Soma Central Hospital

For pancreatic cancer, combination therapies, such as gemcitabine plus nab-paclitaxel (GnP) or FOLFIRINOX (FFX), are recommended as first-line (FL) chemotherapy. Second-line (SL) chemotherapy has been shown to improve survival, but factors predicting eligibility for SL chemotherapy remain unclear. This study aimed to identify factors predicting eligibility for SL chemotherapy and to develop a predictive nomogram. This retrospective multicenter study included 278 patients with unresectable PC who received FL chemotherapy between 2017 and 2023. Patients were divided into the development (n=140) and external validation (n=138) cohorts. Univariate and multivariate logistic regression analyses were performed to identify predictors of eligibility for SL chemotherapy. A nomogram was developed using these independent predictors and was validated via calibration curves and c-statistics. The independent predictors of eligibility for SL chemotherapy included age (<70 years old), C-reactive protein (CRP) levels, and the FL regimen (combination vs. monotherapy). The nomogram demonstrated good predictive accuracy (c-statistic: 0.78) in the development cohort and acceptable accuracy (c-statistic: 0.68) in the validation cohort. The calibration curves showed good agreement between predicted and observed probabilities. The nomogram developed herein is a reliable tool for predicting eligibility for SL chemotherapy among PC patients, thereby facilitating informed treatment decisions.

To identify, synthesise and critically appraise the findings of meta-analyses that compare patient-reported outcome measures (PROMs) between unrestricted kinematic alignment and mechanical alignment in total knee arthroplasty (TKA). It was hypothesised that some meta-analyses inaccurately combine PROMs from unrestricted and restricted kinematic alignment techniques. Two authors independently screened articles based on inclusion and exclusion criteria and assessed the methodological quality based on the 16 domains of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Effect sizes of difference in PROMs were tabulated for each meta-analysis. Studies included in the meta-analyses were assessed to determine if they were on true unrestricted kinematic alignment. A secondary meta-analysis excluded studies on restricted kinematic alignment techniques, to recalculate pooled estimates (mean difference (MD) with their 95% confidence interval (CI)) of the Knee Society Score (KSS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Forgotten Joint Score (FJS). The quality of evidence was assessed using the GRADE. There were 15 meta-analyses pooling data from 39 clinical studies eligible for data extraction. None fulfilled all seven critical AMSTAR-2 domains. Some reported kinematic alignment yielded superior KSS (Function, n = 9; Knee, n = 6: Combined, n = 8), OKS (n = 7), WOMAC (n = 8) and FJS (n = 1). The secondary meta-analysis included only studies on unrestricted kinematic alignment and results at the latest follow-up, for which the mean and standard deviations were reported and revealed no difference in KSS, OKS, WOMAC or FJS between kinematic and mechanical alignment. GRADE analysis revealed 'very low' quality of evidence for KSS, WOMAC and FJS, while it was 'low' quality for OKS. Current evidence suggests no difference in PROMs between kinematic and mechanical alignment in TKA. Meta-analyses that report the contrary often need more rigour as they pool studies on various kinematic alignment techniques or represent the same cohort at different times. Orthopaedic societies should promote using objective outcome measures to evaluate and compare alignment techniques. Systematic review protocol registration (Prospero: CRD42023434713). Level III.

A venous aneurysm (VA) is characterized by localized venous dilatation. We report a case of a left external jugular VA in a child with recurrent thrombophlebitis. The patient was diagnosed at 1 year of age, and the VA temporarily regressed after thrombophlebitis at 3 years of age, but it recanalized and recurred at 7 years of age, necessitating surgical resection. Five years after surgery, no recurrence of VA was observed. Although surgical resection of a VA associated with thrombophlebitis may be an effective treatment option, with a favorable post treatment course, early excision should also be considered.

