (p > 0.05). No progression of lateral arthritis was observed in either group during the follow-up period.

Excluding UKA as an option for cases with lateral meniscus extrusion findings on preoperative MRI may require reconsideration.

Gambling disorder is a behavioral addiction characterized by impulsivity and problem gambling, and it often cooccurs with ADHD. This study investigated the associations between ADHD symptoms and problem gambling, focusing on the roles of various forms of gambling engagement. Based on data from the JASTIS 2024 survey, which included 29,268 valid respondents, this cross-sectional study explored how ADHD symptoms are related to the prevalence of problem gambling and specific forms of gambling engagement. Problem gambling was assessed using the Problem Gambling Severity Index, and ADHD symptoms were measured with the Japanese version of the Adult ADHD Self-Report Scale. The results revealed that 22.2 % of the participants with ADHD symptoms exhibited problem gambling, this proportion was significantly higher than that reported in the general population. Causal mediation analysis revealed that all types of gambling engagement, except for lottery, mediated the relationship between ADHD symptoms and problem gambling. Among them, bicycle racing and online casinos exhibited the strongest effects. Multiple regression analysis revealed that online casino use was the strongest predictor of problem gambling both in the general population and among individuals with ADHD symptoms. These findings suggest that individuals with ADHD characteristics increase the risk of engaging in gambling activities, particularly casino and online gambling, which have a high potential for addiction. Given the association between problem gambling and casino-related experiences, this study underscores the need for stringent regulatory measures and targeted prevention strategies, particularly as Japan considers expanding casino operations.

Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is an indicator of cell membrane health. Low PhA values reflect poor cellular function and low muscle mass. However, consensus regarding the appropriate cutoff value of PhA remains insufficient, and its impact on outcomes after esophagectomy in patients with esophageal malignancies is not well studied. We aimed to investigate whether preoperative PhA is associated with postoperative complication risk and survival prognosis and whether PhA decrease during the surgical preparation period is a prognostic factor in patients with esophageal cancer.

This retrospective cohort study analyzed data from 194 patients who had undergone esophagectomy for esophageal malignancies. A PhA measured several days before surgery, with cutoff values of 5.0° for men and 4.2° for women, was used. The relationship between postoperative pneumonia and clinicopathological factors and between low PhA and postoperative outcomes and survival prognosis was investigated. The preoperative PhA decline and survival prognosis were analyzed in 134 patients whose PhA was measured twice before surgery.

Overall, 93 and 101 patients were classified into the low and high PhA groups, respectively. A multivariate analysis showed that a serum albumin level lower than 3.5 g/dL and low PhA were independent risk factors for pneumonia (odds ratio [OR] = 3.40, P = 0.03; OR = 3.42, P = 0.03, respectively). The low PhA group exhibited significantly higher intraoperative fluid balance (6.7 versus 6.0 mL/kg/h, P = 0.01) and a higher proportion of patients who failed to achieve early mobilization on the first postoperative day (46 versus 32%, P = 0.04) than did the high PhA group. Multivariate analysis using a Cox proportional hazards model revealed that low PhA was a poor survival prognostic factor, independent of the clinical stage of esophageal cancer (hazard ratio = 2.61, P < 0.01). In patients whose PhA was measured twice preoperatively, a decrease in PhA during the preoperative period was a significant indicator of poor survival (hazard ratio = 2.59, P < 0.01). The group with a decrease in PhA during the preoperative period had significantly fewer steps than the group with an increase in PhA (6220 ± 2880 versus 8200 ± 2850, P < 0.01).

Low PhA was a risk factor for postoperative pneumonia in patients who had undergone esophagectomy and was associated with poor survival prognosis. A decrease in PhA during the preoperative period was a significant poor prognostic factor. Increasing physical activity before surgery may lead to an increase in PhA. Thus, it is important to measure and evaluate PhA changes sequentially in patients with esophageal cancer.

Surgical education programs enhance skills but often lack focus on continuing development for post-certification obstetricians and gynecologists. This study evaluates a post-certification educational program for gynecologic surgeons, focusing on laparoscopic skills, academiclapa, and educational activities.

This cross-sectional study utilized a web-based survey administered to past participants of the Training Seminar to Reinforce Laparoscopic Surgeries of Young Generations (TRY) and the Gain the Expert's Technique Seminar (GETS), conducted between 2011 and 2023. The participants were post-certification gynecologic surgeons under 40 years old, selected from across Japan, who were seeking laparoscopy certification and aspired to become leading gynecologic surgeons both in Japan and internationally.

