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Suzuki Y, Kaneko H, Okada A, Ohno R, Yokota I, Fujiu K, Jo T, Takeda N, Morita H, Node K, Yasunaga H, Komuro I. Comparison of SGLT2 inhibitors vs. DPP4 inhibitors for patients with metabolic dysfunction associated fatty liver disease and diabetes mellitus. J Endocrinol Invest 2024; 47:1261-1270. [PMID: 38114769 PMCID: PMC11035461 DOI: 10.1007/s40618-023-02246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE This study aimed to examine the potential benefit of sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and diabetes mellitus (DM) using a real-world database. METHODS We analyzed individuals with MAFLD and DM newly initiated on SGLT2 or dipeptidyl peptidase 4 (DPP4) inhibitors from a large-scale administrative claims database. The primary outcome was the change in the fatty liver index (FLI) assessed using a linear mixed-effects model from the initiation of SGLT2 or DPP4 inhibitors. A propensity score-matching algorithm was used to compare the change in FLI among SGLT2 and DPP4 inhibitors. RESULTS After propensity score matching, 6547 well-balanced pairs of SGLT2 and 6547 DPP4 inhibitor users were created. SGLT2 inhibitor use was associated with a greater decline in FLI than DPP4 inhibitor use (difference at 1-year measurement, - 3.8 [95% CI - 4.7 to - 3.0]). The advantage of SGLT2 inhibitor use over DPP4 inhibitor use for improvement in FLI was consistent across subgroups. The relationship between SGLT2 inhibitors and amelioration of FLI was comparable between individual SGLT2 inhibitors. CONCLUSIONS Our analysis using large-scale real-world data demonstrated the potential advantage of SGLT2 inhibitors over DPP4 inhibitors in patients with MAFLD and DM.
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Grants
- 21AA2007 Ministry of Health, Labour and Welfare
- 20H03907 the Ministry of Education, Culture, Sports, Science and Technology
- 21H03159 the Ministry of Education, Culture, Sports, Science and Technology
- 21K08123 the Ministry of Education, Culture, Sports, Science and Technology
- 22K21133 the Ministry of Education, Culture, Sports, Science and Technology
- The University of Tokyo
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Affiliation(s)
- Y Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - H Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - A Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - R Ohno
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - I Yokota
- Department of Biostatistics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - K Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - T Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - N Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - H Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - K Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - I Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- International University of Health and Welfare, Tokyo, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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2
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Okubo Y, Nishi A, Uda K, Miyairi I, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yasunaga H. Financial incentives for infection prevention and antimicrobial stewardship to reduce antibiotic use: Japan's nationwide observational study. J Hosp Infect 2023; 131:89-98. [PMID: 36424696 DOI: 10.1016/j.jhin.2022.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Japanese government introduced financial incentives to reduce nationwide antibiotic use in hospital settings. AIM This study aimed to determine whether the nationwide financial incentives for creating infection prevention and control (IPC) teams introduced in 2012 and antimicrobial stewardship (ASP) teams introduced in 2018 were associated with changes in antibiotic use and health resource utilization at a national level. METHODS We conducted time-series analyses and a difference-in-differences study consisting of 3,057,517 inpatients with infectious diseases from 472 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. The primary outcome was the days of therapy (DOT) of antibiotic use per 100 patient-days (PDs). The secondary outcomes consisted of types of antibiotic used, health resource utilization, and mortality. RESULTS A total of 5,201,304 financial incentives were observed during 2012-2018, which resulted in a total of 12.1 billion JPY (≈110 million USD). Time-series analyses found decreasing trends in total antibiotic use (79.3-72.5 DOTs/100 PDs (8.6% reduction)) and carbapenem use (9.0-7.0 DOTs/100 PDs (7.8% reduction)) from 2011 to 2018 without adversely affecting other healthcare outcomes (e.g., mortality). In the difference-in-differences analyses, we did not observe meaningful changes in total antibiotic use between the incentivized and unincentivized hospitals for ASP teams, except for the northern part of Japan. No dose-response relationships were observed between the amount of financial incentives and reductions in antibiotic use during 2011-2019. CONCLUSIONS Further research and efforts are needed to accelerate antimicrobial stewardship in hospital settings in Japan.
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Affiliation(s)
- Y Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - A Nishi
- Department of Epidemiology, UCLA Fielding School of Public Health, CA, USA
| | - K Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - I Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, TN, USA; Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - N Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - R Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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HASEGAWA S, Okada A, Yasunaga H, Nangaku M. POS-293 IMPACT OF DIABETES ON MAJOR BLEEDING COMPLICATIONS OF RENAL BIOPSY. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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4
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Mongkonchoo K, Yamana H, Aso S, Machida M, Takasaki Y, Jo T, Yasunaga H, Chongsuvivatwong V, Liabsuetrakul T. Prediction of outpatient visits and expenditure under the Universal Coverage Scheme in Bangkok using subscriber's attributes: A random forest analysis. Public Health in Practice 2021; 2:100190. [PMID: 36101615 PMCID: PMC9461546 DOI: 10.1016/j.puhip.2021.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/22/2021] [Indexed: 10/26/2022] Open
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Seki H, Kaneko H, Matsuoka S, Itoh H, Yano Y, Morita K, Kiriyama H, Kamon T, Fujiu K, Michihaka N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Association between blood pressure classification using the 2017 American College of Cardiology/American Heart Association blood pressure guideline and hypertensive retinopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
We aimed to explore the association of blood pressure (BP) classification using the 2017 American College of Cardiology/ American Heart Association Guideline and the prevalence of hypertensive retinopathy using a nationwide epidemiological database.
Methods
This study is a retrospective observational cross-sectional analysis using the health claims database of the JMDC between 2005 and 2020. We analyzed 280,599 participants who did not take anti-hypertensive medications. Each participant was categorized as having normal BP (systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg; n=159,524); elevated BP (SBP 120–129 mm Hg and DBP <80 mm Hg; n=35,603); stage 1 hypertension (SBP 130–139 mm Hg or DBP 80–89 mm Hg; n=54,795); or stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg; n=30,677). Retinal photography at health check-up was classified as normal, grade 1, grade 2, grade 3, or grade 4 according to the Keith-Wagener-Barker system.
Results
Median (interquartile range) age was 46 (40–53) years, and 50.4% were men. Hypertensive retinopathy which was defined as ≥ Keith-Wagener-Barker system grade 1, was observed in 16,836 participants (6.0%). Multivariable logistic regression analysis showed that, compared with normal BP, elevated BP (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23–1.38), stage 1 hypertension (OR 1.71, 95% CI 1.64–1.79), and stage 2 hypertension (OR 4.10, 95% CI 3.93–4.28) were associated with higher prevalence of hypertensive retinopathy. Even among 92,121 participants without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol drinking, multivariable logistic regression analysis showed that, compared with normal BP, elevated BP (odds ratio 1.34, 95% CI 1.19–1.51), stage 1 hypertension (OR 1.79, 95% CI 1.61–1.98), and stage 2 hypertension (OR 4.42, 95% CI 4.00–4.92) were associated with higher prevalence of hypertensive retinopathy. The association between BP category and hypertensive retinopathy was observed in all subgroups stratified by age or sex.
