Okinawa Prefectural Chubu Hospital

BackgroundAdvancing antimicrobial stewardship programs (ASP) has led to various metrics for assessing antimicrobial consumption. Since introducing the antimicrobial spectrum index (ASI) in 2017, similar metrics, such as days of antibiotic spectrum coverage (DASC), have emerged to better evaluate antimicrobial use, particularly considering de-escalation process. This study assessed antimicrobial consumption with a de-escalation process using DASC in 12 hospitals across three regions in Japan.Table 1.Characteristics of participating hospitalsFigure 1.Trend of monthly DASC/DOT and DOT per 1,000 patient-days stratified by hospital types.MethodsIntravenous antimicrobial consumption data from 12 Japanese hospitals (April 2016–March 2024) were collected. The participating hospitals were located in three regions: West (Okinawa, n=6), East (Tokyo, n=5), and Midwest (Aichi, n=1). Monthly antimicrobial consumption was expressed as days of therapy (DOT) and then converted to DASC per 1,000 patient-days (PD). Hospital-wide de-escalation was evaluated using DASC/DOT. The correlation between DASC/DOT (a new metric) and DOT per 1,000 PD (a conventional metric) was assessed using Spearman’s rank-order correlation test. Hospital characteristics, including ASP availability, and infectious disease consultation, were also collected.Figure 2.Trends of DOT per 1,000 PD, DASC per 1,000 PD and DASC/DOT stratified by hospital regionsResultsA total of 96 months of data were analyzed. Monthly median DOT, DASC, and DASC/DOT were 303.4, 2107.0, and 7.2, respectively. There was little correlation between DASC/DOT and DOT per 1,000 PD (rho=0.11; P< 0.73). University hospitals (median 7.7) and a cancer center (median 8.0) had higher DASC/DOT than the remaining 9 community hospitals (median 6.9), likely owing to the availability of transplant services and a larger number of ICU beds (Figure 1 and Table 1). A substantial decrease in DASC/DOT at one university hospital since August 2022 was observed, likely due to implementing a hospital-wide restriction of carbapenem use. Median DASC/DOTs in East and West were 6.9 and 7.2, respectively, suggesting that the de-escalation process has progressed more at hospitals in Tokyo than at hospitals in Okinawa (Figure 2).ConclusionDASC/DOT, showing little correlation with traditional DOT per 1,000 PD, is a useful metric to assess antimicrobial use and de-escalation process. A regional-level and hospital type-level comparisons can help identify facilities needing further ASP promotion.DisclosuresAll Authors: No reported disclosures

The diagnostic criteria for TAFRO syndrome exclude autoimmune diseases, and they have been considered to be mutually independent. However, several cases of autoimmune diseases with TAFRO signs have been reported in recent years. Also, similarities in cytokine profiles in COVID-19 and TAFRO syndrome have been previously reported. Our patient, a 53-year-old Japanese man, was diagnosed with COVID-19 and had a persistent fever. Two weeks later, pain, numbness, and oedema appeared, mainly in the right lower leg but gradually spreading to the distal extremities. Subsequently, purpura appeared on his forearms and lower legs, and 10weeks after the COVID-19 diagnosis he presented to our hospital. On admission, in addition to fever, polyangiitis, and purpura of the extremities, he had splenomegaly, lymphadenopathy, and anasarca. Skin and renal histopathology revealed fibrinoid necrotising vasculitis of small and medium-sized arteries. In addition, his platelet count was low, Alkaline phosphatase (ALP) was elevated, and there was anasarca, fever, and renal failure. A diagnosis of polyarteritis nodosa with TAFRO signs was made. On the 20th day of admission, high-dose glucocorticoids and high-dose intravenous cyclophosphamide were started. The platelet count initially improved, with gradual improvement of vasculitis and symptoms of fever, purpura, and neuropathy. However, there was another decrease in platelets, progression of renal dysfunction, and worsening of fluid retention. Tocilizumab was added, but the disease could not be controlled, and on the 51st day, necrotising fasciitis developed and the patient died. This case suggests that COVID-19, TAFRO syndrome, and vasculitis may be interrelated in their pathogeneses.