The survey was distributed to 105 graduates of the TRY and GETS programs, with a response rate of 96.1 %. A total of 82.9 % of the participants obtained a laparoscopy-qualified gynecologist certification after the program. The proportion of graduates presenting to the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Congress has significantly increased over time, with several graduates receiving top congress awards. The percentage of graduates serving as laparoscopic surgery educators increased significantly from 21.8 % to 63.3 % (p < 0.001) and the proportion of mentoring colleagues for certification increased from 1.0 % to 25.7 % (p < 0.001).

This study demonstrated that the educational program may effectively enhance the continuous development of laparoscopic skills and professionalism among post-certification obstetricians and gynecologists, resulting in increased academic activities and contributions to surgical education.

The present study aimed to evaluate the clinicopathological and prognostic significance of preoperative prealbumin levels in patients with surgically treated pancreatic cancer. The present retrospective study included 95 patients with pancreatic cancer who underwent radical surgery between January 2011 and December 2021. Of the patients, 49 were male and 46 were female, with a median age of 73 years. According to the median preoperative prealbumin level of 21.1 mg/dl, the patients were divided into low (<21.1 mg/dl) and high (≥21.1 mg/dl) prealbumin groups. Univariate and multivariate analyses were performed to evaluate the prognostic significance of prealbumin levels. Notably, no clinicopathological factors were associated with low prealbumin levels. Overall (P=0.008) and recurrence-free (P=0.004) survival were significantly lower in the low prealbumin group than those in the high prealbumin group. In addition, multivariate analysis showed that low prealbumin levels were an independent risk factor for poor overall (P=0.024) and recurrence-free (P=0.013) survival. Furthermore, the liver (P=0.038) and peritoneal recurrence (P=0.012) rates were higher in the low prealbumin group than those in the high prealbumin group. In conclusion, low preoperative prealbumin levels may be a poor prognostic biomarker in patients with surgically treated pancreatic cancer.

Immune-related adverse events (irAEs) are reportedly associated with favorable outcomes in patients with metastatic urothelial carcinoma (mUC) receiving pembrolizumab. Previous studies on this topic focused on the severity of irAEs. The type and number of organs affected by irAEs may also be associated with the therapeutic outcomes.

The present, retrospective study included 146 patients with mUC receiving pembrolizumab between January 2018 and March 2022. The primary endpoints were the overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) associated with the type and number of organs affected by irAEs and the severity of the symptoms. IrAEs were graded using the Common Terminology Criteria for Adverse Events version 5.0. The treatment response was assessed using the Response Evaluation Criteria in Solid Tumors version 1.1. Cox proportional hazards was used to assess for any association between the variables and survival. Time-dependent analysis was used to assess the status of irAEs as a prognostic factor.

IrAEs ≥ grade (G) 2 were observed in 48 (33%) patients, of whom 9 (6%) had multiple irAEs. IrAEs ≥G2 were significantly associated with a higher ORR (57% vs. 22% for

CONCLUSIONS

The severity and number of irAEs and the organs affected by them appeared to be relevant to the therapeutic efficacy of pembrolizumab in patients with mUC.

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This study aimed to characterize quantitative liver-spleen contrast (Q-LSC) and hepatocellular uptake index (HUI) for evaluating hepatobiliary phase (HBP) images using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) in liver magnetic resonance imaging and to identify differences in the results obtain from these two measurement methods.

Twenty-nine consecutive randomly selected patients were assessed using the 3.0 T MR system. Three regions of interest (ROI) were set for the liver parenchyma and spleen, and signal intensity (SI) was averaged. Q-LSC (SI of the liver divided by the SI of the spleen) and HUI [(Q-LSC-1) × liver volume] were calculated. Moreover, the volume and mean SI of the whole liver and spleen, left lateral segment (LLS), and the other segments were calculated. Subsequently, ROI-based and volume-based values for Q-LSC (R-LSC and V-LSC) and HUI (R-HUI and V-HUI), and the whole and each segment were compared.

R-LSC and V-LSC for the whole and each segment were not significantly different. Conversely, all combinations of HUI, except between R-HUI and V-HUI were significantly different (P < 0.01), for the whole liver. Correlations between R-LSC, R-HUI, and volume-based LLS were lower than the others.

