Japan Community Healthcare Organization

Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with a growing incidence and mortality globally. Although the clinical features, treatment, and prognosis of Mycobacterium avium-intracellulare (MAI) pulmonary disease have been extensively reported, evidence regarding non-MAI NTM-PD remains limited. This retrospective cohort study included patients newly diagnosed with NTM-PD between 2010 and 2017at 18 hospitals in Kyushu, Japan. Data on baseline characteristics, causative organisms, radiological findings, treatment regimens, and clinical outcomes were collected and analysed. In total, 1317 patients were enrolled. M. intracellulare (50.4%), M. avium (40.5%), M. abscessus complex (MABC) (2.4%), and M. kansasii (2.4%) were identified as the major causative organisms. Compared with patients with MAI, those with MABC exhibited a lower body mass index and a higher AFB sputum smear positivity rate. Patients with M. kansasii infection were predominantly male, frequently had underlying chronic obstructive pulmonary disease, and presented with cavitary lesions. Treatment initiation rates for MABC and M. kansasii were 71.9% and 87.5%, respectively. The response rate to the treatment in sputum mycobacterial evaluation was comparable between the two groups. However, the re-treatment rate was higher in the MABC group (30.4% vs. 14.3%). The 10-year mortality rates were 25.0% and 15.6% for MABC and M. kansasii, respectively. Initial treatment responses for MABC and M. kansasii were favourable. However, long-term outcomes for MABC remained poor, potentially owing to the limited availability of effective continuation-phase therapies. Further large-scale prospective studies are warranted to understand the clinical management and prognosis of non-MAI NTM-PD.

Abstract Background Serum leucine-rich alpha-2 glycoprotein (LRG) is a biomarker reflecting endoscopic activity in patients with ulcerative colitis (UC) and, may serve as treatment target for advanced therapy (AT), like C-reactive protein (CRP). However, unlike CRP, serum LRG is produced also by intestinal epithelium in response to stimulation not only by Interluekin-6 (IL-6) but also tumor necrosis factor (TNF) and IL-22. Therefore, a certain number of cases exist where serum LRG is elevated even when CRP is negative. This study aimed to investigate the optimal selection of AT based on serum LRG levels in patients with UC with serum CRP-negative. Methods This was a multicentre prospective cohort study including 259 patients with UC who received AT from January 2019 to March 2024 at 16 hospitals. Among them, 134 patients with UC with CRP-negative who received one of four classes of AT—anti-TNF, vedolizumab (VDZ), ustekinumab (UST), or Janus kinase inhibitor (JAKi)—were included in the present analysis [anti-TNF, n = 27; VDZ, n = 41; UST, n = 42; JAKi, n = 24]. The effectiveness and safety of AT was assessed by comparing the proportion of clinical remission (CR) at week 52 and the incidence rate of adverse events (AE) requiring discontinuation of AT using the person-year (PY) method. We defined CR as a partial Mayo score ≤2, with each subscore ≤1 and no-bleeding, CRP-negative as < 0.20 mg/dL and the low-LRG group as < 14.0 μg/mL, the high-LRG group as ≥ 14.0 μg/mL. Results Among 134 patients with UC who had negative CRP (female, 43%; pancolitis, 73%; AT exposure, 38%), 59 patients (44%) were classified as the high-LRG group. At week 0, median serum LRG and CRP levels were 13.1 μg/mL [Interquartile range (IQR) 10.7-17.9] and 0.04 mg/dL [IQR 0.00-0.09]. Concomitant corticosteroids and immunomodulators were used in 65 (49%) and 47 (35%) patients. In high-LRG group, the proportion of patients achieved CR at week 52 tended to differ among the four AT classes and that in patients received VDZ was only <50% (P = 0.091; anti-TNF, 88%; VDZ, 42%; UST, 60%; JAKi, 75%), and there was no difference in the incidence rate of AEs (anti-TNF, 0; VDZ 0.9; UST, 3.0; JAKi, 0 per 100PY). In low-LRG group, the proportion of CR at week 52 was significantly different among the four AT classes and that in patients received VDZ or UST was >70% (P = 0.013; anti-TNF, 39%; VDZ, 75%; UST, 73%; JAKi, 33%), and there was no difference in the incidence rate of AEs (anti-TNF, 0; VDZ 0.9; UST, 3.0; JAKi, 0 per 100PY) Conclusion For AT selection in CRP-negative UC patients, ATs other than VDZ can be prioritized in the high-LRG group, whereas VDZ and UST are appropriate in the low-LRG group. Conflict of interest: Dr. Amano, Takahiro: No conflict of interest Yoshihara, Takeo: No conflict of interest Sakakibara, Yuko: No conflict of interest Yamada, Takuya: No conflict of interest Hiyama, Satoshi: No conflict of interest Murayama, Yoko: No conflict of interest Ogiyama, Hideharu: No conflict of interest Uema, Ryotaro: No conflict of interest Tsujii, Yoshiki: No conflict of interest Inoue, Takahiro: No conflict of interest Shinzaki, Shinichiro: Shinichiro Shinzaki has received grant support from AbbVie, EA Pharma, Nippon Kayaku, advisor fees from AbbVie, EA Pharma, Gilead Sciences, Janssen Pharmaceutical, Sekisui Medical and Takeda Pharmaceutical and honoraria from AbbVie, EA Pharma, Gilead Sciences, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Kayaku, Pfizer, Sekisui Medical, and Takeda Pharmaceutical. Iijima, Hideki: No conflict of interest Hayashi, Yoshito: No conflict of interest