ABSTRACTIntroductionWhile established in pediatric urology, the laparoscopic use of appendiceal substitution of the ureter in adults is rare.Case PresentationAn 83‐year‐old man developed a 2.5‐cm right mid‐ureteral stricture as a complication after endoscopic treatment for a ureteral stone. Preoperative imaging confirmed an adequate appendix length. A laparoscopic approach was selected due to its minimal invasiveness, which was considered particularly appropriate for an elderly patient. After isolation with a linear cutting stapler, both ends of the appendix were resected, and a guidewire was passed through. To prevent mesoappendix torsion, the cecal side was oriented cranially before ureteral anastomosis. The operative time was 336 min, with 10 mL blood loss. Postoperative ureteral stone formation resolved spontaneously, and renal function was preserved.ConclusionLaparoscopic appendiceal interposition is a viable and minimally invasive option for right mid‐ureteral reconstruction in selected elderly patients.

<bold>Background:</bold> Drug-induced lung injury associated with lung cancer chemotherapy is a serious adverse event that can complicate treatment management and worsen prognosis. However, there are limited reports on the usefulness of serum SP-D and KL-6 in drug-induced lung injury related to lung cancer drug therapy. We aimed to investigate the clinical significance of serum SP-D and KL-6 in this condition. <bold>Method:</bold> We conducted a retrospective study of 121 patients who had serum SP-D and KL-6 measured at the time of diagnosis of drug-induced lung injury at our hospital and collaborating institutions. SP-D and KL-6 levels at disease onset were analyzed using descriptive statistics. We defined the differences between the values at onset and those at the initiation of lung cancer drug therapy as ⊿SP-D and ⊿KL-6, respectively. ROC analysis and multivariate analysis were performed to assess their association with disease severity, comparing CTCAE pneumonitis severity Grade 1–2 and Grade 3–5 groups. <bold>Results:</bold> In ROC analysis, the AUC for ⊿SP-D and ⊿KL-6 were 0.66 and 0.50, respectively. The optimal cutoff values were 108 for ⊿SP-D and 141 for ⊿KL-6. In multivariate analysis, the odds ratios of ⊿SP-D and ⊿KL-6 above the cutoff values were 3.8 and 0.9, respectively, with ⊿SP-D showing a statistically significant difference. <bold>Conclusion:</bold> SP-D and KL-6 may be useful biomarkers for diagnosing drug-induced lung injury and can be detected with high sensitivity when used in combination. We also report on its potentially important role in disease assessment, and severity prediction.

Background:Platinum-based compounds have been instrumental in clinical oncology, underscoring the critical need to identify predictive biomarkers for these agents to advance personalized medicine.Objectives:This study aimed to identify predictive biomarkers for platinum-based chemotherapies in gastrointestinal cancers.Design:This study was designed to explore candidate single-nucleotide polymorphisms (SNPs) through a genome-wide association study (GWAS), followed by re-evaluation using external nationwide cohorts. Subsequently, the biological functions of the selected SNPs were analyzed utilizing the online multi-omics databases.Methods:First, we conducted a GWAS in a discovery cohort of esophageal cancer (EC) patients undergoing platinum-based chemoradiation therapy, followed by Cox proportional-hazards analyses for overall survival and progression-free survival. Potential candidate polymorphisms identified in the discovery phase were validated in an external cohort derived from the nationwide BioBank Japan (BBJ).Results:Validation analysis revealed a significant association between the T allele of rs12876842 and tumor control rates in a gastric cancer cohort (p = 0.006). In other BBJ cohorts, including the chemoradiotherapy-treated BBJ-EC cohort, the odds ratio trends were consistent with the hazard ratios observed in the discovery cohort, indicating concordance of the risk allele across cancer types, although statistical significance was not reached. Analysis of online databases suggests that the C allele, identified as a risk allele, exhibits higher binding affinity to KLF4, while POLR1D, a downstream target of KLF4, may contribute to adverse prognostic signatures across multiple cancers. Besides, a significant association between genotype of rs12876842 and POLR1D expression in the gastroesophageal junction is confirmed in Genome Tissue Expression (p = 0.0000113), and prior studies have linked POLR1D expression with disease progression, neoplastic transformation, chemotherapy resistance, and poor clinical outcomes in various malignancies.Conclusion:Given the centrality of platinum-based drugs in cancer therapy, our findings align with biochemical evidence and prior literature, highlighting rs12876842 as a promising prognostic biomarker.