Q-LSC and HUI were characterized through an imaging evaluation of HBP with Gd-EOB-DTPA. R-LSC and R-HUI, or V-HUI, of the whole liver were strongly correlated, but the LLS affected the data, and HUI depends on liver volume. R-LSC is simple and easy to use for HBP evaluation.

The lateral pelvic cavity is an anatomically tricky site to access using a linear approach; therefore, robot-assisted lateral lymph node dissection (LLND) may be superior over existing laparoscopic procedures. In this study, we aimed to compare the short- and long-term outcomes of robot-assisted LLND (R-LLND) versus laparoscopic LLND (L-LLND) for locally advanced low rectal cancer and explore the potential advantages of robot-assisted surgery.

This single-center, retrospective cohort study included patients aged ≥ 18 years who underwent minimally invasive total mesorectal excision (TME) plus LLND for low rectal adenocarcinoma. Patients were divided into L-LLND and R-LLND groups. The short- and long-term outcomes of the procedures were compared.

There were 41 patients in the L-LLND group and 21 in the R-LLND group. The incidence of postoperative complications was significantly lower in the R-LLND group (49% vs. 19%, p = 0.029), especially urinary retention (29% vs. 5%, p = 0.046). The median postoperative hospital stay was significantly shorter in the R-LLND group (22 vs. 15 days, p < 0.001). The 3-year relapse-free survival rates in the L-LLND and R-LLND groups were 75.3% (95% confidence interval [CI]: 58.9-85.9) and 65.7% (95% CI: 30.7-86.1), respectively. No significant differences were observed in long-term survival outcomes.

Patients with locally advanced rectal cancer who underwent TME plus R-LLND had a significantly lower incidence of postoperative complications and a significantly shorter postoperative hospital stay compared to those who underwent TME plus L-LLND. The long-term outcomes were comparable, and no oncological concerns associated with R-LLND were observed.

The corneal epithelium, which consists of superficial, intermediate, and basal layers, demonstrates layer-by-layer shedding with the prolongation of postmortem interval (PMI). This study aimed to evaluate postmortem changes in the corneal epithelium via impression cytology. Specimens were obtained from 134 cases of postmortem CT and/or autopsy, which were divided into 6 groups by PMI (6 h-14 days). The cells collected from the corneal surface using membrane filters were double-stained with antibodies against ZO-1 (expressing on superficial cells) and occludin (expressing on either superficial or intermediate cells) to identify them. With the prolongation of PMI, the percentage of ZO-1 (+)/occludin (+) cells decreased, whereas that of ZO-1 (-)/occludin (-) cells increased, demonstrating the shedding of the corneal epithelium. Meanwhile, ZO-1 (-)/occludin (+) cells initially exhibited an increase in percentage until 48 h and then became undetectable, suggesting a decline in stainability. Age, gender, and wet conditions did not have a significant effect on the number of ZO-1 (+)/occludin (+) or ZO-1 (-)/occludin (-) cells. The effects of ambient temperature and whether the eyelids were open or closed remain unclear due to a lack of data. A simple and noninvasive impression cytology may be applicable for diagnosis in forensic practice.

The diagnostic performance and clinical utility of fecal calprotectin (FC), fecal immunochemical occult blood test (FIT), leucine-rich alpha-2 glycoprotein (LRG), C-reactive protein (CRP), and prostaglandin E-major urinary metabolite (PGE-MUM) as established biomarkers for ulcerative colitis (UC) were evaluated. Significant correlations were observed between the clinical activity index, Mayo endoscopic subscore (MES), and each biomarker. Among MES groups, fecal biomarkers demonstrated significant differences, except between MES 2 and MES 3. CRP and LRG showed significant differences, except between MES 1 and MES 2. PGE-MUM exhibited significant differences across all MES groups. Areas under the curve (AUCs) for receiver operating characteristic (ROC) analysis in predicting MES 0 or 1 were as follows: FC, 0.891; FIT, 0.853; LRG, 0.723; CRP, 0.747; PGE-MUM, 0.795. For predicting MES 0 alone, AUCs were as follows: FC, 0.885; FIT, 0.845; LRG, 0.708; CRP, 0.691; PGE-MUM, 0.732. In distinguishing between each MES group, fecal biomarkers exhibited the highest AUC and accuracy in differentiating MES 0 from MES 1, whereas LRG, CRP, and PGE-MUM were most effective in differentiating MES 2 from MES 3. In summary, in UC, fecal biomarkers effectively detect mucosal healing, whereas LRG, CRP, and PGE-MUM are valuable for assessing mucosal healing and active inflammation.

