Ureshino Medical Center

Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with a growing incidence and mortality globally. Although the clinical features, treatment, and prognosis of Mycobacterium avium-intracellulare (MAI) pulmonary disease have been extensively reported, evidence regarding non-MAI NTM-PD remains limited. This retrospective cohort study included patients newly diagnosed with NTM-PD between 2010 and 2017at 18 hospitals in Kyushu, Japan. Data on baseline characteristics, causative organisms, radiological findings, treatment regimens, and clinical outcomes were collected and analysed. In total, 1317 patients were enrolled. M. intracellulare (50.4%), M. avium (40.5%), M. abscessus complex (MABC) (2.4%), and M. kansasii (2.4%) were identified as the major causative organisms. Compared with patients with MAI, those with MABC exhibited a lower body mass index and a higher AFB sputum smear positivity rate. Patients with M. kansasii infection were predominantly male, frequently had underlying chronic obstructive pulmonary disease, and presented with cavitary lesions. Treatment initiation rates for MABC and M. kansasii were 71.9% and 87.5%, respectively. The response rate to the treatment in sputum mycobacterial evaluation was comparable between the two groups. However, the re-treatment rate was higher in the MABC group (30.4% vs. 14.3%). The 10-year mortality rates were 25.0% and 15.6% for MABC and M. kansasii, respectively. Initial treatment responses for MABC and M. kansasii were favourable. However, long-term outcomes for MABC remained poor, potentially owing to the limited availability of effective continuation-phase therapies. Further large-scale prospective studies are warranted to understand the clinical management and prognosis of non-MAI NTM-PD.

PurposeThe Saga Fall-related Injury Risk Model (SFIRM) was developed in an acute care hospital to predict fall-related injuries based on six factors upon admission: age, sex, emergency transport, medical referral letters, history of falls, and bedriddenness ranks. This study aims to validate the applicability of the model across various hospitals through external validation using data from multiple hospitals. Additionally, the common predictors of fall-related injuries across these hospitals were explored.Patients and MethodsThis multicenter, retrospective, observational study included patients aged 20 years and older who were admitted to 8 hospitals (chronic-care, acute-care, and tertiary acute-care) between April 2018 and March 2021. A calculated sample size of patients was selected and the area under the curve (AUC) of the SFIRM was determined for fall-related injuries during hospitalization. Multivariate analyses were conducted for each hospital using the surveyed factors as covariates and fall-related injuries as outcomes. The significant factors associated with fall-related injuries were compared across hospitals.ResultsFrom 144,777 patients, 2376 were randomly sampled and analyzed. Among them, 51 patients (2.1%) experienced falls during hospitalization and 35 (1.5%) sustained fall-related injuries. The AUC of SFIRM was 0.617 (95% confidence interval 0.534–0.701). In multivariate analyses by hospital, age and bedriddenness ranks were significantly associated with fall-related injuries in five hospitals, whereas male sex, history of falls, and diabetes were significantly associated with fall-related injuries in four hospitals.ConclusionThe SFIRM demonstrated low discrimination in a population from various hospitals. The predictive models for fall-related injuries require redevelopment and validation to suit various hospitals. In the multivariate analyses across hospitals, age, bedriddenness ranks, male sex, history of falls, and diabetes mellitus were common and significant factors associated with fall-related injuries. These factors are most favorable for developing a predictive model for fall-related injuries.

The management of bulky tumors (>80 mm) is technically challenging via laparoscopic surgery with high incidence of open conversion. The aim of this study was to evaluate the safety and efficacy of robotic surgery for bulky colorectal tumors. A total of 317 patients from seven hospitals (Nagasaki, Japan) with bulky colorectal cancer who underwent surgery between 2016 and 2024 were eligible for inclusion. The patients were divided into three groups: robotic surgery group (R group, n=18), laparoscopic surgery group (L group, n=234), and open surgery group (O group, n=65). In the R group, rectal cancer was more common (61.1% vs. 14.1% vs. 10.8%, p<0.001), operation time was longer (363 vs. 259 vs. 210 min, p<0.001), blood loss was less (44 vs. 39 vs. 185 ml, p=0.018), and hospital stay was shorter (15 vs. 14 vs. 19 days, p=0.044) compared with the L and O groups, respectively. Conversion to open surgery was necessary in 0% of the R group and 2.5% of the L group. Multivariate analysis revealed rectal cancer [p=0.003; odds ratio (OR)=2.627; 95% confidence interval (CI)=1.377-5.020] and distant metastasis (p=0.047; OR=1.731; 95%CI=1.092-3.247) as independent predictive factors for postoperative complications. Robotic surgery for bulky colorectal tumors appears to be as safe as laparoscopic surgery and may reduce the rate of conversion to open surgery.

