Otaru Municipal Hospital

Guideline-consistent prophylaxis is more effective in managing chemotherapy-induced nausea and vomiting than non-guideline approaches. However, the extent to which patients undergoing anticancer treatment receive guideline-recommended antiemetic therapy in real-world clinical practice remains unclear. This study evaluated the real-world patterns of antiemetic therapy among patients undergoing high emetic risk chemotherapy (HEC) and carboplatin-based moderate emetic risk chemotherapy (MEC) according to cancer type and treatment regimen and identified factors associated with antiemetic use. We used health service utilization data linked to hospital-based cancer registries from 601 hospitals in Japan. Data from patients aged ≥ 18years diagnosed with cancer in 2020 and 2021 and treated with intravenous HEC or carboplatin-based MEC were analyzed. The percentage of patients prescribed antiemetics was calculated. A multilevel mixed-effects logistic regression was performed to identify factors associated with antiemetic therapy. A total of 157,705 patients were analyzed (HEC: 100,163; MEC: 57, 542). Triple-drug antiemetics (an NK1 receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone) were prescribed to 70.6% and 71.9% of patients undergoing HEC and MEC, respectively. In the HEC group, 8.9% received olanzapine in addition to triple-drug antiemetics. Antiemetic therapy varied by cancer type and regimen. In multilevel analysis, odds of receiving triple-drug antiemetics were the highest in small-cell lung cancer (OR = 3.065) for HEC and in endometrial cancer (OR = 1.324) for MEC. Antiemetic therapy for patients receiving HEC or carboplatin-based MEC varies by cancer type and treatment regimen. Future research should explore reasons for and barriers to non-adherence to guidelines.

In this study, a questionnaire was used to identify the components of place engagement and structural characteristics. Factor analysis revealed that place engagement consists of “Community Involvement and Contribution Orientation Factor” and “Place Attachment and Orientation Toward Unity Factor.” In addition, latent variables extracted from the results of the factor analysis were analyzed using a structural analysis of covariance. The results revealed the following:

Battery longevity in high-voltage devices (HVDs), specifically implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy-defibrillators (CRT-Ds), is critical for reducing the frequency of generator replacements, minimizing procedural risks, and enhancing patient outcomes. Despite technological advancements, significant variability in battery performance remains among the major manufacturers. This study aimed to evaluate the battery longevity among ICDs and CRT-Ds from the major manufacturers implanted at a single institution and identify the factors influencing battery depletion. We conducted a retrospective analysis of 353 patients implanted with HVDs (63 Abbott, 150 Boston Scientific, 140 Medtronic) at Hokkaido University Hospital between 2012 and 2021. Kaplan-Meier curves and Cox proportional hazards models were used to analyze the device longevity, with a primary endpoint of the time to battery depletion, defined by the elective replacement indicator. A multivariate analysis adjusted for the potential confounders. Boston Scientific devices exhibited a significantly longer battery life than Abbott and Medtronic devices (p < 0.001), with a 6-year replacement-free survival of 99% for ICDs and 93% for CRT-Ds. A multivariate analysis identified the device manufacturer, device type (ICD vs. CRT-D), and ventricular pacing rate as independent predictors of battery depletion (p < 0.001). Battery longevity differed significantly by the manufacturer, which may influence device selection. Devices with a longer battery life may help reduce the replacement frequency and could potentially contribute to improved patient outcomes and cost-effectiveness.

Clazosentan (CLZ) therapy prevents delayed ischemia following aneurysmal subarachnoid hemorrhage (aSAH), but non-ischemic adverse events necessitate optimized protocols. This study presents outcomes of contemporary CLZ therapy under a unified protocol and identifies factors influencing delayed ischemic and non-ischemic adverse events following aSAH. This multicenter prospective registry analyzed data from 80 aSAH patients receiving CLZ therapy (April 2023 - October 2024). Primary endpoints were delayed ischemic events and non-ischemic adverse events; secondary endpoint was favorable outcome (modified Rankin Scale 0-2) at discharge or six weeks post-onset. Delayed ischemic events occurred in 19 patients (23.8%), including delayed ischemic neurological deterioration (8.8%), moderate-to-severe cerebral vasospasm (20.0%), and symptomatic delayed cerebral infarction (7.5%). Non-ischemic adverse events were observed in 22 patients (27.5%). Favorable outcomes were achieved in 52 patients (65.0%). Delayed ischemic events were associated with female sex, poor severity grades, higher Fischer scale scores, and elevated neutrophil-to-lymphocyte ratios. Non-ischemic adverse events were associated with older age, anemia, hypoproteinemia, and elevated cardiothoracic ratios. Multivariate analysis identified non-ischemic adverse events as significant for unfavorable outcomes (FDR p <.001), whereas delayed ischemic events were not (FDR p =.705). Among non-ischemic adverse events, pulmonary edema was the strongest factor associated with unfavorable outcomes. In conclusion, CLZ therapy with appropriate candidate selection and management protocol appears promising as a treatment option to prevent delayed ischemia after aSAH, though potential confounders warrant careful consideration. Addressing clinical risk factors for non-ischemic adverse events may further enhance treatment outcomes. Clinical trial number Not applicable.

