Global health & medicine最新文献

Liver resection (LR) remains a cornerstone curative option for patients with hepatocellular carcinoma (HCC), and yet the high rate of postoperative intrahepatic recurrence poses a significant clinical challenge. Despite numerous attempts, no adjuvant therapy has shown definitive efficacy in preventing recurrence. In this context, salvage liver transplantation (SLT) and repeat hepatectomy (RH) have emerged as key curative strategies for recurrent disease. While SLT is associated with the most favorable survival outcomes, limited donor availability, particularly in Eastern countries, often necessitates the use of RH, which can also offer promising results. These evolving treatment strategies underscore the urgent need for improved risk stratification, optimized surgical decision-making, and innovative approaches to managing recurrent HCC.

Cognitive behavioral therapy (CBT) is reimbursed under the national insurance system of Japan, although predominantly for adults. Recent mental health crises among children and adolescents have prompted policy reforms to expand access to CBT. This study aimed to assess trends in CBT insurance claims among Japanese youth (0-19 years) from fiscal year 2014-2022 using national claims data. Outpatient psychotherapy and CBT claims from the National Database of Health Insurance Claims (NDB) were analyzed and stratified by age group. Linear regression was applied to assess trends. The number of CBT claims for youth increased markedly from 691 (1.5%) in 2014 to 4,497 (12.8%) in 2022, with significant upward trends for ages 5-9, 10-14, and 15-19 (all p < 0.05). Claims for adults declined during the same period. The use of CBT among children and adolescents in Japan has grown substantially, but most protocols remain adult-oriented. These results highlight the need for child-specific CBT programs and broader provider eligibility. A key limitation is that the data lacked disorder-specific information, which restricts analysis of treatment indications.

Frailty increases the risk of complications and delays recovery in older patients with acute calculous cholecystitis (ACC). Early identification is crucial to improving outcomes. Subjects were 386 older inpatients with ACC at two hospitals who were randomly divided into a training set (n = 270) and validation set (n = 116). Patients were categorized into frail and non-frail groups. Binary logistic regression identified significant predictors, and a nomogram was developed. The incidence of frailty was 27% (n = 73). Smoking, a sleep disorder, impaired ADL, and malnutrition were independent predictors for frailty (p < 0.05). The nomogram showed good discrimination (AUC = 0.752), with a sensitivity of 82.6% and a specificity of 67.4%. Calibration was acceptable (Hosmer-Lemeshow χ² = 4.407, p = 0.732), and decision curve analysis demonstrated clinical utility. The developed nomogram reliably predicts the risk of frailty in older patients with ACC and may facilitate targeted early interventions in clinical practice.

Although well established, laparoscopic surgery for ascending colon cancer is a difficult procedure due to the presence of many blood vessels requiring treatment and the need for sufficient mobilization to extract the right colon through a small laparotomy. This is the first study to investigate the adequacy of vascular ligation and bowel mobilization for laparoscopic resection of ascending colon cancer and extracorporeal reconstruction. This retrospective study included 103 consecutive patients who underwent laparoscopic colectomy for ascending colon cancer from 2015 to 2022 at the Center Hospital of the National Center for Global Health and Medicine. We analyzed correlations between clinicopathological factors and vessels ligation or the mobilization range. The strongest factor correlated with vascular ligation was the distance from the Bauhin valve to the distal edge of the tumor (Length B). These lengths were significantly longer in the vascular ligated group (the right colic artery (RCA): 81 mm; the accessory right colic vein (ARCV): 85 mm; right branch of the middle colic artery (MCA-rt): 106.5 mm) than in the nonligated group (50 mm, 43 mm, 50 mm, p < 0.01). Mobilization range was not correlated with tumor location or size. According to the result, we developed practical indicators to assist during laparoscopic surgery: i) To omit the RCA ligation, Length B should be shorter than approximately 5 cm; ii) If Length B exceeds approximately 8 cm, both the RCA and ARCV should be ligated; and iii) If Length B exceeds approximately 10 cm, the MCA-rt should be ligated.

Identifying the right border of the caudate lobe against the right liver is clinically important; however, this remains challenging. As the paracaval portion (PC) of the caudate lobe is adjacent to segment 8 of the right liver, we dissected a liver cast made from epoxy resin and colored dye to define the right border of the PC against segment 8. On the right border of the PC, two major venous plexuses appearing as bouquet-shaped branches joined the inferior vena cava and the middle hepatic vein, forming short hepatic veins, whereas the venous plexuses in segment 8 joined the right hepatic and the vein inferior vena cava. These venous plexuses in PC and segment 8 created a zigzag boundary plane, which coincided with the boundary found between the caudate lobe and the right liver. Moreover, no longitudinal venous branch was found between the PC and segment 8 in the liver cast.

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting synovial joints. Biosimilar disease-modifying anti-rheumatic drugs offer cost-effective alternatives to originator biologics for RA treatment but remain expensive for long-term use. This prospective study investigated the clinical benefit of discontinuing CT-P13, a biosimilar of infliximab, in RA patients maintaining clinical remission or low disease activity. Five patients were enrolled from the IFX-SIRIUS STUDY I. CT-P13 was discontinued for 48 weeks, with evaluation using clinical indices, musculoskeletal ultrasound (MSUS), and serum biomarkers. Two patients experienced clinical relapse at weeks 5 and 36. The patient who relapsed at week 36 was re-administered CT-P13 and showed improved clinical outcomes without adverse events. Patients with non-clinical relapse showed no changes in disease activity scores or MSUS scores, with no notable alterations in serum cytokine levels. Over 50% of the patients maintained non-clinical relapse after CT-P13 discontinuation, and relapsed patients improved after re-administration without adverse events. This study was registered in the Japan Registry of Clinical Trials (https://jrct.mhlw.go.jp) on April 20, 2020, as jRCTs071200007.