Pseudomonas aeruginosa, a causative microorganism of febrile neutropenia (FN), accounts for approximately 15% of bloodstream infections and is associated with a high mortality rate. Therefore, antibiotics with anti-P. aeruginosa activity should be administered appropriately during the initial treatment of FN. While other countries have examined guideline adherence and its associated factors in FN initial treatment, limited data are available on these aspects in Japan. This study aimed to evaluate adherence to FN treatment guidelines regarding antibiotics used in patients with cancer and identify factors associated with adherence using a Japanese health insurance claims database.

This study used the JMDC hospital-based administrative claims database between April 2014 and August 2022 obtained from JMDC Inc. Hospitalized patients with cancer with a definitive diagnosis of FN were included in the study. FN cases were defined as patients who underwent bacteriological culture and identification test for blood in the same month as their first definitive FN diagnosis. The date of the first bacteriological culture and identification test for blood was considered the date of the first FN definitive diagnosis.

Among 31,947 patients diagnosed with FN, 12,008 underwent bacteriological culture and identification test for blood in the same month as their FN diagnosis. After applying exclusion criteria, 11,292 patients were included in the analysis. The overall adherence rate to FN treatment guidelines for initial antibiotic selection in Japan was 78.8% and remained stable over time, consistently above 75%. Factors significantly associated with guidelines adherence included patients with hematologic malignancies (OR: 1.117, 95% CI: 1.007-1.239). The study also identified trends in antibiotic use in initial treatment. The use of penicillin with beta-lactamase inhibitor significantly increased over time (r = 0.01621, p < 0.001), while carbapenem use significantly decreased (r = -0.00813, p < 0.001).

The study revealed an FN guideline adherence rate of 78.8% in Japan, along with changes in antibiotic prescribing patterns, including a trend toward carbapenem-sparing strategies between 2014 and 2022. Continuous surveillance is necessary, as adherence rates and antibiotic selection may be influenced by future guideline revisions and antimicrobial stewardship initiatives.

Second coiling for recanalized aneurysms can mitigate the risk of delayed rupture, though re-recanalization may still occur. However, factors associated with re-recanalization after second coiling for recanalized aneurysms have yet to be adequately investigated. The present study explored a large, multicenter data set accumulated over 20 years to identify factors associated with major re-recanalization after second coiling for recanalized aneurysms.

We retrospectively reviewed 188 consecutive aneurysms in 185 patients who underwent second coiling for saccular recanalized aneurysms at 3 institutions from January 2003 to December 2023. Patients were classified into 2 groups: with major re-recanalization (R group) and without major re-recanalization (NR group). To identify factors associated with major re-recanalization, clinical, anatomic, and procedural characteristics were compared between the 2 groups by multivariate logistic regression analysis and stepwise selection.

During follow-up (mean, 62.3 ± 51.2 months), 72 (38.3%) of the 188 recanalized aneurysms showed major re-recanalization. In univariate analysis, compared with the NR group, the R group showed significantly larger aneurysm size, neck size, and aneurysm volume at first coiling and lower rates of stent-assisted coiling, use of an intermediate catheter (IMC), and complete occlusion at second coiling. Stepwise multivariate logistic regression analysis revealed neck size at first coiling (OR 1.18; 95% CI: 1.04-1.33) as an independent risk factor and stent-assisted coiling (OR 0.34; 95% CI: 0.15-0.79), use of an IMC (OR 0.35; 95% CI: 0.16-0.80), and complete occlusion at second coiling (OR 0.16; 95% CI: 0.033-0.70) as independent protective factors for major re-recanalization.

The main risk factor for major re-recanalization after second coiling of recanalized aneurysms was neck size at first coiling, and protective factors included stent-assisted coiling, use of an IMC, and complete occlusion at second coiling. Second coiling for recanalized aneurysms may reduce the risk of major re-recanalization by using a stent or IMC and achieving complete occlusion.

Head magnetic resonance imaging (MRI) is of critical importance in the diagnosis and management of neurodevelopmental disorders. However, the use of sedation in affected children can present a significant challenge.

To identify the factors associated with sedation and MRI failure in children with neurodevelopmental disorders undergoing head MRI with oral triclofos sodium or rectal chloral hydrate.