Conclusion
Our investigation showed that the prevalence of hypertensive retinopathy increased with the blood pressure category, suggesting that atherosclerotic change could start even in elevated BP and stage 1 hypertension.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).
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Affiliation(s)
- H Seki
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Kaneko
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - S Matsuoka
- New Tokyo Hospital, Department of cardiovascular Medicine, Chiba, Japan
| | - H Itoh
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - Y Yano
- Yokohama City University Hospital, Department of cardiovascular Medicine, Yokohama, Japan
| | - K Morita
- The University of Tokyo, Department of Clinical Epidemiology and Health Economics, School of Public Health, Tokyo, Japan
| | - H Kiriyama
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Kamon
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - K Fujiu
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - N Michihaka
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Jo
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - N Takeda
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Morita
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Yasunaga
- Tsukuba University, Department of Health Services Research, Faculty of Medicine, Tsukuba, Japan
| | - I Komuro
- The University of Tokyo, Department of Cardiovascular Medicine, Tokyo, Japan
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Iwasaki Y, Ohbe H, Shigemi D, Fushimi K, Yasunaga H. Effect of antithrombin III among patients with disseminated intravascular coagulation in obstetrics: a nationwide observational study in Japan. BJOG 2021; 129:805-811. [PMID: 34545675 DOI: 10.1111/1471-0528.16938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/11/2021] [Accepted: 09/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of antithrombin III (ATIII) for DIC in obstetrics; however, its effect remains uncertain. The present study aimed to investigate the effect of ATIII for DIC in obstetrics, using a national inpatient database in Japan. DESIGN Nationwide observational study. SETTING Japan. POPULATION We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018. METHODS Propensity score matching analyses were performed to compare in-hospital maternal mortality and hysterectomy during hospitalisation between users and non-users of ATIII on the day of delivery. MAIN OUTCOME MEASURES In-hospital mortality, hysterectomy. RESULTS A total of 9920 patients were enrolled, including 4329 patients (44%) who used ATIII and 5511 patients (56%) who did not use ATIII. One-to-one propensity score matching created 3290 pairs. In-hospital maternal mortality did not differ significantly between the propensity-matched groups (0.3% in the ATIII group versus 0.5% in the control group; odds ratio 0.73; 95% CI 0.35-1.54). A significantly lower proportion of patients in the ATIII group, compared with those in the control group, underwent hysterectomy during hospitalisation (5.3% versus 8.7%; absolute risk difference -2.9%; 95% CI -4.2 to -1.6%). CONCLUSIONS Although the present study did not show a mortality-reducing effect of ATIII for patients with DIC in obstetrics, it may have clinical benefit in terms of reducing the number of patients undergoing hysterectomy. TWEETABLE ABSTRACT This study did not show mortality-reducing effect of antithrombin III for patients with DIC in obstetrics.
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Affiliation(s)
- Y Iwasaki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - D Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Sakamoto T, Fujiogi M, Ishimaru M, Matsui H, Fushimi K, Yasunaga H. Comparison of postoperative infection after emergency inguinal hernia surgery with enterectomy between mesh repair and non-mesh repair: a national database analysis. Hernia 2021; 26:217-223. [PMID: 34138368 DOI: 10.1007/s10029-021-02439-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Synthetic non-absorbable mesh is used for elective inguinal hernia repair but is not commonly used for incarcerated or strangulated inguinal hernia requiring enterectomy to reduce the risk of surgical-site infection. This study aimed to evaluate the safety of synthetic non-absorbable mesh repair in patients with incarcerated or strangulated inguinal hernia requiring enterectomy versus non-mesh repair. METHODS We analyzed patients with incarcerated or strangulated inguinal hernia with enterectomy from April 2012 to March 2017 using a nationwide inpatient database in Japan. We conducted overlap propensity score-weighted analyses to compare surgical-site infection (SSI), duration of anesthesia, antibiotic use at > 3 days after surgery, postoperative hospital stay, and 30 day readmission. Two sensitivity analyses were performed. First, we compared the proportions of patients requiring wound culture at ≥ 3 days after surgery. Second, we performed overlap propensity score-weighted logistic regression analyses for surgical-site infection. RESULTS We identified 668 eligible patients, comprising 223 patients with mesh repair and 445 with non-mesh repair. Overlap propensity score-weighted analyses showed no significant differences between the mesh repair and non-mesh repair groups for SSI (2.5 vs. 2.8%, P = 0.79). Secondary outcomes did not differ significantly between the groups. Proportion of wound culture at ≥ 3 days after surgery was similar in the two groups (11.1 vs. 14.6%, P = 0.18). Logistic regression analysis showed no significant association between mesh repair and SSI (odds ratio, 0.93; 95% confidence interval, 0.34-2.57). CONCLUSION Synthetic non-absorbable mesh use may be safe for incarcerated or strangulated inguinal hernia requiring enterectomy.
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Affiliation(s)
- T Sakamoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | - M Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - M Ishimaru
- Department of Health Services Research, Faculty of Medicine, Institutes of Medicine, University of Tsukuba, Ibaraki, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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8
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Konishi T, Fujiogi M, Michihata N, Tanaka-Mizutani H, Morita K, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Breast cancer surgery in patients with schizophrenia: short-term outcomes from a nationwide cohort. Br J Surg 2021; 108:168-173. [PMID: 33711128 DOI: 10.1093/bjs/znaa070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/04/2020] [Accepted: 09/30/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Although patients with schizophrenia have a higher risk of developing breast cancer than the general population, studies that have investigated postoperative complications after breast cancer surgery in patients with schizophrenia are scarce. This study examined associations between schizophrenia and short-term outcomes following breast cancer surgery. METHODS Patients who underwent surgery for stage 0-III breast cancer between July 2010 and March 2017 were identified from a Japanese nationwide inpatient database. Multivariable analyses were conducted to compare postoperative complications and hospitalization costs between patients with schizophrenia and those without any psychiatric disorder. Three sensitivity analyses were performed: a 1 : 4 matched-pair cohort analysis with matching for age, institution, and fiscal year at admission; analyses excluding patients with schizophrenia who were not taking antipsychotic medication; and analyses excluding patients with schizophrenia who were admitted to hospital involuntarily. RESULTS The study included 3660 patients with schizophrenia and 350 860 without any psychiatric disorder. Patients with schizophrenia had a higher in-hospital morbidity (odds ratio (OR) 1.37, 95 per cent c.i. 1.21 to 1.55), with more postoperative bleeding (OR 1.34, 1.05 to 1.71) surgical-site infections (OR 1.22, 1.04 to 1.43), and sepsis (OR 1.20, 1.03 to 1.41). The total cost of hospitalization (coefficient €743, 95 per cent c.i. 680 to 806) was higher than that for patients without any psychiatric disorder. All sensitivity analyses showed similar results to the main analyses. CONCLUSION Although causal inferences remain premature, multivariable regression analyses showed that schizophrenia was associated with greater in-hospital morbidity and higher total cost of hospitalization after breast cancer surgery than in the general population.