This study examined the characteristics of service users requiring frequent visits (≥ 3 times/week) and support coordination from home-visit nursing stations and psychiatric home-visit nursing in Japan. Psychiatric home-visit nursing is vital for individuals with mental disorders, but its implementation has lagged behind physical home-visit nursing because of Japan's historical emphasis on institutional psychiatric care. A questionnaire survey was conducted from October 2024 to January 2025, involving 56 home-visit nursing stations with 224 service users. Home-visit nursing stations into four types and users into three care patterns: persistent frequent visits without support coordination, support coordination without persistent frequent visits, and both. In total, 15.6% of users received home visits ≥ 3 times/week, with significant variation by facility type. Frequent visits were associated with schizophrenia, long-term service use, comorbid physical conditions, and low levels of functioning (Global Assessment of Functioning [GAF], mean score, 41.9). Those needing frequent visits and coordination had the lowest GAF scores and highest rates of hallucinations, impulsivity, and self-harm. The primary reasons for support coordination and frequent visits included psychiatric symptom fluctuations, changes in self-care, and family-related issues. The finding show that frequent psychiatric home-visit nursing is associated with diverse and complex care needs requiring tailored coordination and resource allocation, highlighting the importance of structured, individualized care planning and the need to document visit rationales and assessment methods. This is the first Japanese study detailing the profiles of high-need psychiatric home-visit nursing users, offering foundational data for future policy and practice development.

We conducted a study to determine the impact of body mass index (BMI) (underweight, normal weight, and overweight) on the severity of COVID-19 across different periods of variant predominance using a large-scale data registry of hospitalized COVID-19 patients in Japan (COVIREGI-JP), involving 46,291 Japanese patients aged 20-89 years. Severity was classified based on the most intensive treatment received throughout the hospitalization. Multiple logistic models were used to assess the risk of severe disease, and adjusted odds ratios (ORs) for BMI < 18.5, 18.5-20, and ≥ 25 relative to BMI of 20.1-24.9 were calculated by sex and age group. The risk of severe COVID-19 and death was high among those with BMI < 18.5 [OR (95% CI): 1.88 (1.52-2.33), 1.59 (1.22-2.07)] as well as those with BMI ≥ 25 [1.38 (1.20-1.60), 1.87 (1.50-2.34)] for both men and women, respectively. The risk was extremely high among those with BMI < 18.5 when the Omicron variant was predominant [2.41 (1.66-3.49) for men, 2.96 (1.77-4.97) for women]. An important point to note is that being underweight as well as obesity increased the risk of severe COVID-19 and death. More attention should be paid to underweight individuals when predicting COVID-19 risk.

Knowledge gaps pertaining to antimicrobial stewardship (AMS) among different hospital professions can hinder program effectiveness. This study aimed to identify and comparatively analyze AMS knowledge levels at a Japanese hospital. We conducted a cross-sectional, internet-based survey of all hospital employees (n = 2,703) to assess their knowledge of the antimicrobial stewardship team (AST) and programs (ASPs). The survey response rate was 48.4% (1,307 of 2,703). Significantly lower proportions of nurses and administrative staff than medical doctors and pharmacists knew about the AST and ASPs (p < 0.001). Critically, a significantly lower proportion of nurses (62.5%) than medical doctors (97.4%) (p < 0.001) was aware of the importance of sample collection for bacterial cultivation before antibiotic administration. These findings reveal significant role-specific knowledge gaps and strongly suggest that educational interventions targeting nurses and administrative staff are needed for promoting hospital-wide ASPs and ensuring their effective implementation.

Identification of a tumor-bearing portal territory using indocyanine green (ICG) fluorescence imaging (IGFI) facilitates precise laparoscopic anatomic hepatectomy (LAH). However, it is technically challenging to perform a transhepatic portal injection of ICG or to clamp the target portal pedicle and inject ICG during LAH. Herein, we aimed to investigate the feasibility and efficacy of portal territory identification using IGFI under the combined guidance of three-dimensional (3D) virtual imaging and intraoperative ultrasound (IOUS) in LAH. We enrolled patients eligible for LAH in the current study between June 2020 and April 2023. All patients had preoperative surgical planning based on 3D virtual imaging in which the boundaries of the tumor-bearing portal territory were displayed and the predicted remnant liver volumes (PRLVs) were calculated. We then conducted ICG fluorescence liver-segment staining and LAH under the combined guidance of 3D virtual imaging and IOUS. Actual remnant liver volumes (ARLVs) were calculated using 3D virtual imaging after surgery. Of the 73 patients who achieved a valid demarcation by IGFI, 14 (19.2%) underwent hemi-hepatectomy, while 19 (26%) and 40 (54.8%) underwent sectionectomy and segmentectomy, respectively. The IGFI-identified intraoperative hepatic segment boundaries were highly matched with the boundaries of the tumor-bearing portal territory in the 3D virtual images in 72 (98.6%) patients, and we observed that the ARLVs and PRLVs were also robustly correlated (r ² = 0.8734, p < 0.0001). In summary, 3D virtual imaging and IOUS contribute significantly to the staining and identification of a tumor-bearing portal territory and the accurate implementation of LAH.