Programmed death ligand 1 (PD-L1) serves as a crucial biomarker for predicting the efficacy of immune checkpoint inhibitors in patients with non-small cell lung cancer (NSCLC). This study aimed to identify the most suitable first-line treatment regimen for patients with PD-L1 expression <1% (PD-L1-negative) NSCLC by comparing nivolumab plus ipilimumab (NI), NI combined with chemotherapy (NICT), and pembrolizumab and chemotherapy (PCT). We analyzed data from 141 patients with PD-L1-negative NSCLC treated with NI, NICT, or PCT at 14 Japanese institutions between December 2020 and November 2022. Propensity score analysis was employed to minimize selection bias, and Kaplan-Meier analysis and Cox proportional hazards regression were used to evaluate progression-free survival (PFS) and overall survival (OS). Neither NI nor NICT demonstrated superior PFS or OS than PCT. Subgroup analyses revealed no significant differences between treatment groups across age, histological subtypes, or clinical features. Results from propensity score matching and inverse probability of treatment weighting were consistent with those observed in the overall cohort. Moreover, safety profiles showed that PCT was associated with the lowest rates of treatment discontinuation and immune-related adverse events requiring systemic corticosteroid therapy. In patients with PD-L1-negative NSCLC, the efficacy of NI and NICT was not superior to that of PCT. Thus, we concluded that PCT could be a favorable treatment option for this patient population.

ObjectiveThe incidence and mortality rates of endometrial cancer are increasing globally, including in Japan. Quality of cancer care is promoted through guideline adherence. This study aimed to establish quality indicators (QIs) for endometrial cancer and explore the factors contributing to treatment nonadherence.MethodsQIs and pattern-of-care indicators (PCIs) were developed using the Research and Development/University of California Los Angeles modified Delphi method. QIs reflect desirable healthcare patterns, whereas PCIs address treatment areas with lacking evidence. Data from the Hospital-Based Cancer Registry and Diagnosis Procedure Combination Survey were used. Patients diagnosed or treated between January 1 and December 31, 2020 were included. The reasons for nonadherence were collected. Logistic regression was used to analyze the factors influencing adherence, including age, body mass index, comorbidities, facilities, and recurrence risk.ResultsOf the 35 proposed QI candidates, 8 QIs and 9 PCIs were selected, predominantly focusing on surgical aspects. Adherence rates varied, with peritoneal lavage cytology being the highest (93.1%), and postoperative hormone replacement therapy (HRT) for patients aged <45 years being the lowest (30.9%), when focusing on process indicators. Reasons for nonadherence included patient preference and medical comorbidities as significant factors. Multivariate analysis highlighted age, clinical stage, and Barthel index as significant contributors to nonadherence.ConclusionWe developed QIs to comprehensively assess endometrial cancer treatment. Adherence rates are favorable; however, HRT has a low adherence rate. Factors leading to nonadherence include advanced age and incomplete activities of daily living, particularly in advanced stages.

Because the concepts of goal setting and patient education are intertwined, it is important to understand the details of patient education content for cancer survivors. This study aimed to conduct a comprehensive review of the timing (during or after treatment), setting, and content of patient education provided to cancer survivors prior to setting goals. A systematic search was conducted across three databases to identify articles on rehabilitation that included patient education, conducted prior to goal setting for cancer survivors. The patient education was then mapped according to the survivors' treatment stage and the 13 elements outlined in the health decision model proposed by Eraker et al. RESULTS: A review of 21 studies revealed that only four (19.0%) were randomized controlled trials (RCTs). Additionally, education for patients, including goal setting, often considers survivors' feelings and provides adequate information through interactive and repeated communication. However, the satisfaction of survivors (an element of patient education) is not sufficiently reflected in the education provided. During treatment, education more includes personalized materials and evaluations of patient comprehension than after treatment. After treatment, other healthcare professionals are more involved, and social networks are more incorporated than during treatment. Current patient education research evaluating comprehension by cancer survivors after treatment, multidisciplinary approaches during treatment, and active participation by family members in outpatient or home care, is lacking. Studies that address these gaps should be conducted as RCTs.