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Affiliation(s)
- T Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - M Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - N Michihata
- Department of Health Services Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - H Tanaka-Mizutani
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - K Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.,Department of Health Services, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - M Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Y Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
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Kiriyama H, Kaneko H, Kamon T, Itoh H, Jo T, Fujiu K, Daimon M, Morita H, Yasunaga H, Komuro I. Association between surgical treatment and in-hospital mortality in patients with infective endocarditis stratified by NYHA classification: a nationwide retrospective study in Japan. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is one of the major complications of infective endocarditis (IE). The ESC guideline described that surgical treatment should be performed for the patients with IE complicated with HF. However, decision making of surgical indication in real-world clinical setting is not easy for patients with IE concomitant with HF due to complicated conditions, and the clinical benefit of surgical intervention for IE and HF is unclear.
Purpose
We sought to uncover the association between surgical treatment and in-hospital mortality among the patients admitted for community-acquired IE respectively according to the severity of HF symptoms (NYHA class I to IV).
Methods
We studied 3,403 patients diagnosed as IE (mean age 65.9 years, 61.6% males) with records of baseline NYHA classification (I to IV) who survived for more than 2 days, using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. Patients were classified into four groups: 919 patients (27.0%) in NYHA I, 1,007 patients (29.6%) in NYHA II, 767 patients (22.5%) in NYHA III, and 710 patients (20.9%) in NYHA IV. A multivariable logistic regression model adjusted for age, gender, Barthel Index, Charlson Comorbidity Index, and usage of inotropic therapy at admission was performed to evaluate the association between the surgical treatment and in-hospital mortality.
Results
Patients with higher NYHA classification were significantly older and were more likely to be female than those with lower NYHA classification. At admission, patients with higher NYHA classification had lower baseline activities and higher comorbidities, and also had more complications including stroke, shock and disseminated intravascular coagulation than those with lower NYHA classification. In-hospital mortality was seen in 406 patients (11.9%) in the entire cohort. The mortality rate significantly increased with the NYHA class (NYHA I, 3.6%; NYHA II, 8.4%; NYHA III, 11.9%; NYHA IV, 27.9%: p<0.001). According to the multivariable logistic regression analysis, surgical treatment was independently associated with lower in-hospital mortality (Odds ratio 0.395, 95% Confidence Interval 0.297–0.526; p<0.001). A fragmentated analysis in each NYHA classification showed that the survival benefit of surgical intervention was pronounced in patients with higher NYHA class (Figure). The limitation of our study was including the potential unmeasured confounders, which lead to overestimate the relationship between the surgical treatment and in-hospital mortality even after excluding the critically ill patients who died within 2 days and adjusting for the measured confounders.
Conclusion
Surgical treatment was associated with lower in-hospital mortality among the patients with IE complicated with HF, particularly among those with more advanced HF status. Our study implies that surgical treatment might be beneficial for the patients with advanced HF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - H Kaneko
- University of Tokyo, Tokyo, Japan
| | - T Kamon
- University of Tokyo, Tokyo, Japan
| | - H Itoh
- University of Tokyo, Tokyo, Japan
| | - T Jo
- University of Tokyo, Tokyo, Japan
| | - K Fujiu
- University of Tokyo, Tokyo, Japan
| | - M Daimon
- University of Tokyo, Tokyo, Japan
| | - H Morita
- University of Tokyo, Tokyo, Japan
| | | | - I Komuro
- University of Tokyo, Tokyo, Japan
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10
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Yotsumoto H, Kaneko H, Itoh H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Morita H, Yasunaga H, Komuro I. Geographic variation in the outcome of patients hospitalized for heart failure: analysis of a nationwide inpatient database. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The prevalence of heart failure (HF) is increasing in developed countries. Considering the significant socioeconomic burden of HF, nationwide actions against HF are indispensable. To that end, relevant information on regional variations among HF patients are required.
Purpose
We aimed to explore the geographic variations in the characteristics and outcomes of hospitalized HF patients using a nationwide inpatient database.
Methods and results
Using the Diagnosis Procedure Combination database which is a nationwide inpatient database in Japan, we carried out a comprehensive analysis of 447,818 hospitalized patients with HF (median age 81 years, 238,192 men) who were admitted between January 2010 and March 2018 in Japan. We divided the study population into seven geographical regions based on the location of the admitted hospital. Background characteristics were almost similar among all seven regions. The implementation rates of intubation, hemodialysis, inotropic agent, and advanced circulatory supports including intra-aortic balloon pumping and extracorporeal membrane oxygenation varied among the seven regions. There was a significant difference in the length of hospital stay and the in-hospital mortality among the seven regions. The multivariable logistic regression analysis including baseline clinical charasteristics and medication administered within two days after hospital admission fitted with a generalized estimation equation for in-hospital mortality showed that there was still a significant difference in the in-hospital mortality among the seven regions (Table).
Conclusion
The analysis of a nationwide inpatient database showed that geographical variations existed regarding the outcomes of patients hospitalized for HF. This suggests the necessity of further efforts to establish a standardized medical care system in this era of HF pandemic.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141)
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Affiliation(s)
| | - H Kaneko
- The University of Tokyo, Tokyo, Japan
| | - H Itoh
- The University of Tokyo, Tokyo, Japan
| | | | - T Kamon
- The University of Tokyo, Tokyo, Japan
| | - K Fujiu
- The University of Tokyo, Tokyo, Japan
| | - K Morita
- The University of Tokyo, Tokyo, Japan
| | | | - T Jo
- The University of Tokyo, Tokyo, Japan
| | - H Morita
- The University of Tokyo, Tokyo, Japan
| | | | - I Komuro
- The University of Tokyo, Tokyo, Japan
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11
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Honda C, Yamana H, Matsui H, Nagata S, Yasunaga H, Naruse T. Age in months and birth order in infant nonfatal injuries: A retrospective cohort study. Public Health in Practice 2020; 1:100005. [PMID: 36101695 PMCID: PMC9461530 DOI: 10.1016/j.puhip.2020.100005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/02/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To examine the age in months at which infants visited outpatient clinics or emergency rooms for the first time for nonfatal injuries and to identify risk factors for the occurrence of these injuries. Study design Retrospective cohort study. Methods We used a health insurance claims database in Japan. Infants born between April 2012 and December 2014 were identified and followed until 12 months of age. We identified their first visit to outpatient clinics or emergency rooms because of nonfatal injuries (wounds/fractures, foreign bodies, and burns). Cox regression analysis was used to examine the association of nonfatal injuries with infants’ sex, birth order, and parental age. Results We identified 46,431 eligible infants. Of these, 7606 (16.4%) were brought to an outpatient clinic or emergency room for nonfatal injuries within 12 months of birth. Of the 7,606, 21.7% were aged ≤4 months and 44.7% ≤ 7 months. First-born infants were more likely to have wounds/fractures and burns. Conclusion One-fifth of first nonfatal infant injuries occurred within 4 months of age. Healthcare providers should provide early education about injury prevention, especially to caregivers of first-born infants. Nonfatal injuries within first year of birth occurred in 16% of infants. 22% of first injuries occurred within 4 months of birth. First-born infants were more likely to have wounds/fractures and burns.