This retrospective study analyzed 215 MRI sessions of children with neurodevelopmental disorders from January 2020 to December 2021. Sedation was administered via oral triclofos sodium or rectal chloral hydrate. Multivariate logistic regression was used to determine the factors associated with sedation failure and MRI failure.

The sedation failure rate was 38.1 % (82/215). Factors significantly associated with sedation failure were older age (odds ratio [OR] 1.59, 95 % confidence interval [CI] 1.30-1.95, p < 0.001) and stranger anxiety (OR 4.07, 95 % CI 1.95-8.49, p < 0.001). The age cut-off for increased sedation failure risk was 4.0 years (p < 0.01). The MRI failure rate was 21.9 % (47/215), associated with autism spectrum disorder (ASD) diagnosis (OR 19.00, 95 % CI 2.43-149.00, p < 0.01), stranger anxiety (OR 3.66, 95 % CI 1.62-8.24, p < 0.01), and place anxiety (OR 3.18, 95 % CI 1.33-7.57, p < 0.01).

Older age and stranger anxiety are significant risk factors for sedation failure, while ASD diagnosis, stranger anxiety, and place anxiety increase MRI failure risk in children with neurodevelopmental disorders undergoing head MRI.

Bloodstream infections (BSIs) are common and fatal conditions in hospitalized patients. Despite higher BSI mortality rates in older adult patients, predicting BSIs in this population remains challenging. This study aimed to assess whether blood culture (BC) collection is adequate for these patients.

We conducted a retrospective study of BCs collected from hospitalized patients between June 2020 and March 2024 at a tertiary care hospital in Japan.

A total of 11,674 BC sets were collected from 5837 hospitalized patients. The true-positive rate was significantly higher in patients aged ≥80 years than in those aged <80 years (13.6 % vs. 10.6 %, p < 0.001). Additionally, the contamination rate was higher in patients aged ≥80 years than in those aged <80 years (3.1 % vs. 2.2 %, p = 0.016). However, chills were less frequent in patients aged ≥80 years. Additionally, the median temperature was lower in older adult patients than in those aged <80 years.

BCs may be insufficiently collected in patients aged ≥80 years. Furthermore, a bundled intervention approach is needed for proper BC collection among patients aged ≥80 years.

Sex disparities remain pervasive across most cardiovascular diseases and continue to demonstrate notably worse early and late outcomes for women, especially after surgical repair. This study aims to investigate outcomes of mitral valve (MV) repair by sex and identify opportunities for improvement.

A single center retrospective analysis of consecutive patients undergoing MV repair from May 2008 to February 2023 was conducted. In-hospital and long-term outcomes, including survival and symptomatic disease recurrence were examined by sex. Adjusted outcome analysis was performed using inverse-probability treatment weighting.

In total, 490 patients underwent MV repair (median age, 65 years; interquartile range [IQR], 57-73 years; sternotomy n = 128 [26%], minimally invasive n = 362 [74%]), including 343 male and 147 female patients. Median follow-up time was 5.4 years (IQR, 3.1-8.4 years). inverse-probability treatment weighting-adjusted 30-day outcomes for female vs male, including death (1.4% vs 0.6%, P = .59) and major adverse cardiovascular events (8.2% vs 7.6%, P = .81), were not significantly different. Survival for female vs male after mitral valve repair was 94.9% vs 98.0% at 2 years, 91.4% vs 97.8% at 4 years, and 87.2% vs 88.7% at 8 years (hazard ratio, 0.52; IQR, 0.19-1.44). Both unadjusted and inverse-probability treatment weighting-adjusted Cox-regression hazard ratios for survival and freedom from symptomatic disease recurrence demonstrated no significant difference between sexes at long-term follow-up.

These contemporary results are encouraging and suggest that a critical "bridging of the gap" between sexes is possible with comprehensive efforts including earlier detection and awareness and improved surgical techniques, though other factors may be important to explore further.

Non-small cell lung cancer (NSCLC) with driver mutations, notably epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase, shows reduced sensitivity to immune checkpoint inhibitors. A subgroup analysis of the IMpower150 data on patients resistant to EGFR tyrosine kinase inhibitors (EGFR-TKI) before enrollment demonstrated prolonged progression-free survival (PFS) with atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) over bevacizumab, carboplatin, and paclitaxel. However, due to the exploratory nature and small sample size, the efficacy of ABCP post-EGFR-TKI failure is still debated. We evaluated ABCP therapy against other platinum-based regimens without immune checkpoint inhibitors in terms of effectiveness and toxicity.

