Azumi Hospital

The EMPA-REG OUTCOME trial confirmed empagliflozin reduced mortality and heart failure hospitalization risk. These findings raised the possibility that empagliflozin may modulate cardiac autonomic function in patients with type 2 diabetes (T2D). The EMPYREAN study was a prospective randomized open-label assessor-blinded multicenter investigation of patients with T2D without prior antidiabetic therapy with sodium-glucose cotransporter 2 or dipeptidyl peptidase 4 inhibitors. Electrocardiographic monitoring was performed at study onset and after 12 and 24 weeks of treatment. Heart rate variability was analyzed using the MemCalc method. The primary endpoint was the change in the low frequency (LF; 0.04-0.15 Hz)/high frequency (HF; 0.15-0.4 Hz) ratio from baseline to 24 weeks. In all, 113 patients were randomized. The median age in the empagliflozin and sitagliptin groups was 60 and 63 years, respectively. There were no significant differences in serial changes in the LF/HF ratio (0.52, 95% confidence interval [CI] -0.15 to 1.19, P=0.126) or HF (16.13, 95% CI -11.58 to 43.84, P=0.251) between the 2 groups. In time domain analysis, serial changes in root mean square successive difference (1.90, 95% CI -0.56 to 4.38, P=0.12) and percent of difference between adjacent normal RR intervals >50 ms (1.04, 95% CI -0.32 to 2.41, P=0.13) were not significantly different. The effects of empagliflozin and sitagliptin on autonomic nerve activity did not differ significantly in patients with T2D.

This study aimed to identify factors influencing perceived social distance from epilepsy, depression, panic disorder, and schizophrenia in Japan, with a focus on informing targeted stigma-reduction strategies. We conducted face-to-face interviews with 103 participants, gathering data on sociodemographic factors, attitudes using the Japanese version of the Scales of Attitudes toward People with Epilepsy (SAPE-J), and perceived social distance via visual analog scales (VASs). To identify significant predictors for each condition, we applied multiple linear regression analyses and rigorously validated the models through diagnostic checks. Our analysis revealed that epilepsy was perceived as the most distant condition (M = 6.11), while depression was perceived as the closest (M = 4.03). We identified distinct predictors for each condition: belief in epilepsy's treatability had a marginally significant effect (β = 0.203, p = 0.064), higher education was strongly associated with reduced perceived social distance for depression (β = -0.283, p = 0.006), and witnessing an epileptic seizure significantly increased perceived social distance for panic disorder (β = 0.285, p = 0.012) and schizophrenia (β = 0.298, p = 0.011). We demonstrate that perceptions of social distance are condition-specific and shaped by unique factors, such as beliefs, education, and personal experiences. We advocate for tailored stigma-reduction approaches, emphasizing the treatability of epilepsy and addressing misconceptions about unpredictability in mental health conditions. Our findings provide a foundation for fostering social inclusion and advancing public understanding of these conditions.

Abstract Background: Patients with fibrotic interstitial lung diseases (ILDs) often experience impaired health-related quality of life (HRQoL). The King's Brief Interstitial Lung Disease Questionnaire (K-BILD) has been developed to measure disease-specific HRQoL. However, its clinical application in real-world settings has not been fully explored. Methods: This prospective longitudinal study enrolled 290 patients with fibrotic ILD who initiated antifibrotic therapy. HRQoL was assessed using K-BILD at the start of antifibrotic therapy, at 6 months, and at 1 year. Associations between K-BILD scores, pulmonary function, and mortality risk were evaluated. Results: K-BILD was assessed in 284, 159, and 154 patients at the start of antifibrotic therapy, at 6 months, and at 1 year, respectively. The median K-BILD scores were 63, 67, and 67 points at the respective time points. At 6 months and 1 year, there were increases of 10 points or more in K-BILD in 45 and 41 patients, respectively. Conversely, there were decreases of 10 points or more in 30 and 42 patients, respectively. K-BILD was moderately associated with pulmonary function tests at the start of antifibrotic therapy; however, only weak correlations were found between changes in K-BILD and %FVC over time. Patients with K-BILD scores in the lowest tertile had significantly shorter survival compared to those in higher tertiles (median survival: 27.8 vs. 40.6 months). A longitudinal decrease in K-BILD of ≥10 points was associated with shorter survival. Multivariate analyses indicated that K-BILD was associated with mortality risk independent of ILD-GAP stage at the start of antifibrotic therapy. Conclusion: Antifibrotic therapy improves HRQoL in certain patients with fibrotic ILDs. Assessing K-BILD may be useful for monitoring mortality risk independently of pulmonary function tests.

Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD). In addition, the cardiovascular prevalence in diabetic patients is around 32.2%, with a two-fold increased mortality risk compared to those without diabetes. Recent investigations have shed light on the promising cardioprotective and nephroprotective benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) for individuals with T2D. The evidence robustly indicates that SGLT2i and GLP-1RA significantly reduce the risk of CKD and cardiovascular disease (CVD), all while effectively managing blood glucose levels. Furthermore, combining SGLT2i with nsMRAs amplifies the benefits, potentially offering a more profound reduction in cardiovascular and renal outcomes. The data analysis strongly supports the integration of these pharmacological agents in the management strategies for CKD and CVD prevention among T2D patients, highlighting the importance of awareness among nephrologists, especially in regions with limited healthcare resources.

296 Background: Proximal gastrectomy (PG) has become an increasingly preferred procedure for treating early cancer in the upper third of the stomach when oncological safety is ensured, with expectation for improvement of nutritional status and quality of life (QOL) attributable to the remnant stomach. Although few studies compare postoperative outcomes of patients who undergo total gastrectomy (TG) and PG based on questionnaires, their significant limitations include the retrospective design, use of a questionnaire not specific to a postgastrectomy setting, and observation at a fixed time or after a short postoperative period. Methods: A multi-institutional prospective study (CCOG1602) of patients who undergo PG or TG for cStage I gastric cancer was conducted. We used the Post-Gastrectomy Syndrome Assessment Scale (PGSAS)-37 and The European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC-QLQ-C30) to evaluate the changes in body weight and QOL over a 3-year postoperative period. The primary endpoint was the weight loss rate 3 years after surgery. Results: We enrolled 109 patients from 18 institutions and selected 65 and 19 patients for inclusion in the TG and PG groups, respectively. There were no differences in age, sex, or preoperative body mass index between the TG and PG groups. Mean postoperative weight loss rates were 16.0% and 11.7% for the TG and PG groups, respectively (Cohen's D 0.656) during postoperative year 1 and 15.0% and 10.8% for TG and PG (Cohen's D 0.543), respectively, during postoperative year 3, indicating that the PG group achieved a better trend with a moderate effect size. According to the PGSAS-37, the PG group experienced a better trend in the indigestion subscale (Cohen's D –1.085) and total symptom score (Cohen's D –0.59) during postoperative year 3 compared with the TG group. In contrast, the EORTC-QLQ-C30 identified no difference between the groups at any time point during the 3-year postoperative period. Conclusions: The CCOG1602 demonstrates that PG tended to be more favorable compared with TG with respect to postoperative weight loss and QOL, particularly regarding indigestion. Clinical trial information: UMIN000020070 .

To determine the frequency of domestic violence in pregnancy and its adverse maternal outcomes among Pakistani women. This was a prospective descriptive longitudinal study conducted at the Department of Obstetrics & Gynecology of Jinnah Postgraduate Medical Center, Karachi from October 2021 to March 2022. The questionnaire was filled during an interview. First part included demographic profile, second part comprised of 5 items with 'yes' or 'no' options. Any positive answer meant woman was subjected to abuse. Adverse maternal outcome was also assessed. Out of a total of 105 pregnant women, 43(41%) women suffered domestic violence. Verbal or emotional violence (39%) was the most common type of violence. In our study, anemia (71.4%) was the most common complication. Preterm labor (63.8%) was the second on the list. was significantly associated with domestic violence (P-value<0.05). Educational status, employment status, substance abuse, and household monthly income of spouse had a significant association (P-value<0.05) with domestic violence. Our study shows that high frequency of violence at the time of pregnancy is related to negative maternal outcomes. Women should be screened for violence and support services for such women should be provided in the country.

