Matsudo City Hospital

Morbidity and mortality rates after surgery in patients with perforated peptic ulcer (PPU) remain high. Although several scoring systems have been proposed, only a few machine learning models have been designed to predict postoperative adverse events. This study aimed to develop and deploy a predictive model for the risk of postoperative adverse events in patients with PPU. We analyzed data from the Perforated Peptic Ulcer Analyzing Project, which is a retrospective survey of adult patients with PPU in seven participating institutions in Japan between January 2011 and December 2022. The postoperative adverse events were defined as complications with a Clavien-Dindo classification of Grade III or higher. The variables were selected based on permutation feature importance derived from a random forest algorithm using bootstrap sampling. Internal-external cross-validation was conducted to develop and evaluate the model's performance. The final model was deployed as an interactive web application. Of the 702 potentially eligible patients, 425 were treated surgically. Of these, 78 patients (18.3%) experienced postoperative adverse events. Ten variables were selected and used to develop a random forest model that displayed favorable discriminatory ability, with a pooled area under the receiver operating characteristic curve (AUROC) of 0.83. Compared to the other systems, the random forest model outperformed the PULP (AUROC, 0.79) and Boey scores (AUROC, 0.67). In this study, a machine learning model was developed and deployed to predict postoperative adverse events in patients with PPU. Further external validation is required for clinical use.

In Japan's historical regions, particularly those designated as World Heritage sites, maintaining the use of existing buildings while preserving the traditional landscape has become an urgent task. Recently, there has been a growing trend of repurposing wooden structures for new functions-for example, converting them into small music venues. One such case is the opera house Omoriza, a former post office that has been transformed into a unique music facility. What sets Omoriza apart is that its exterior, a valuable World Heritage building, has been carefully preserved. However, since it was not originally designed for musical performances, its acoustic performance remains a challenge. In particular, Omoriza's asymmetrical layout and the close proximity of some seats to the walls create variations in the strength and direction of early reflected sound at different seating positions. To better understand these acoustic characteristics, this study conducted two experiments: an acoustic measurement to analyze sound arrival directions and a perceptual experiment to examine the auditory impressions unique to small music venues. The results revealed significant directional variations in sound energy, especially in the low-frequency range of early reflections (0-25 ms), which had a noticeable impact on auditory perception.

This study aimed to evaluate the clinical and radiological outcomes of stems using the line-to-line technique with a minimum follow-up of 10 years. A retrospective comparative study was conducted on 282 consecutive primary total hip arthroplasties (244 patients) using two cemented stem types at a single institution by a single surgeon from 1996 to 2011. Clinical and radiological assessments and stem survival analysis were performed. There were no significant differences in hip function outcomes or complication rates between the groups. The 10-year stem survival rate for any revision was 97.0% (95% CI [confidence interval]: 93.6 to 99.6) in stem group A and 99.0% (95% CI: 94.6 to 99.9) in stem group B, respectively (P = 0.279). Both groups had a 100% survival rate for aseptic loosening. Stem subsidence was more in stem group B (P < 0.001). Cortical hypertrophy occurred in 28.9 and 19.8% of the two groups, respectively, with good clinical outcomes in affected patients. The 10-year clinical and radiological outcomes for stems using the line-to-line technique were excellent, with no revisions required for aseptic loosening.

Background:EGFR L858R mutation is associated with poorer efficacy of EGFR-tyrosine kinase inhibitors (TKIs) than EGFR Ex19del in patients with non-small cell lung cancer (NSCLC). However, ramucirumab (RAM) + erlotinib (ERL) therapy exhibited comparable efficacy between patients with L858R mutation and Ex19del mutation (median progression-free survival (PFS): 19.6 vs 19.4 months) in the RELAY study, with favorable PFS for both gene mutations at 19.4 months in the Japanese subset. Meanwhile, the FLAURA study revealed shorter PFS with osimertinib (OSI) for L858R mutation than Ex19del mutation, with poorer PFS in the Japanese subset than in the overall population. The treatment discontinuation rates of RAM + ERL and OSI in Japanese patients were 18% and 29%, respectively. Consequently, RAM + ERL may exhibit superior efficacy and safety in Japanese patients with the L858R mutation.Objectives:To evaluate the therapeutic efficacy and safety of RAM + ERL as a first-line treatment for advanced or recurrent NSCLC harboring the L858R mutation in Japanese patients.Design:A multicenter, noninterventional, retrospective cohort study.Methods and analysis:This study will involve patients with advanced or recurrent NSCLC (ECOG PS score 0–2) with L858R mutation who received RAM + ERL between November 1, 2020 and August 31, 2023, with the planned sample size of 200 patients. The primary endpoint is time to treatment failure, and the secondary endpoints are overall survival, PFS, PFS2, time to discontinuation of any EGFR-TKI, time to failure of strategy, objective response rate, disease control rate, and safety. Exploratory endpoints are effects of ERL and RAM on PD-L1 expression and neutrophil-to-lymphocyte ratio.Discussion:To the best of our knowledge, this is the first retrospective study focusing on L858R mutations associated with the RELAY regimen, providing the corresponding real-world data.Trial registration:UMIN Clinical Trials Registry identifier: UMIN000052047.