Background: Reduced or delayed access to medical resources on weekends could lead to worsening outcomes, in critically ill infected patients requiring intensive care unit (ICU) admission. Objective: To investigate the “weekend effect,” on critically ill infected patients in Japanese ICUs for the first time. Design: Multicenter retrospective cohort study. Methods: We examined data from Japanese ICU patients participating in the DIANA study, a multicenter international observational cohort study. This prospective investigation enrolled critically ill patients with infections admitted to the ICU. The primary endpoint was successful discharge from the ICU within 28 days of admission. Outcome measures were evaluated through both univariate and covariate Cox regression analyses, providing hazard ratios (HRs) along with estimated 95% confidence intervals (CIs). Results: Out of the 276 patients enrolled in the DIANA study across 31 facilities, 208 patients (75.4%) meeting the inclusion criteria were included in the analysis. The weekday ICU admission group comprised 156 patients (75.0%), while the weekend ICU admission group comprised 52 patients (25.0%). In the multivariate Cox regression analysis, there were no statistically significant differences observed in the rates of ICU discharge alive within 28 days and 14 days (28 days, HR: 0.94, 95% CI: 0.63–1.40; 14 days, HR: 0.97, 95% CI: 0.64–1.48). Furthermore, the overall ICU mortality rates at 28 days and 14 days after ICU admission did not show statistical significance between patients admitted on weekends and those admitted on weekdays (ICU mortality, 28 days: 13.5% vs 11.5%, p = 0.806; 14 days: 7.7% vs 10.9%, p = 0.604). Conclusion: The rates of ICU discharge alive within 28 days after ICU admission did not differ significantly between weekday and weekend admissions, both in the unadjusted and adjusted analyses. Moreover, further well-designed studies are warranted to thoroughly assess this effect.

Conflicts of interest (COIs) in medical research can introduce biases affecting research integrity. This study investigated the scale and disclosure of COIs among Japanese authors of cancer clinical trials. Fifty-eight cancer randomized controlled trials from 2020, involving 226 Japanese authors, were systematically abstracted and analyzed. The financial relationships between these authors and pharmaceutical companies were examined using payment data from 56 companies for the years 2018-2019. COI statements were extracted from each publication, and COI declaration rates were calculated by comparing declared companies against those that reported payments. The analysis was conducted at both the author and article levels. For author-level analyses, the declaration rate was calculated per declaration rather than per author. For article-level analyses, payments were aggregated and attributed to their respective articles. Phase III trials comprised 82.8% (48/58) of the included studies. Of 226 authors, 202 (89.4%) were medical doctors and 208 (92.0%) received at least one payment. The median number of companies providing at least one payment per author was 9 (IQR, 4-12), with a median total payment of $19,183 US dollars (USD; IQR, $5,158-$62,534 USD). Among 280 unique disclosures from authors with payments, only 29 (10.4%) accurately reported COIs, whereas 80 (28.6%) reported no COIs. For 58 articles, only two (3.4%) accurately reported COIs, seven (12.1%) reported no COIs, and 49 (84.5%) partially disclosed COI information. Japanese cancer clinical trial authors frequently received industry payments, yet their COI disclosures were often inadequate. This highlights the need for stricter guidelines and improved education on COI reporting in Japan.

ObjectivesAlthough accurate assessment of polyp morphology helps endoscopists select the appropriate management for colorectal polyps, some studies have reported unsatisfactory accuracy in such assessment. This study aimed to clarify the usefulness of a short educational video available on the Internet for accurate polyp morphology assessment.MethodsThis was a multicenter randomized controlled trial. Participants were randomly assigned to the pre‐ or post‐education groups after a pre‐test comprising images of 42 polyps, including 12 laterally spreading tumors. Participants who scored ≥ 80% on the pre‐test were excluded. Only the post‐education group completed the diagnostic test after watching an online educational video. The primary outcome was the difference in diagnostic accuracy between the pre‐test and diagnostic tests for each group.ResultsOf the 296 endoscopists enrolled from 48 institutions, 34 missed the test deadline, and 29 who scored ≥ 80% in the pre‐test were excluded. The primary outcome analysis sets were 117 and 116 in the pre‐ and post‐education groups, respectively. The mean pre‐test accuracies in the pre‐education and post‐education groups were 60.6% and 60.7%, respectively. The difference in diagnostic accuracy between the pre‐test and diagnostic test was significantly higher in the post‐education than the pre‐education group (12.0 points, 95% confidence interval [CI] 9.9–14.1 and 2.3 points, 95% CI 0.9–3.6; p < 0.001).ConclusionThis multicenter randomized controlled trial demonstrated the usefulness of a short educational video for accurate polyp morphology assessment.