This study was performed to assess postoperative aortic remodelling (AR) after total arch replacement for acute type A aortic dissection (AAD) with a frozen elephant trunk (FET) or conventional elephant trunk (cET). Furthermore, the shape of the residual true lumen was analysed based on elliptical Fourier analysis and evaluated as a predictor of AR. This study involved patients who underwent total arch replacement with a cET or FET for AAD from December 2006 to January 2023 at five institutions. AR was assessed at the levels of the 4th thoracic vertebra (Th4), Th7, Th10, and above the coeliac trunk. The shape of the residual true lumen at all four levels was analysed based on elliptical Fourier analysis to calculate shape patterns as principal component (PC) values. Inverse probability of treatment weighting was performed for adjustment between the groups. In total, 180 patients (88 with cET and 92 with FET) were enrolled. The complete AR rate, defined as false lumen remodelling throughout the entire descending thoracic aorta, was significantly higher in the FET than cET group (63.4% vs 32.0%, P = 0.0013). The inverse probability of treatment weighting-adjusted Fine-Gray regression model revealed that the mean PC2 (hazard ratio, 0.22; P < 0.001) and PC3 (hazard ratio, 0.24; P = 0.009) of the four levels were independent predictors of complete AR. In AAD repair, the AR rate was significantly higher with use of the FET than cET. The shape patterns of the residual true lumen can be an important reference for predicting postoperative AR.

BackgroundSodium-glucose cotransporter-2 inhibitors (SGLT2i) have been reported to have effects beyond lowering blood glucose levels, with certain SGLT2i expanding their indications to chronic kidney disease and chronic heart failure. We focused on the hepatoprotective and renoprotective effects of six SGLT2i and assessed whether the effects were unique to each drug or common class effects, in addition to whether the renal and hepatoprotective effects vary based on renal and hepatic status.MethodsPatients with diabetes (ipragliflozin: 837, empagliflozin: 850, canagliflozin: 922, dapagliflozin: 590, tofogliflozin: 288, and luseogliflozin: 193) who initiated SGLT2i treatment and were monitored for one year were included. The propensity score (PS) was calculated using patient backgrounds (age, sex, height, weight, body mass index [BMI], disease duration, concomitant diabetes medications, underlying conditions, glycated hemoglobin [HbA1c], estimated glomerular filtration rate [eGFR], aspartate aminotransferase [AST], alanine aminotransferase [ALT], high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglyceride [TG] levels) as covariates. Additionally, the inverse probability of treatment weighting (IPTW) approach was used to compare liver and renal function test values.ResultsPre- and 12-month post-treatment comparisons demonstrated a significant reduction in hepatic function (AST and ALT) and an increase in renal function (eCcr and eGFR) for all SGLT2i. Comparison of differences between pre- and 12-month post-treatment using the IPTW approach demonstrated no significant differences in AST, ALT, and eGFR levels between SGLT2i. At 12 months post-treatment, 67 patients were classified as having a more severe CKD than those at pre-treatment, representing only 1.8% of all patients (67/3,680). Similarly, 107 patients with AST and 147 patients with ALT were classified as having progressed to a more severe grade than at pre-treatment, representing only 2.9 and 4.0%, respectively.ConclusionsRenoprotective and hepatoprotective effects are class effects of SGLT2i, and their effects are thought to be independent of kidney or liver status.

Unsedated peroral endoscopy, including ultrathin endoscopy (UE) and conventional endoscopy (CE), is feasible in clinical practice but requires improved endoscopic operability and patient tolerance. Currently, the impact of the breathing method on these factors remains unclear. We conducted the first randomized controlled trial comparing oral breathing (OB) and nasal breathing (NB) during both UE and CE to assess their influence. About 252 eligible patients undergoing CE or UE were randomly assigned to OB or NB groups. Endoscopists and patients rated endoscopic operability and patient tolerance using a 100-mm visual analog scale. Visibility from the oral cavity to the middle pharynx was recorded. OB led to a higher rate of improved visibility from the oral cavity to the middle pharynx compared with NB, ranging from 79.3% to 81.0%. Multivariate correlation analyses showed significantly lower visual analog scale scores for endoscopic operability with OB compared with NB in both UE and CE groups ( P < 0.05). No significant differences were found in the overall evaluation of patient tolerance between OB and NB groups in UE and CE, whereas the smaller diameter of UE exhibited better patient tolerance compared with CE. Discriminant analysis comparing endoscope types and breathing methods revealed that UE with OB outperformed other combinations in the overall evaluation of endoscopic operability and patient tolerance ( P < 0.05). OB facilitates endoscopic operability compared with NB in peroral endoscopy. UE with OB is recommended as the preferred choice for unsedated peroral endoscopy in daily practice.