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Affiliation(s)
- C. Honda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Corresponding author. Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - H. Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - H. Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - S. Nagata
- Faculty of Nursing and Medical Care, Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - H. Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - T. Naruse
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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12
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Itoh H, Kaneko H, Kiriyama H, Kamon T, Michihata N, Jo T, Morita H, Yasunaga H, Komuro I. Cardiovascular health metrics of 122,788 couples: analysis of a nationwide epidemiological database. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The American Heart Association suggests that cardiovascular health (CVH) metrics based on established risk factors and behaviors to reduce the morbidity and mortality of cardiovascular disease. Couples share environmental and lifestyle habits, and therefore, there can be an intra-couple correlation of CVH metrics. However, the clinical data on the association of the CVH metrics among couples are limited.
Purpose
We aimed to explore the intra-couple relationship of the AHA-defined cardiovascular health metrics using a nationwide epidemiological database.
Methods
This study is a retrospective observational cross-sectional analysis using the health claims database of the Japan Medical Data Center between January 2005 and December 2016. We modified the American Heart Association CVH metrics and defined ideal CVH component as following: 1) nonsmoking, 2) body mass index <25 kg/m2, 3) physical activity at goal, 4) untreated blood pressure <120/80 mm Hg, 5) untreated fasting glucose <100 mg/dL, and 6) untreated total cholesterol <200 mg/dL.
Results
We analyzed 122,788 heterosexual couples enrolled in the Japan Medical Data Center database. The average age of participants was 50.2±9.5 years in men and 48.6±8.9 years in women. Good correlation was observed between couples in terms of the modified ideal CVH metrics (Figure 1A). The prevalence of meeting ≥5 ideal components in the female partners increased from 31% in the male partners meeting no ideal components to 55% in those meeting 6 ideal components. The concordance ratio is particularly higher in the component of smoking status, blood pressure, and fasting glucose level. A man who meets ≥5 ideal components probably had a woman partner who meets ≥5 ideal components (Odds ratio 1.6, 95% CI: 1.6–1.7, p<0.001). The P value for the McNemar test was significant for all components, indicating that women apparently met ideal metrics for metrics in discordant Couples (Figure 1B).
Conclusion
Our investigation showed that there was a good intra-couple correlation of the ideal modified CVH metrics, suggesting the potential of couple-based assessment and management for improving CVH status.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Itoh
- University of Tokyo, Tokyo, Japan
| | - H Kaneko
- University of Tokyo, Tokyo, Japan
| | | | - T Kamon
- University of Tokyo, Tokyo, Japan
| | | | - T Jo
- University of Tokyo, Tokyo, Japan
| | - H Morita
- University of Tokyo, Tokyo, Japan
| | | | - I Komuro
- University of Tokyo, Tokyo, Japan
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13
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Sakamoto T, Fujiogi M, Lefor AK, Matsui H, Fushimi K, Yasunaga H. Stent as a bridge to surgery or immediate colectomy for malignant right colonic obstruction: propensity-scored, national database study. Br J Surg 2020; 107:1354-1362. [DOI: 10.1002/bjs.11561] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/27/2019] [Accepted: 01/26/2020] [Indexed: 01/02/2023]
Abstract
Abstract
Background
The aim of this study was to compare perioperative outcomes of urgent colectomy and placement of a self-expanding metallic stent followed by colectomy for patients with malignant right colonic obstruction. Right-sided malignant obstruction is less common than left-sided. Stenting for malignant left colonic obstruction has been reported to reduce postoperative complications. However, the impact of stenting for malignant right colonic obstruction remains undefined.
Methods
The study included patients with right-sided malignant obstruction or stenosis undergoing colectomy between April 2012 and March 2017 identified from a nationwide database. Propensity score matching analysis was used to compare mortality and morbidity rates, proportion receiving a stoma and postoperative stay between urgent colectomy and stent groups.
Results
From 9572 patients, 1500 pairs were generated by propensity score matching. There was no significant difference in in-hospital mortality between the urgent colostomy and stent groups (1·6 versus 0·9 per cent respectively; P = 0·069). Complications were more common after urgent colectomy than stenting (22·1 versus 19·1 per cent; P = 0·042). Surgical-site infection was more likely with urgent colectomy (7·1 versus 4·4 per cent; P = 0·001). There was no significant difference between the two groups in anastomotic leakage (3·8 versus 2·6 per cent; P = 0·062). The proportion of patients needing a stoma was higher with urgent colectomy than primary treatment with stents (5·1 versus 1·7 per cent; P < 0·001). Postoperative stay was longer after urgent colectomy (15 versus 13 days; P < 0·001).
Conclusion
Stenting followed by colectomy in patients with malignant right colonic obstruction may provide more favourable perioperative outcomes than urgent colectomy.
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Affiliation(s)
- T Sakamoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Centre, Urayasu, Japan
| | - M Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - A K Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
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14
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Fukumoto K, Jo T, Yasunaga H, Nakajima J. P1.17-38 Does Use of Epidural Anesthesia Affects Survival of Resectable NSCLC? Analysis from a Japanese Nationwide Database. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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MIYAMOTO Y, Iwagami M, Aso S, Yasunaga H, Matsui H, Fushimi K, Hamasaki Y, Nangaku M, Doi K. SUN-164 ASSOCIATION BETWEEN INTRAVENOUS CONTRAST MEDIA AND NON-RECOVERY FROM DIALYSIS-REQUIRING SEPTIC ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT PATIENTS: A NATIONWIDE OBSERVATIONAL STUDY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Tsuchiya A, Yasunaga H, Tsutsumi Y, Kawahara T, Matsui H, Fushimi K. Nationwide observational study of mortality from complicated intra-abdominal infections and the role of bacterial cultures. Br J Surg 2019; 106:606-615. [PMID: 30883708 DOI: 10.1002/bjs.11095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The benefit of taking intra-abdominal cultures during source control procedures in patients with complicated intra-abdominal infection (CIAI) is unknown. The aim of this study was to evaluate whether intra-abdominal cultures reduce the mortality rate of CIAI. METHODS The Japanese Diagnosis Procedure Combination database was used to identify adult patients with CIAI who had undergone source control procedures on the first day of admission to hospital between April 2014 and March 2016. In-hospital mortality was compared between patients who did and those who did not have intra-abdominal cultures taken. A generalized linear mixed-effect logistic regression model and a random intercept per hospital were used to adjust for baseline confounders and institutional differences. Subgroup analyses were also performed according to disease cause, site of onset and severity of CIAI. RESULTS Intra-abdominal cultures were taken from 16 303 of 41 495 included patients. Multivariable logistic regression analysis showed that patients with intra-abdominal cultures had a significantly lower mortality than those without (odds ratio 0·85, 95 per cent c.i. 0·77 to 0·95). Subgroup analyses revealed statistically significant differences in mortality between patients with and without cultures among those with lower intestinal perforation, biliary tract infection/perforation, healthcare-associated CIAI and high-risk community-acquired CIAI. CONCLUSIONS Intra-abdominal cultures obtained during source control procedures may reduce in-hospital mortality, especially in patients with lower intestinal perforation, biliary tract infection/perforation, or healthcare-associated or high-risk community-acquired CIAI.