Data from patients with advanced or recurrent NSCLC harboring EGFR-sensitizing mutations treated with platinum-based chemotherapy or ABCP at five Japanese hospitals were retrospectively analyzed. Propensity score matching compared efficacy outcomes, including overall response rate (ORR), PFS, and OS.

Of 183 EGFR mutation carriers, 33 underwent ABCP therapy, while 150 received platinum-based chemotherapy. Following propensity score matching, 32 and 74 patients were analyzed. In the ABCP group, median PFS and OS were 6.8 and 16.7 months compared to 5.8 and 25.7 months with platinum-based chemotherapy, showing no significant differences in PFS (p = 0.46) and OS (p = 0.85). In liver metastases, ABCP yielded a median PFS of 9.9 versus 6.1 months and an ORR of 62.5 % versus 35.7 % relative to platinum-based chemotherapy, without statistical significance (PFS p = 0.16; ORR p = 0.70).

Compared with platinum-based chemotherapy, ABCP did not improve effectiveness in patients with EGFR-mutated NSCLC after EGFR-TKI failure.

To assess the efficacy of continuous dasatinib in improving outcomes for adult patients with BCR::ABL1 ALL.

The prospective, multicenter ALL/MRD2014 trial introduced a modified protocol compared to the MRD2008 trial, incorporating continuous dasatinib use and reduced chemotherapy intensity.

Among the 164 adult ALL patients enrolled (2014-2019), 61 were Philadelphia-positive (Ph+) (median age 50 years; 38 males, 23 females). Post-induction, 96.7% achieved complete remission (CR). The 3-year event-free survival (EFS) and overall survival (OS) were 51% and 76%, respectively. Patients undergoing allo-HSCT in CR1 had improved outcomes, with a 3-year EFS of 64% and OS of 87%. MRD-negative patients before transplantation exhibited superior survival (EFS: 71% vs. 29%; OS: 94% vs. 57%). Comparison with the MRD2008 trial revealed similar outcomes, with the MRD2014 trial achieving a 3-year EFS of 51% and OS of 76% vs. 52% and 84% in MRD2008. Although not statistically significant, the MRD2014 trial showed trends of increased relapse (CIR: 39% vs. 26%, p = 0.305) and reduced non-relapse mortality (NRM: 10% vs. 21%, p = 0.181).

The ALL/MRD2014 trial underscores the importance of MRD status and allo-HSCT in Ph+ ALL. Continuous dasatinib-based regimens offer favorable outcomes in MRD-negative patients.

This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR), number UMIN000012382.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i) have demonstrated effectiveness in reducing cardiovascular death and heart failure hospitalization (HFH). However, the efficacy and safety of SGLT2 inhibitors in elderly patients with poor general status, such as very low bodyweight or low nutritional status, who are not included in randomized controlled trials, has not yet been examined. In a real-world setting, the introduction of SGLT2 inhibitors to such elderly patients is a very difficult decision to make. We therefore examined the efficacy and safety of these drugs in elderly heart failure patients in a real-world setting.

In Kokura Memorial Hospital, a retrospective study was conducted on 1559 patients over 80 years old hospitalized for HF between 2018 and 2023. Among them, 1326 were included in the non-SGLT2i group and 233 in the SGLT2i group. A multivariate Cox regression model was used to compare the risk of primary composite outcome (all-cause death and HFH) and secondary safety composite outcome (ischaemic stroke, urinary tract infection and dehydration) at 1 year post-discharge between the two groups. The cumulative 1 year incidence of the composite outcome was significantly higher in the non-SGLT2i group (47.3% vs. 31.6%, P < 0.01). SGLT2 inhibitors independently reduced the risk of all-cause death [adjusted hazard ratio (HR): 0.58, 95% confidence interval (CI): 0.39-0.87, P < 0.01] and HFH (adjusted HR: 0.69, 95% CI: 0.52-0.91, P < 0.01), whereas the risk of safety composite events was not increased (adjusted HR: 0.80, 95% CI: 0.49-1.29, P = 0.36). Subgroup analysis showed no significant interactions between age, diabetes, body mass index, left ventricular ejection fraction, clinical frailty scale, geriatric nutritional risk index and SGLT2 inhibitors consistently reduced composite outcomes across all strata. Similarly, SGLT2 inhibitors did not increase safety composite outcomes at any strata.