The introduction of new-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) has afforded promising overall survival outcomes in clinical trials for non-small-cell lung cancer. We aim to investigate the current adoption rate of these agents and the real-world impact on overall survival among institutions. In a nationwide retrospective cohort study of 46 Tokushukai Medical Group hospitals in Japan, we analyzed clinical data of consecutive patients with non-small-cell lung cancer receiving EGFR-TKIs between April 2010 and March 2020. Univariate and multivariate Cox regression analyses examined the associations between overall survival and patient/tumor-related factors and first-line EGFR-TKIs. A total of 758 patients (58.5% females; median age, 73years) were included. Of 40 patients diagnosed in 2010, 72.5% received gefitinib, whereas 81.3% of 107 patients diagnosed in 2019 received osimertinib as the first-line EGFR-TKI. With a median follow-up of 15.8months, the median overall survival was 28.4months (95% confidence interval, 15.3-31.0). In a multivariate Cox regression analysis, age, body mass index, disease status, EGFR mutational status and first-line epidermal growth factor receptor tyrosine kinase inhibitor were identified as significant prognostic factors after adjusting for background factors including study period, hospital volume and hospital type. The estimated 2-year overall survival rates for gefitinib, erlotinib, afatinib and osimertinib were 70.1% (95% confidence interval 59.7-82.4), 67.8% (95% confidence interval 55.3-83.2), 75.5% (95% confidence interval 64.7-88.0) and 90.8% (95% confidence interval 84.8-97.3), respectively. The median time to treatment failure of gefitinib, erlotinib, afatinib and osimertinib were 12.8, 8.8, 12.0 and 16.9months or more, respectively. Our real-world data revealed that the swift and widespread utilization of newer-generation EGFR-TKIs in patients with EGFR mutation-positive non-small-cell lung cancer, and that these newer-generation EGFR-TKIs can prolong overall survival regardless of hospital volume or type. Therefore, osimertinib could be a reasonable first choice treatment for these patients across various clinical practice settings.

BACKGROUNDDisseminated carcinomatosis of the bone marrow (DCBM) is a widespread metastasis with a hematologic disorder that is mainly caused by gastric cancer. Although it commonly occurs as a manifestation of recurrence long after curative treatment, the precise mechanism of relapse from dormant status remains unclear. Granulocyte colony-stimulating factor (G-CSF) can promote cancer progression and invasion in various cancers. However, the potential of G-CSF to trigger recurrence from a cured malignancy has not been reported.CASE SUMMARYA 55-year-old Japanese woman was diagnosed with Ewing sarcoma localized on the fifth lumbar vertebrae 6 years after curative gastrectomy for T1 gastric cancer. After palliative surgery to release nerve compression, pathological diagnosis of the resected specimen was followed by curative radiation and chemotherapy. During treatment, G-CSF was administered 32 times for severe neutropenia prophylaxis. Eight months after completing definitive treatment, she complained of severe back pain and was diagnosed as multiple bone metastases with DCBM from gastric cancer. Despite palliative chemotherapy, she died of disseminated intravascular coagulation 13 d after the diagnosis. Immunohistochemical examination of the autopsied bone marrow confirmed a diffuse positive staining for the G-CSF receptor (G-CSFR) in the relapsed gastric cancer cell cytoplasm, whereas the primary lesion cancer cells showed negative staining for G-CSFR. In this case, G-CSF administration may have been the key trigger for the disseminated relapse of a dormant gastric cancer.CONCLUSIONWhen administering G-CSF to cancer survivors, recurrence of a preceding cancer should be monitored even after curative treatment.

BackgroundWe previously reported that high body weight was a risk factor affecting the onset of anti-epidermal growth factor receptor (EGFR) antibody drug-induced acneiform rash. The current study investigated the relationship between risk factors for anti-EGFR antibody drug-induced acneiform rash and survival probability in colorectal cancer patients, as well as effects of drug withdrawal, dose reduction, or treatment discontinuation on treatment continuation.MethodsThis retrospective study included 67 patients with unresectable advanced or recurrent colorectal cancer treated with anti-EGFR antibody drugs for the first time.ResultsThe survival time and acneiform rash grade of patients with high body weight (≥ 67.2 kg) were significantly longer and higher than those of patients with low body weight (< 67.2 kg). Moreover, the treatment continuation time of patients with drug withdrawal or dose reduction was significantly longer than that of patients without drug withdrawal or dose reduction or with/without treatment discontinuation. Meanwhile, the treatment continuation time of patients with treatment discontinuation was significantly shorter than that of patients with drug withdrawal or dose reduction or those without drug withdrawal, dose reduction, or treatment discontinuation.ConclusionsHigh body weight is a novel prognostic factor for patients receiving cancer drugs with anti-EGFR antibody drugs. Hence, the results of this study suggest that patients with high body weight should be carefully monitored for the development of acneiform rash when receiving anti-EGFR antibody drugs as cancer drug therapy.