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Affiliation(s)
- A Tsuchiya
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Centre, Ibaraki, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Y Tsutsumi
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Centre, Ibaraki, Japan
| | - T Kawahara
- Biostatistics Division, Central Coordinating Unit, Clinical Research Support Centre, University of Tokyo Hospital, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
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17
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Ishimaru M, Matsui H, Ono S, Hagiwara Y, Morita K, Yasunaga H. Preoperative oral care and effect on postoperative complications after major cancer surgery. Br J Surg 2018; 105:1688-1696. [DOI: 10.1002/bjs.10915] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 01/30/2023]
Abstract
Abstract
Background
Improving patients' oral hygiene is an option for preventing postoperative pneumonia that may be caused by aspiration of oral and pharyngeal secretions. Whether preoperative oral care by a dentist can decrease postoperative complications remains controversial. A retrospective cohort study was undertaken to assess the association between preoperative oral care and postoperative complications among patients who underwent major cancer surgery.
Methods
The nationwide administrative claims database in Japan was analysed. Patients were identified who underwent resection of head and neck, oesophageal, gastric, colorectal, lung or liver cancer between May 2012 and December 2015. The primary outcomes were postoperative pneumonia and all-cause mortality within 30 days of surgery. Patient background was adjusted for with inverse probability of treatment weighting using propensity scoring.
Results
Of 509 179 patients studied, 81 632 (16·0 per cent) received preoperative oral care from a dentist. A total of 15 724 patients (3·09 per cent) had postoperative pneumonia and 1734 (0·34 per cent) died within 30 days of surgery. After adjustment for potential confounding factors, preoperative oral care by a dentist was significantly associated with a decrease in postoperative pneumonia (3·28 versus 3·76 per cent; risk difference − 0·48 (95 per cent c.i. −0·64 to−0·32) per cent) and all-cause mortality within 30 days of surgery (0·30 versus 0·42 per cent; risk difference − 0·12 (−0·17 to −0·07) per cent).
Conclusion
Preoperative oral care by a dentist significantly reduced postoperative complications in patients who underwent cancer surgery.
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Affiliation(s)
- M Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - S Ono
- Department of Biostatistics and Bioinformatics, University of Tokyo, Tokyo, Japan
| | - Y Hagiwara
- Department of Biostatistics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - K Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
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18
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Funakoshi H, Sugawara S, Nakashima Y, Homma Y, Mizobe M, Takahashi J, Inoue T, Shiga T, Yasunaga H. 268 The Effectiveness of Fasudil Hydrochloride Administration to Prevent Cerebral Vasospasm After Intervention for Subarachnoid Hemorrhage. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Isogai T, Matsui H, Tanaka H, Fushimi K, Yasunaga H. P601Body mass index and in-hospital mortality among patients with takotsubo syndrome: a nationwide retrospective cohort study in Japan. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Sato M, Tateishi R, Yasunaga H, Matsui H, Fushimi K, Ikeda H, Yatomi Y, Koike K. Association between hospital volume and in-hospital mortality following radiofrequency ablation for hepatocellular carcinoma. BJS Open 2017; 1:50-54. [PMID: 29951606 PMCID: PMC5989986 DOI: 10.1002/bjs5.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/30/2017] [Indexed: 12/21/2022] Open
Abstract
Background Radiofrequency ablation (RFA) is a minimally invasive treatment for hepatocellular carcinoma (HCC). There is increasing evidence of an association between increasing hospital volume and lower postoperative mortality for many surgical procedures, but this is difficult to establish with minimally invasive treatments, where postoperative mortality is low. The aim of this study was to investigate the relationship between hospital volume and in-hospital mortality following RFA using a Japanese nationwide database. Methods Data from the Diagnostic Procedure Combination database were analysed from 1 July 2010 to 31 March 2012. Multivariable logistic regression was used to analyse the relationship between hospital volume and in-hospital mortality following RFA, with adjustment for patient background. Results Some 36 675 patients with HCC were identified in the database. The overall in-hospital mortality rate from RFA was 0·31 per cent. In-hospital mortality was significantly higher in low-volume than high-volume hospitals (odds ratio 2·57, 95 per cent c.i. 1·61 to 4·09; P < 0·001). Higher in-hospital mortality was significantly associated with older age and a higher Charlson Co-morbidity Index score. Conclusion RFA for HCC was associated with acceptably low mortality in Japan, but in-hospital mortality following RFA was affected by hospital procedural volume.
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Affiliation(s)
- M Sato
- Department of Clinical Laboratory Medicine University of Tokyo Tokyo Japan.,Department of Gastroenterology, Graduate School of Medicine University of Tokyo Tokyo Japan
| | - R Tateishi
- Department of Gastroenterology, Graduate School of Medicine University of Tokyo Tokyo Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health University of Tokyo Tokyo Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health University of Tokyo Tokyo Japan
| | - K Fushimi
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School of Medicine Tokyo Japan
| | - H Ikeda
- Department of Clinical Laboratory Medicine University of Tokyo Tokyo Japan
| | - Y Yatomi
- Department of Clinical Laboratory Medicine University of Tokyo Tokyo Japan
| | - K Koike
- Department of Gastroenterology, Graduate School of Medicine University of Tokyo Tokyo Japan
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21
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Sasabuchi Y, Yasunaga H, Matsui H, Lefor AK, Fushimi K, Sanui M. Epidural analgesia is infrequently used in patients with acute pancreatitis : a retrospective cohort study. Acta Gastroenterol Belg 2017; 80:381-384. [PMID: 29560667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUNDS AND AIMS Epidural analgesia is an option for pain control in patients with acute pancreatitis. The aim of this study is to describe characteristics, morbidity and mortality of patients with acute pancreatitis treated with epidural analgesia. PATIENTS AND METHODS Data was extracted from a national inpatient database in Japan on patients hospitalized with acute pancreatitis between July 2010 and March 2013. A total of 44,146 patients discharged from acute care hospitals were included in this retrospective cohort study. The patient background, timing and duration of epidural analgesia, complications (epidural hematoma or abscess), surgery (for cholelithiasis / cholecystitis or complications) and mortality were verified. RESULTS Epidural analgesia was used in 307 patients (0.70 %). The mean age was 64.0 years (standard deviation, 15.4 years) and 116 (37.8%) of the patients were female. The median duration of epidural analgesia was four days (interquartile range, 3-5 days). No patient underwent surgery for epidural hematoma or abscess. Six (2.0%) patients died during hospitalization. Most likely causes of death were pulmonary embolism, multiple organ failure, sepsis, and methicillin-resistant staphylococcus aureus enterocolitis. The responsible physician for 250 of the patients (81.4%) was a gastroenterological surgeon. Epidural analgesia was started on the day of surgery in 278 (90.6%) patients. CONCLUSION Epidural analgesia is rarely used in patients with acute pancreatitis. None of the patients included in the study required surgery for epidural hematoma or abscess. Further research to evaluate the efficacy and safety of epidural analgesia in patients with acute pancreatitis is warranted.