SGLT2 inhibitors reduce the risk of all-cause death and HFH without increasing adverse events, even in patients over 80 years old. It may be that SGLT2 inhibitors are effective and safe in patients who are basically hesitant to be introduced to SGLT2 inhibitors, such as those with high frailty, low nutritional status or very low bodyweight.

Recently, the use of disinfectants to treat bacterial skin diseases in dogs has garnered attention from the perspective of preventing the spread of antibiotic-resistant bacteria. Ozone water is a disinfectant that combines high antibacterial efficacy and safety; however, there have been no reports verifying its effects on skin barrier function in dogs.

This study aimed to verify the antibacterial properties and effects of ozone water on skin barrier function in dogs.

Four beagles for the antibacterial test and six beagles for the barrier function test.

Purified water, 3 mg/L ozone water and 0.005% and 0.05% sodium hypochlorite were used as test products. Skin bacteria were collected 5 min after a single application of each and cultured to measure the bacterial counts. Trans-epidermal water loss (TEWL) and skin surface hydration (SSH) were measured before and after application once a day for 2 weeks. Additionally, the proliferation of canine epidermal keratinocytes (CPEK) was examined after a 5-min incubation with the test products.

Ozone water and 0.05% sodium hypochlorite significantly reduced the number of skin bacteria. None of the test products worsened TEWL and SSH values. Sodium hypochlorite completely inhibited the proliferation of CPEK, while ozone water did not.

Ozone water has an antibacterial effect on canine skin comparable to that of 0.05% sodium hypochlorite, but does not inhibit keratinocyte proliferation in vitro. Thus, ozone water has the potential to be used as a safe and effective disinfectant for canine skin.

To provide real-world evidence regarding the association between the initial relative dose intensity (RDI) of enfortumab vedotin (iRDI-EV) during the first 2 to 3 cycles for locally advanced or metastatic urothelial carcinoma (la/mUC) and patient characteristics, including EV-Ineligible criTeriA (EVITA), tumor response, and survival.

A multicenter database registered 83 patients with locally advanced or metastatic treated with late-line EV monotherapy between 2021 and 2023. The iRDI-EV was calculated based on the dose modification during the first 2 to 3 cycles. A dose of 1.25 mg/kg on days 1, 8, and 15 of a 28-day cycle was considered the standard full regimen. Patients were categorized into RDI-1 (lowest), RDI-2, RDI-3, and RDI-full (100% RDI) groups.

In total, 68 patients were available for iRDI-EV analysis and response evaluation. The overall median iRDI-EV was 87%, with 14, 13, 13, and 28 patients in the 4 groups exhibiting median iRDI-EV of 62%, 73%, 83%, and 100%, respectively. No clear association between the iRDI-EV and objective response was observed. The disease control rate was significantly higher in the RDI-full group (96%) than in the other groups. The patients in higher RDI groups (RDI-3/RDI-full) had longer progression-free survival than the lower RDI groups (RDI-1/RDI-2), with no difference in overall survival. A multiple linear regression analysis revealed higher iRDI-EV was a strong contributor to better response and longer survival. Of the 83 patients, 4 met ≥2 EVITA, exhibiting a higher risk of progression, whereas 79 had EVITA ≤1.

Oncologists must continue to learn from real-world data on late-line EV monotherapy for combination therapy.

Assessing lower limb ranges of motion (ROMs) is crucial for diagnosing and treating musculoskeletal and neurological disorders in children. Although prior studies examining decline in flexibility among school-age children suggest potential age-related changes in lower limb ROMs, this hypothesis remains unproven. Therefore, in this study, we aim to examine age-related differences in lower limb ROMs among school-age children.

The passive ROMs in the lower limbs of 572 typically developing children aged 6-15 years were measured by physiotherapists using goniometers. To examine developmental changes in lower limb ROMs, participants were categorized into four groups: 6-7 years (189 participants), 8-9 years (147 participants), 10-11 years (124 participants), and 12-15 years (112 participants).

We observed a consistent trend of decreasing ROMs with age across all measures (hip flexion, popliteal angle, knee flexion, knee extension, ankle dorsiflexion, and ankle plantar flexion), excluding hip extension. Notably, only the popliteal angle exhibited values indicating clinically significant sex differences.

Lower limb ROMs in school-age children generally decrease with age, with notable sex differences observed in the popliteal angle. The lower limb ROM values presented herein can serve as reference values to identify disease- and injury-related changes in lower limb ROMs during this developmental stage.