Endocrine surgery encompasses various organ systems, but thyroid surgery represents the major component. The Japanese Association of Thyroid Surgeons published nationwide data on thyroid cancer surgery until 2005, since when no further reports have been published. Thus, we analyzed thyroid surgery trends using data from the National Clinical Database (NCD) from 2014 to 2023. We analyzed cases of thyroid surgery, for malignant and benign conditions, recorded in the NCD. A detailed analysis of papillary thyroid carcinoma (PTC) cases was conducted in 2014, 2019, and 2023 to assess TNM classification, surgical procedures, complications, and outcomes. The number of thyroid surgery facilities and the number of thyroid surgeries being performed have both declined since 2020. A trend toward more hemithyroidectomies and fewer total thyroidectomies for PTC is evident. The number of surgeries for cancers < 1cm and lateral node dissection for PTC have also decreased. Endoscopically assisted surgery has increased continuously, accounting for > 4% of thyroid operations in 2020. The incidence of permanent hypoparathyroidism has decreased and perioperative mortality is rare. The changes in surgical trends are aligned with guideline updates and shifts in surgical practice. Future efforts will refine data collection and utilize the NCD to improve thyroid surgical quality and research.

BackgroundCryoballoon ablation (CBA) achieves satisfactory outcomes in patients with atrial fibrillation (AF). However, its feasibility in older patients with heart failure (HF) remains unclear.ObjectivesThis study examined the efficacy and prognosis of CBA in older patients with HF.MethodsAmong 3,655 patients undergoing CBA at 17 institutions, 549 patients (185 with ≥75 years [older], and 364 with <75 years [younger]) diagnosed with HF were analyzed. Recurrence, mortality, and HF hospitalization after CBA between the older and younger groups were compared using Kaplan-Meier curves and Simon-Makuch analyses. Changes in left ventricular ejection fraction (LVEF) on echocardiography and B-type natriuretic peptide levels were evaluated using linear regression analysis. Major procedural complications included stroke, cardiac tamponade, phrenic nerve injury, prolonged hospitalization, and others.ResultsMost (78%) patients had a preserved LVEF of ≥50%. Major procedural complications were similar in the older and younger groups (3.2% vs 4.7%; P = 0.670). The recurrence-free survival and mortality rates were comparable between the 2 groups during a median follow-up period of 21.5 (12.0-37.0) months. The HF hospitalization rate was higher in the older group (4.0 vs 1.5 per 100 patient-years; P = 0.008). In the older group, LVEF and B-type natriuretic peptide levels improved after ablation (from 57.4% to 60.0%, and 173 [113-292] to 87.8 [42-218] pg/mL). AF recurrence and HF hospitalization were closely linked, with most hospitalizations occurring after a year postablation.ConclusionsCBA for AF in older patients with HF is feasible and improves cardiac parameters; however, specific care is required owing to this population’s unique characteristics.

The effect of intraoperative position on cerebral perfusion remains unclear. We examined changes in zero flow pressure (ZFP) relative to the supine position in the beach-chair, Trendelenburg, and prone positions under propofol anesthesia. ZFP is defined as the arterial pressure at which cerebral blood flow theoretically ceases, and it can represent effective downstream pressure, including cerebrovascular tone and intracranial pressure. This prospective, observational study conducted at two institutions included patients undergoing shoulder surgery, robotic-assisted laparoscopic prostatectomy, or lumbar spine surgery (n = 15 for each position) under propofol anesthesia. The flow velocity of the middle cerebral artery was recorded using transcranial Doppler. ZFP was determined by linear regression analysis of the pressure-flow velocity plot, with a pressure transducer calibrated at the heart level regardless of patient posture. Head height relative to the heart increased by 25cm in the beach-chair position, decreased by 13cm in the Trendelenburg position, and was unchanged in the prone position. ZFP significantly increased by 12 and 5mmHg in the beach-chair and Trendelenburg positions, respectively, whereas no significant change was observed in the prone position. The beach-chair and Trendelenburg positions increased ZFP. In both positions, it might be preferable to maintain mean arterial pressure higher than in the supine position to preserve cerebral perfusion.