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Affiliation(s)
- Y Sasabuchi
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, 113-0033, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, 113-0033, Japan
| | - A K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, 329-0498, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - M Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Saitama Medical Center, Saitama, 330-0834, Japan
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22
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Ono S, Ishimaru M, Ono Y, Matsui H, Yasunaga H. IMPACT OF ORAL CARE BY DENTAL PROFESSIONALS AMONG ELDERLY PATIENTS IN A REHABILITATION FACILITY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S. Ono
- The University of Tokyo, Tokyo, Japan,
| | | | - Y. Ono
- National Defense Medical College, Saitama, Japan
| | - H. Matsui
- The University of Tokyo, Tokyo, Japan,
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23
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Abe H, Sumitani M, Uchida K, Matsui H, Yasunaga H, Yamada Y. Abstract PR181. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492580.78691.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Sasabuchi Y, Yasunaga H, Lefor AK. Propofol infusion in children - a reply. Anaesthesia 2016; 71:987. [DOI: 10.1111/anae.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Sasabuchi Y, Yasunaga H, Matsui H, Lefor AK, Fushimi K. Prolonged propofol infusion for mechanically ventilated children. Anaesthesia 2016; 71:424-8. [PMID: 26874247 DOI: 10.1111/anae.13401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
We retrospectively analysed 30-day mortality and duration of intubation for 8016 children ventilated for three or more days, sedated with midazolam (n = 7716) or propofol (n = 300). We matched the propensity scores of 263 pairs of children. The propensity-matched 30-day mortality (95% CI) was similar: 17/263 (6.5%) with midazolam vs. 24/263 (9.1%) with propofol, p = 0.26. Weaning from mechanical ventilation of children sedated with midazolam was slower than weaning of children sedated with propofol, subhazard ratio (95% CI) 1.43 (1.18-1.73), p < 0.001.
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Affiliation(s)
- Y Sasabuchi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - A K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
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26
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Iwagami M, Doi, Yasunaga H, Noiri E, Yahagi N. Effect of endotoxin absorption by polymixin B hemoperfusion in dialysis-requiring acute kidney injury. Intensive Care Med Exp 2015. [PMCID: PMC4798321 DOI: 10.1186/2197-425x-3-s1-a625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Hasegawa W, Yamauchi Y, Yasunaga H, Sunohara M, Jo T, Matsui H, Fushimi K, Takami K, Nagase T. Factors that predict in-hospital mortality in eosinophilic granulomatosis with polyangiitis. Allergy 2015; 70:585-90. [PMID: 25703656 DOI: 10.1111/all.12597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic small-vessel vasculitis associated with asthma, eosinophilia, and necrotizing vasculitis. EGPA is potentially life-threatening and often involves peripheral neuropathies, peptic ulcers, cerebral vessel disease, and cardiovascular disease. However, there is limited understanding of the prognostics factors for patients with EGPA. We investigated the clinical features and factors affecting patients' in-hospital mortality, using a national inpatient database in Japan. METHODS We retrospectively collected data of EGPA patients who required hospitalization between July 2010 and March 2013, using the Diagnosis Procedure Combination database. We evaluated EGPA patients' characteristics and performed multivariate logistic regression analyses to assess the factors associated with in-hospital mortality. RESULTS A total of 2195 EGPA patients were identified. The mean age was 61.9 years, 42.1% (924/2195) were male, and 41.6% (914/2195) had emergent admission. In-hospital deaths occurred in 97/2195 patients (4.4%). Higher in-hospital mortality was associated with age older than 65 years, disturbance of consciousness on admission, unscheduled admission, respiratory disease, cardio-cerebrovascular disease, renal disease, sepsis, and malignant disease on admission. Lower mortality was associated with female gender and peripheral neuropathies. CONCLUSIONS Our study revealed the clinical features of EGPA patients who required hospitalization and the factors associated with their mortality. These results may be useful for physicians when assessing disease severity or treatments for hospitalized EGPA patients.
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Affiliation(s)
- W. Hasegawa
- Department of Respiratory Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Y. Yamauchi
- Department of Respiratory Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Division for Health Service Promotion; The University of Tokyo; Tokyo Japan
| | - H. Yasunaga
- Department of Clinical Epidemiology and Health Economics; School of Public Health; The University of Tokyo; Tokyo Japan
| | - M. Sunohara
- Department of Respiratory Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - T. Jo
- Department of Respiratory Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Division for Health Service Promotion; The University of Tokyo; Tokyo Japan
| | - H. Matsui
- Department of Clinical Epidemiology and Health Economics; School of Public Health; The University of Tokyo; Tokyo Japan
| | - K. Fushimi
- Department of Health Policy and Informatics; Tokyo Medical and Dental University Graduate School of Medicine; Tokyo Japan
| | - K. Takami
- Department of Respiratory Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - T. Nagase
- Department of Respiratory Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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Tagami T, Matsui H, Yasunaga H. Antithrombin or thrombomodulin administration in severe pneumonia patients with sepsis and disseminated intravascular coagulation: reply to two papers. J Thromb Haemost 2015; 13:686-8. [PMID: 25650788 DOI: 10.1111/jth.12869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Tagami T, Matsui H, Yasunaga H. Antithrombin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation: an observational nationwide study: reply. J Thromb Haemost 2015; 13:680-2. [PMID: 25530550 DOI: 10.1111/jth.12821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Sasabuchi Y, Yasunaga H, Matsui H, Lefor AT, Horiguchi H, Fushimi K, Sanui M. The Dose-Response Relationship Between Body Mass Index and Mortality in Subjects Admitted to the ICU With and Without Mechanical Ventilation. Respir Care 2015; 60:983-91. [DOI: 10.4187/respcare.03694] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Necrotising soft-tissue infections (NSTIs) of the upper limb are uncommon, but potentially life-threatening. We used a national database to investigate the risk factors for amputation of the limb and death. We extracted data from the Japanese Diagnosis Procedure Combination database on 116 patients (79 men and 37 women) who had a NSTI of the upper extremity between 2007 and 2010. The overall in-hospital mortality was 15.5%. Univariate analysis of in-hospital mortality showed that the significant variables were age (p = 0.015), liver dysfunction (p = 0.005), renal dysfunction (P < 0.001), altered consciousness (p = 0.049), and sepsis (p = 0.021). Logistic regression analysis showed that the factors associated with death in hospital were age over 70 years (Odds Ratio (OR) 6.6; 95% confidence interval (CI) 1.5 to 28.2; p = 0.011) and renal dysfunction (OR 15.4; 95% CI 3.8 to 62.8; p < 0.001). Univariate analysis of limb amputation showed that the significant variables were diabetes (p = 0.017) mellitus and sepsis (p = 0.001). Multivariable logistic regression analysis showed that the factors related to limb amputation were sepsis (OR 1.8; 95% CI 1.5 to 24.0; p = 0.013) and diabetes mellitus (OR 1.6; 95% CI 1.1 to 21.1; p = 0.038). For NSTIs of the upper extremity, advanced age and renal dysfunction are both associated with a higher rate of in-hospital mortality. Sepsis and diabetes mellitus are both associated with a higher rate of amputation.