[Purpose] This study aimed to examine the relationship between bioelectrical impedance analysis measurements and 10 repetition maximum for chest press and leg press, and to develop a regression model to determine if bioelectrical impedance analysis can predict 10 repetition maximum in healthy young adults. [Participants and Methods] Ninety-four healthy adults participated in the study. Correlations between 10 repetition maximum and bioelectrical impedance analysis measurements were calculated, and simple linear regression was performed using bioelectrical impedance analysis measurements as independent variables to develop 10 repetition maximum prediction models. [Results] Significant correlations were found between 10 repetition maximum and bioelectrical impedance analysis measurements. The regression models for 10 repetition maximum for chest press based on upper limb muscle mass, skeletal muscle mass, and skeletal muscle mass index were Y=16.40X-13.27, Y=3.81X-36.78, and Y=20.51X-81.27, respectively. The regression models for 10 repetition maximum for leg press based on lower limb muscle mass, skeletal muscle mass, and skeletal muscle mass index were Y=12.60X-3.21, Y=8.09X-24.39, and Y=43.68X-119.60, respectively. [Conclusion] These findings may contribute to developing a safe and efficient method for measuring 10 repetition maximum, which can be useful in resistance training prescriptions.

Amino acid (AA) substitutions in the fusion (F) protein of respiratory syncytial virus (RSV) and their effects on antibody susceptibility remain unclear. We analyzed AA substitutions in the main neutralizing epitopes of the F protein. We analyzed F protein genes of 236 RSV strains isolated from children hospitalized with RSV infection in Fukushima, Japan (June 2008-February 2023). AA substitutions in antigenic sites II, V, and Ø were detected, and their effects on antibody susceptibility and viral replication were evaluated. Site II: The K272M (RSV-A) and the K272E (RSV-B) substitutions in strains from palivizumab-treated children reduced antibody susceptibility. Site V: In RSV-A, >50% of strains isolated since 2022 harbored the V178I substitution; however, this did not change antibody susceptibility. In RSV-B, L172Q/S173L mutant strains became predominant around 2016, leading to reduced antibody susceptibility. Site Ø: No AA substitutions were detected in RSV-A. In RSV-B, the I206M/Q209R mutant strain became predominant around 2018, leading to improved antibody susceptibility and replicative ability. However, none of the substitutions reduced antibody susceptibility. The RSV F protein in Fukushima has naturally undergone AA substitutions with corresponding changes in antibody susceptibility, including unique regional patterns. Monitoring substitutions and antibody susceptibility is essential.

Objective: This study aims to investigate the prognostic value of cardiac troponin levels measured at admission to the emergency department (ED) for stroke severity assessed by the National Institutes of Health Stroke Scale (NIHSS) and neurological outcomes determined by Modified Rankin Scale (mRS) scores in patients diagnosed with acute ischemic stroke (AIS). Materials and Methods: Patients presenting to ED with a diagnosis of AIS confirmed by neuroimaging findings were included. Patients were divided into 2 groups based on troponin-I levels: elevated and normal. NIHSS during admission, 30-day all-cause mortality data, and 30-day mRS were examined. In comparisons between groups, categorical variables were evaluated with Chi-square and continuous variables were evaluated with the Mann-Whitney-U test. To determine the prognostic value of troponin with poor outcomes in stroke patients, diagnostic 2x2 tables were made. Results: The study was conducted with 200 patients. Troponin elevation was detected in 37, and mortality was significantly higher in this group. The sensitivity of troponin to predict mortality was 88.89%, and PLR (positive likelihood ratio) was 5.85 (3.89–8.79). The 30-day mRS scores were significantly higher in the elevated troponin group. NIHSS scores didn’t show a significant difference between groups. Conclusions: Troponin levels assessed at admission in AIS patients may be a prognostic marker for mortality and adverse neurological outcomes.