Nishikawa Hospital

Mobility limitation is prevalent in patients with heart failure (HF), but the dose-response relationship between its severity and adverse outcomes remains unquantified. We conducted a patient-level pooled analysis of two prospective Japanese cohort studies, including 2103 hospitalised patients with HF with no exclusion criteria. Mobility limitation at discharge was categorised into four levels: category I (independent outdoor walking), category II (indoor independence but requiring outdoor assistance), category III (requiring indoor assistance) and category IV (unable to walk). The primary endpoint was a 2-year composite of HF rehospitalisation or all-cause mortality. Adjusted analyses accounted for age, sex, comorbidities, biomarkers and medications. Among 2820.7 person-years of follow-up, 998 composite outcomes occurred. Incidence rates per 100 person-years for the primary outcome increased with mobility limitation severity: 24.9 (category I), 47.0 (II), 59.3 (III) and 84.8 (IV) (p for trend <0.001). Adjusted HRs (95% CI) using category I as reference were 1.22 (95% CI 1.04 to 1.45) for II, 1.39 (95% CI 1.11 to 1.73) for III and 1.71 (95% CI 1.34 to 2.20) for IV. While the graded association was clear for mortality, it was less evident for HF rehospitalisation alone, likely reflecting competing mortality risks. This study demonstrates a strong and graded association between mobility limitation severity and adverse outcomes in HF, suggesting its utility for refined risk stratification.

Globally, multi-disciplinary advance care planning (ACP) in multi-facility settings for aging communities is essential; however, it does not consistently yield the desired outcomes. Japan's population is rapidly aging; nonetheless, no studies have examined comprehensive ACP implementation by diverse professionals across various community healthcare facilities. Within the context of an aging community, this study aimed to identify the barriers and facilitators to ACP implementation by multiple professionals in various healthcare facilities. A qualitative research design was employed. The study participants included 22 multidisciplinary members of a community-based palliative care (CBPC) team. Individual semi-structured interviews were conducted between September and October 2019. A total of 19 barriers and 19 facilitators were identified and categorized into seven practice domains: "Understanding patients' intentions," "Family support," "Information sharing using tools," "Collaboration among multiple professions," "Cross-facility and cross-departmental cooperation," "Raising awareness in the community," and "Efforts by implementation promoters and their departments." Barriers included "Inability to understand the patient's intentions," "Physical and psychological distance between patient and family," and "Different information needs and sharing methods at each facility," among others. Facilitators included "Skills for better understanding the true meaning of patients' intentions," "Compatibility of daily tasks and ACP by utilizing tools," "Human connections between professionals in multiple facilities and departments," and "Engagement with ACP implementation," among others. The study identified important domains for practical ACP implementation using a community-based palliative care team collaborating across multiple community facilities, as well as the barriers and facilitators. The findings indicate that multi-disciplinary, multi-facility ACP implementation in regions with aging populations requires establishing a regional collaborative network system and a human network. Healthcare professionals must develop practical ACP experience to identify its benefits while enhancing their skills as "advocates."

Background and objective: Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with increasing prevalence and mortality worldwide. Chronic pulmonary aspergillosis (CPA) is a significant complication of NTM-PD and is associated with a poor prognosis. In this multicenter, retrospective, cohort study, we examined the epidemiology, comorbidities, risk factors for CPA coinfection, and long-term prognoses of patients with NTM-PD infected with CPA in Japan. Methods: Patients aged ≥18 years with newly diagnosed NTM-PD who visited 18 acute-care hospitals in Kyushu, Japan, between 2010 and 2017 were included. Medical records were reviewed for patient characteristics, underlying diseases, mycobacterial species, laboratory data, radiological features, Aspergillus coinfection, and all-cause mortality. Risk factors for CPA coinfection were analyzed using multiple logistic regression, and survival analysis was performed before and after propensity score matching with risk factors. Results: Among 1,304 patients with NTM-PD, 45 (3.5%) were diagnosed with CPA during the observation period. Risk factors for CPA coinfection included male sex, chronic obstructive pulmonary disease, oral corticosteroid use, and cavity formation. All-cause mortality was significantly higher in patients with NTM-PD with CPA than in those without CPA (log-rank test, P &lt; .001; crude HR, 3.98). Survival analysis after propensity score matching confirmed that CPA was an independent poor prognostic factor (log-rank test, P = .036; adjusted HR, 1.59). Conclusion: CPA is an independent poor prognostic factor in patients with NTM-PD. Clinicians must consider CPA when treating patients with NTM-PD, particularly those with high-risk factors, to ensure their timely diagnosis and management.

The treatment of patients with early breast cancer using breast-conserving surgery (BCS) commonly leads to local control and acceptable cosmetic results. We herein report a useful technique to achieve symmetry of the breast shape and size for a central lesion of the breast. A Japanese patient with early breast cancer located in the central area of the breast was enrolled in this study. Intraductal spread to the nipple was suspected. We resected the cylindrically shaped breast tissue with the nipple–areola complex and repaired the resected area using a modified Grisotti technique, a volume displacement technique using breast tissue with extra-breast tissue. The modified Grisotti flap technique during oncoplastic breast-conserving surgery (OPBCS) may thus be useful for patients who desire a symmetrical breast shape and size.

A retrospective observational study. This study aimed to determine an accurate and convenient screening method for predicting proximal junctional fractures (PJFr) following surgery for adult spinal deformity (ASD) using computed tomography (CT)-based measurement of Hounsfield units (HUs). CT-based measurement of HUs is an alternative tool for assessing bone mineral density. However, the optimal method for predicting adjacent vertebral fractures following spinal fusion using HUs remains unclear. This retrospective observational study included 42 patients who underwent reconstructive surgery for ASD. Elliptical regions of interest (ROIs) on the axial section and rectangular ROIs on the sagittal section were placed at the upper instrumented vertebrae (UIV), UIV+1, and UIV+2. In addition, the HU value of the L2 vertebra was used as the representative. PJFr occurred in 28.6% of patients within 2 years following surgery. The HU values obtained from the axial sections of L2, UIV, UIV+1, and UIV+2 were not significantly associated with the incidence of PJFr within 2 years, except for the ROI set in the lower region of the L2 vertebra. However, the HU value of the anterior third of the UIV in the sagittal section was significantly lower in the PJFr group than in the nonPJFr group (87.0 vs. 160.3, p =0.001). A UIV HU value of <100 was associated with a higher incidence of PJFr than an HU vaue of >100 (p <0.05). Measurements of HU in the anterior one-third of the UIV in the sagittal section demonstrated predictive ability for PJFr following ASD surgery. A UIV HU value of <100 emerged as a risk factor for PJFr.

Background: The number of studies on cognitive impairment in patients with chronic obstructive pulmonary disease (COPD) has been increasing in recent years. However, no study has comprehensively examined the relationship between cognitive impairment and occupation. Thus, the relationship between cognitive impairment and occupation in patients with COPD remains unclear.