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Affiliation(s)
- K Uehara
- Department of Orthopaedic Surgery, The University of Tokyo, Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Y Morizaki
- Department of Orthopaedic Surgery, The University of Tokyo, Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - H Horiguchi
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, 2-5-21 Higashigaoka, Meguro-ku, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - S Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
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Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Recombinant human soluble thrombomodulin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation: an observational nationwide study. J Thromb Haemost 2015; 13:31-40. [PMID: 25393713 DOI: 10.1111/jth.12786] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/06/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The association between recombinant human soluble thrombomodulin (rhTM) use and mortality in patients with sepsis-associated disseminated intravascular coagulation (DIC) remains controversial. OBJECTIVES To examine the hypothesis that rhTM could be effective in the treatment of patients with sepsis-associated DIC following severe pneumonia. METHODS Propensity score and instrumental variable analyses using a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database, were used. The main outcome was 28-day in-hospital all-cause mortality. RESULTS Eligible patients (n = 6342) from 936 hospitals were categorized into the rhTM group (n = 1280) or control group (n = 5062). Propensity score matching created a matched cohort of 1140 pairs with and without rhTM. No significant difference in 28-day mortality was documented between the two groups in the unmatched analysis (rhTM vs. control, 37.0%, 474/1280 vs. 36.9%, 1866/5062; odds ratio [OR], 1.00; 95%CI, 0.98-1.03), nor in the propensity-matched analysis (37.6%, 429/1140 vs. 37.0%, 886/1140; OR, 1.01; 95%CI, 0.93-1.10). The logistic regression analysis did not show a significant association between the use of rhTM and 28-day mortality in propensity-matched patients (OR, 1.00; 95%CI, 0.87-1.22). An analysis using the hospital rhTM-prescribing rate as an instrumental variable found that receipt of rhTM was not associated with reduction in mortality at 28 days (risk difference, 0.008; 95% CI, -0.08-0.98). CONCLUSIONS This large retrospective nationwide study demonstrated that there might be little association between the use of rhTM and mortality in severe pneumonia patients with sepsis-associated DIC. A multinational randomized trial is required to confirm this.
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Affiliation(s)
- T Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Yamana H, Matsui H, Fushimi K, Yasunaga H. Treatment options and outcomes of hospitalised tuberculosis patients: a nationwide study. Int J Tuberc Lung Dis 2014; 19:120-6. [PMID: 25519801 DOI: 10.5588/ijtld.14.0333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Although standardised multidrug treatments exist, mortality among hospitalised tuberculosis (TB) patients is high. OBJECTIVE To characterise TB patients requiring acute hospital care and identify factors associated with in-hospital mortality. DESIGN Using a Japanese national database of acute-care hospitals, we identified patients with sputum smear-positive pulmonary TB who were discharged (both deceased and alive) between July 2010 and March 2013. Demographic characteristics, comorbidity, procedures and treatments were examined. We performed a multivariable logistic regression analysis to identify risk factors for in-hospital mortality. RESULTS Of 877 treated patients (566 males, mean age 74.5 years) identified, 152 (17.3%) died. A standard four-drug regimen of isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide was given to 279 (31.8%) patients, and INH, RMP and EMB to 335 (38.2%) patients. Multivariable analysis showed that the three-drug regimen was significantly associated with higher rates of in-hospital mortality (OR 1.87, 95%CI 1.07-3.27, P = 0.028). Other factors associated with in-hospital death were age, male sex, smoking habit, emergency admission, dementia and severe respiratory condition. CONCLUSION The risk factors for in-hospital death identified include the use of the three-drug regimen. Treatment choice could influence the outcome of hospitalised TB patients.
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Affiliation(s)
- H Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Bunkyo City Public Health Center, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Antithrombin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation: an observational nationwide study. J Thromb Haemost 2014; 12:1470-9. [PMID: 24943516 DOI: 10.1111/jth.12643] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The association between antithrombin use and mortality in patients with sepsis-associated disseminated intravascular coagulation (DIC) remains controversial. OBJECTIVES To examine the hypothesis that antithrombin could be effective in the treatment of patients with sepsis-associated DIC following severe pneumonia. METHODS Propensity score and instrumental variable analyses were performed by use of a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database. The main outcome was 28-day mortality. RESULTS Severe pneumonia patients diagnosed with sepsis-associated DIC (n = 9075) were categorized into antithrombin (n = 2663) and control (n = 6412) groups. Propensity score matching created a matched cohort of 2194 pairs of patients with and without antithrombin use. Mortality differences were found between the two groups (antithrombin vs. control: unmatched, 40.8% vs. 45.7%; propensity-matched, 40.6% vs. 44.2%; inverse probability-weighted, 41.1% vs. 45.1%). Multiple logistic regression analyses showed an association between antithrombin use and 28-day mortality (unmatched with propensity score adjusted, adjusted odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78-0.97; propensity-matched, adjusted OR 0.85, 95% CI 0.75-0.97; inverse probability-weighted, adjusted OR 0.85, 95% CI 0.79-0.90). An analysis with the hospital antithrombin-prescribing rate as an instrumental variable showed that receipt of antithrombin was associated with a 9.9% (95% CI 3.5-16.3) reduction in 28-day mortality. CONCLUSIONS This retrospective, large, nationwide database study demonstrates that antithrombin administration may be associated with reduced 28-day mortality in patients with severe pneumonia and sepsis-associated DIC. A large, multinational randomized trial is required.