Nonoperative management (NOM) is the standard of care for hemodynamically stable pediatric blunt liver and/or spleen injuries (BLSIs). The value of interventional radiology (IR) in NOM of pediatric BLSIs is not clearly established. This study aimed to describe the use and outcomes of IR in the management of pediatric BLSIs. This post hoc analysis examined data from an 83-center retrospective study called the Splenic and Hepatic Injury in Pediatric Patients study in Japan. Participants included patients 16 years or younger who sustained BLSIs and received IR interventions between January 2008 and December 2019. The patients were categorized based on the indication for initial IR: acute hemorrhage, delayed hemorrhage/ruptured pseudoaneurysm, unruptured pseudoaneurysm, and others. The primary endpoint was IR failure, defined as requiring laparotomy after deciding for NOM with IR. Descriptive statistics were used to illustrate the baseline patient characteristics and IR treatment details. Among the 1,462 pediatric patients with BLSIs, 316 patients who underwent IR were evaluated. The median patient age was 11 years, and 68% were male. Organ injuries included 176, 118, and 20 splenic, liver, and simultaneous injuries, respectively. Contrast extravasation on pre-IR computed tomography imaging was found in 60.6% of the patients. The median time to IR from admission varied by indication, with the acute hemorrhage group treated in approximately 2 hours. Transcatheter arterial embolization was performed in 273 patients. In-hospital complications occurred in 7%, with IR-related complications in 0.6%. Interventional radiology failed in 3.8% of the patients, and the in-hospital mortality rate was 1.9%. Splenic salvage was successful in 98.4% of the patients. Interventional radiology demonstrated low failure and procedural complication rates in pediatric BLSIs. Therapeutic/Care Management; Level IV.

Patients with cervical spinal cord injuries (CSCI) experience hypotension mainly caused by attenuated total peripheral resistance. Some physicians and nurses believe that this peripheral blood pressure (PBP) decrease in patients with CSCI results in the formation of pressure injuries. We hypothesized that the measurement of PBP, such as arteriole and capillary pressure, could be a simple and efficient means of detecting skin and deep tissue damage in patients with CSCI. However, PBP in the skin has not been measured in patients with CSCI. The purpose of this study was to investigate PBP in patients with CSCI. Eleven men patients with CSCI with a lesion between C6 and C7 (American Spinal Injury Association score A, average age 32.5 years) and 13 healthy participants (average age 40.1 years) participated in the study. To measure PBP, laser Doppler blood flowmetry with a fixed pressure transducer was gently applied to the pretibial skin, and the pressure when skin blood velocity was zero was determined as the PBP. The mean blood pressure (MBP) was measured simultaneously. There was a significant correlation between MBP and PBP in patients with CSCI, but not in healthy individuals. A significantly lower MBP was observed in patients with CSCI (means ± SE; 76.7 ± 3.9 mm Hg) than in healthy individuals (means ± SE; 91.0 ± 4.0 mm Hg). PBP in patients with CSCI (means ± SE; 55.7 ± 2.0 mm Hg) was significantly greater than in healthy individuals (means ± SE; 45.9 ± 2.3 mm Hg). Transection of the sympathetic nervous system from the medulla to the peripheral nerves in patients with CSCI results in decreased MBP and increased PBP. We suggest that cervical spine transection diminishes the tonic impulses of sympathetic nerves to resistant vessels in patients with CSCI.