Linked color imaging (LCI) was developed to detect gastrointestinal neoplasms. The current study aimed to determine whether the use of LCI, compared with white-light imaging (WLI), can improve the miss rates of colorectal polyp. A multicenter, randomized back-to-back study was conducted in 16 Japanese endoscopy units. Patients were randomized according to examination: tandem colonoscopy with WLI followed by LCI (WLI-LCI group) and with LCI followed by WLI (LCI-WLI group). The detected polyps were evaluated according to location, size, morphology, and histopathological diagnosis. The primary outcome was polyp miss rate per patient (PMR-PP) in total colonoscopy. The secondary outcome was adenoma detection rate (ADR) during the first assessment in each group. The full analysis set comprised 327 participants, and 320 were included in either two groups. The PMR-PPs were 9.3% and 20.6% in the LCI-WLI and WLI-LCI groups, respectively. Regarding location, the PMR-PP of LCI was significantly lower than that of WLI in the transverse and descending colons and rectum. In terms of diminutive adenomas (< 5 mm), the ADR of LCI (38.2%) was significantly higher than that of WLI (29.1%). LCI was superior to WLI in terms of polyp miss rate particularly in the transverse and descending colons and rectum.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-20633-2.

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.

Left main (LM) percutaneous coronary intervention (PCI) with routine intracoronary imaging guidance is recommended; however, its real-world effectiveness remains unclear. A total of 743 consecutive patients undergoing drug-eluting stent implantation for de novo unprotected LM lesions across 19 Japanese National Hospital Organization hospitals where routine imaging guidance was adopted were analyzed. The primary endpoint was 1-year major adverse cardiovascular and cerebrovascular events (MACCE), comprising all-cause death, cerebrovascular disorder, clinical-driven revascularization, and myocardial infarction. In this cohort, acute coronary syndrome was present in 31.2%, with 39.3% classified as Canadian Cardiovascular Society functional angina (CCS) class ≥ III. LM bifurcation lesions were observed in 78.0%, with two-stent implantation in 8.8%. MACCE occurred in 17.5%, with target lesion revascularization and cardiac death rates of 2.0% and 3.4%, respectively. Independent risk factors for MACCE included two-stent implantation (hazard ratio [HR], 2.49), mechanical cardiac support device use (HR, 2.17), CCS class ≥ III (HR, 2.07), 10% increase in left ventricular ejection fraction (HR, 0.72), and radial access (HR, 0.62). Routine imaging-guided LM-PCI is associated with favorable low rate of target lesion revascularization and cardiac death. However, severe left ventricular dysfunction and LM bifurcation treated with two-stent implantation increase risks, requiring more comprehensive management.

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.

ObjectivesIn gastroenterology, sedation demand is increasing, although elderly patients are more prone to experiencing adverse events. Remimazolam, a novel ultra‐short‐acting benzodiazepine, may reduce recovery time after endoscopic procedures.MethodsThis study was a secondary analysis of the investigator‐initiated trial, which investigated the efficacy and safety of remimazolam in gastrointestinal endoscopy (REM‐IICT JP01). Remimazolam sedation was administered during upper gastrointestinal endoscopy. Patients were divided into two groups: 45 non‐elderly and 11 elderly patients (aged ≥65 years). The primary outcome was sedation success. Secondary outcomes included the dose required for sedation, time to awakening, time to regain the ability to walk, and occurrence of adverse events.ResultsEndoscopic sedation was successful in 95.6% of the non‐elderly group and 100% of the elderly group. The total dose of remimazolam was significantly higher in the non‐elderly group (4.0 [3.0–8.0] mg) than in the elderly group (3.0 [2.0–3.0] mg; p < 0.01). The time to awakening was 0.0 (0.0–10.0) min in the non‐elderly group compared to 0.0 (0.0–30.0) min (p = 0.98) in the elderly group. The time to regain the ability to walk was significantly longer in the elderly group (5.0 [0.0–60.0] min) than in the non‐elderly group (5.0 [0.0–30.0] min; p = 0.03). During the procedure, adverse events included hypotension in two cases (4.4%) in the non‐elderly group and hypoxemia in one case (9.0%) in the elderly group.ConclusionsUpper gastrointestinal endoscopy with remimazolam was effective and safe, regardless of age.

Objective: This prospective single-center study aimed to evaluate platelet function and coagulation ability in patients undergoing thromboelastography (TEG) during the perioperative period of transcatheter aortic valve implantation (TAVI).