ObjectiveAdvanced ovarian clear cell carcinoma (OCCC) is associated with poor outcomes owing to chemoresistance. Bevacizumab (Bev) is increasingly being used to treat advanced ovarian cancer; however, its efficacy in OCCC remains unclear. This study evaluated the treatment outcomes of frontline bevacizumab chemotherapy in patients with OCCC.MethodsThis retrospective multi-institutional study included patients diagnosed with advanced OCCC at eight institutions in Japan between 2008 and 2018. Patients were categorized into pre and post-market groups based on the Bev approval dates. Progression-free survival (PFS) and overall survival (OS) were analyzed using univariate and multivariate methods. Additionally, patients were classified into Bev-treated (Bev+) and non-Bev-treated (Bev−) groups, and their prognoses were compared.ResultsA total of 96 patients were in the pre-market group and 82 in the post-market group. The post-market group had a significantly higher proportion of patients with poor performance status and patients who underwent interval debulking surgery (p<0.01 and p<0.01, respectively). Univariate analysis demonstrated a better PFS in the post-market group (p=0.041). In multivariate analysis, better PFS (hazard ratio [HR]=0.52; p=0.002) and OS (HR=0.47; p=0.002) were observed in the post-market group than in the pre-market group. Bev+ patients had significantly better PFS and OS than Bev− patients in univariate (p<0.001 and p<0.001, respectively) and multivariate analyses (PFS: HR=0.36; p<0.001 and OS: HR=0.21; p=0.001, respectively).ConclusionIncorporating Bev into frontline chemotherapy may improve outcomes in patients with advanced OCCC.

Injecting local anesthetics into the cervical sympathetic ganglion creates a stellate ganglion block. In this study, we examined changes in oral blood flow and vital signs after performing an SGB at the transverse process of the sixth cervical vertebra（i.e., C6SGB）. We enrolled 60 healthy adult male volunteers and performed C6SGB by injecting 6 mL of 1% mepivacaine hydrochloride. Subjects were divided into two groups: right-sided C6SGB（n = 30）and left-sided C6SGB（n = 30）. Buccal mucosa blood flow was measured on the treated and nontreated sides. Baseline measurements were taken 5 minutes before the injection, and subsequent readings were recorded at 5-minute intervals for 30 minutes post-injection. Heart rate（HR）and blood pressure（BP）were also measured at the same intervals. A physiological saline solution served as a control and was administered to the volunteers on a separate date for comparative measurements. Both the right-sided and left-sided C6SGB groups exhibited increased blood flow on the treated side for 30 minutes post-injection. The nontreated side also showed an increase but only for 10 minutes post-injection. Similarly, HR and BP increased for 30 minutes after the injection in both groups. C6SGB elevates facial blood flow on the treated side due to the local anesthetic’s effect on the cervical sympathetic trunk. The consequent uptick in blood flow on the non-treated side is thought to result from augmented venous circulation on both sides induced by C6SGB, along with a boost in arterial circulation specifically on the untreated side due to altered hemodynamics.

PurposeTriamcinolone tendon sheath injection is a useful nonsurgical treatment for trigger finger; however, complications, such as tendon rupture, and infections caused by excessive administration, have been reported. Considering the complication risk, we inject 4 mg triamcinolone into the tendon sheath without limitation on the number of injections at intervals of at least 1 month. This study aimed to retrospectively examine the results of triamcinolone tendon sheath injections for trigger finger at multiple facilities.MethodsThe participants included patients with trigger finger who visited four facilities between April 2009 and October 2021, received at least one triamcinolone tendon sheath injection, and could be evaluated for effectiveness. Patients with a follow-up period of <3 months from the initial injection, and pediatric patients aged <16 years old were excluded. Quinnell’s severity classification, number of injections per finger, interval of injections (when performed ≥2 times), complications, proportion of diabetes, hemoglobin A1c (HbA1c) levels, and proportion that required surgery were collected.ResultsOverall, 356 cases and 715 fingers were included (men, 260 fingers; women, 455 fingers). The mean age of the participants was 64.9 years (17–92 years), and the mean number of affected fingers per person was 1.9 (1–7 fingers). The median follow-up period was 27 (3–134) months. According to Quinnell’s severity classification, 234, 274, 126, and 50 fingers were classified as grade 1, 2, 3, and 4, respectively. The average number of injections per finger was 3.3. The mean interval between injections was 6.3 months. Complications, such as tendon rupture, or infection, were not observed. The rate of diabetes was 22.4%, and the median HbA1c value was 7.2%. In total, 9.8% of all patients required surgery.ConclusionsNo complications were observed for 4 mg triamcinolone injections when administered at intervals of at least 1 month.Type of study/level of evidenceTherapeutic Ⅳ.