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Affiliation(s)
- T Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Inokuchi H, Yasunaga H, Nakahara Y, Horiguchi H, Ogata N, Fujitani J, Matsuda S, Fushimi K, Haga N. Effect of rehabilitation on mortality of patients with Guillain-Barre Syndrome: a propensity-matched analysis using nationwide database. Eur J Phys Rehabil Med 2014; 50:439-446. [PMID: 24651152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Rehabilitation for patients with Guillain-Barre Syndrome (GBS) is recommended as it improves the outcome of neurological deficits. Few studies focused on the effect of rehabilitation on mortality of the patients. AIM To investigate the effect of rehabilitation on hospital mortality of patients with GBS using the Japanese Diagnosis Procedure Combination (DPC) nationwide administrative claims database. DESIGN A retrospective observational cohort study. SETTING Hospitals adopting the Japanese DPC system. POPULATION Patients hospitalized with a diagnosis of GBS between July 2007 and October 2011. METHODS Data analyzed included sex, age, Barthel index at admission, use of ventilation, immune therapy, and rehabilitation during hospitalization, comorbidity, hospital volume, type of hospital, and in-hospital death. One-to-one propensity score-matching was used to compare hospital mortality rates within 30- and 90-days after admission in rehabilitation and non-rehabilitation groups. The adjusted odds ratios of rehabilitation to hospital mortality were also estimated. RESULTS A total of 3835 patients were identified and analyzed. Patients with advancing age, lower Barthel index at admission, comorbidities, ventilation, or immune therapy were more likely to receive rehabilitation during hospitalization. Propensity-matched analysis of 926 pairs showed that the rehabilitation group had lower hospital mortality rates within both 30- and 90-days than the non-rehabilitation group. The adjusted odds ratios of rehabilitation to hospital mortality within 30- and 90-days were 0.14 and 0.23, respectively. CONCLUSION After matching patients' background, rehabilitation was associated with lower hospital mortality of patients with GBS. CLINICAL REHABILITATION IMPACT Rehabilitation treatment is essential for patients with GBS to improve their survival.
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Affiliation(s)
- H Inokuchi
- Department of Rehabilitation Medicine Graduate School of Medicine, The University of Tokyo, Tokyo, Japan -
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Hamada T, Nakai Y, Yasunaga H, Isayama H, Matsui H, Takahara N, Sasaki T, Takagi K, Watanabe T, Yagioka H, Kogure H, Arizumi T, Yamamoto N, Ito Y, Hirano K, Tsujino T, Tada M, Koike K. Prognostic nomogram for nonresectable pancreatic cancer treated with gemcitabine-based chemotherapy. Br J Cancer 2014; 110:1943-9. [PMID: 24642625 PMCID: PMC3992497 DOI: 10.1038/bjc.2014.131] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/14/2014] [Accepted: 02/20/2014] [Indexed: 12/26/2022] Open
Abstract
Background: A nomogram is progressively being used as a useful predictive tool for cancer prognosis. A nomogram to predict survival in nonresectable pancreatic cancer treated with chemotherapy has not been reported. Methods: Using prospectively collected data on patients with nonresectable pancreatic cancer receiving gemcitabine-based chemotherapy at five Japanese hospitals, we derived a predictive nomogram and internally validated it using a concordance index and calibration plots. Results: In total, 531 patients were included between June 2001 and February 2013. The American Joint Committee on Cancer (AJCC) TNM stages were III and IV in 204 and 327 patients, respectively. The median survival time of the total cohort was 11.3 months. A nomogram was generated to predict survival probabilities at 6, 12, and 18 months and median survival time, based on the following six variables: age; sex; performance status; tumour size; regional lymph node metastasis; and distant metastasis. The concordance index of the present nomogram was higher than that of the AJCC TNM staging system at 12 months (0.686 vs 0.612). The calibration plots demonstrated good fitness of the nomogram for survival prediction. Conclusions: The present nomogram can provide valuable information for tailored decision-making early after the diagnosis of nonresectable pancreatic cancer.
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Affiliation(s)
- T Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Y Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - H Yasunaga
- Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - H Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - H Matsui
- Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - N Takahara
- Department of Gastroenterology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo 158-8531, Japan
| | - T Sasaki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - K Takagi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - T Watanabe
- Department of Gastroenterology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo 158-8531, Japan
| | - H Yagioka
- Department of Gastroenterology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo 151-8528, Japan
| | - H Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - T Arizumi
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Izumi-cho, Kanda, Chiyoda-ku, Tokyo 101-8643, Japan
| | - N Yamamoto
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Y Ito
- Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - K Hirano
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - T Tsujino
- Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - M Tada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - K Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Yoshioka R, Yasunaga H, Hasegawa K, Horiguchi H, Fushimi K, Aoki T, Sakamoto Y, Sugawara Y, Kokudo N. Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy. Br J Surg 2014; 101:523-9. [PMID: 24615349 DOI: 10.1002/bjs.9420] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND High morbidity and mortality rates after pancreaticoduodenectomy (PD) have led to concentration of this surgery in high-volume centres, with improved outcomes. The extent to which better outcomes might be apparent in a healthcare system where the mortality rate is already low is unclear. METHODS The Japanese Diagnosis Procedure Combination database was used to identify patients undergoing PD between 2007 and 2010. Patient data included age, sex, co-morbidities at admission, type of hospital, type of PD, and the year in which the patient was treated. Hospital volume was defined as the number of PDs performed annually at each hospital, and categorized into quintiles: very low-, low-, medium-, high- and very high-volume groups. The Charlson co-morbidity index was calculated using the International Classification of Diseases, tenth revision, codes of co-morbidities. RESULTS A total of 10 652 patients who underwent PD in 848 hospitals were identified. The overall in-hospital mortality rate after PD was 3·3 per cent (350 of 10 652), and for the groups ranged from 5·0 per cent for the very low-volume group to 1·4 per cent for the very high-volume group (P < 0·001). Multivariable analysis revealed a significant linear relationship between higher hospital volume and shorter postoperative length of stay compared with the very low-volume group, and between increasing hospital volume and lower total costs. CONCLUSION A significant relationship exists between increasing hospital volume, lower in-hospital mortality, shorter length of stay and lower costs for patients undergoing PD in Japan. Centralization of PD in this healthcare system is therefore justified.
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Affiliation(s)
- R Yoshioka
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Yasunaga H, Horiguchi H, Matsuda S, Fushimi K, Hashimoto H, Ayanian JZ. Body mass index and outcomes following gastrointestinal cancer surgery in Japan. Br J Surg 2013; 100:1335-43. [PMID: 23939845 DOI: 10.1002/bjs.9221] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recent studies in the USA have shown a lower postoperative mortality rate in mildly obese patients, described as the 'obesity paradox'. The results from the relatively obese population in Western countries may not be generalizable to Asian countries, prompting the present study to investigate the relationship between body mass index (BMI) and outcomes after gastrointestinal surgery. METHODS Patients who underwent gastrectomy or colorectal resection for stage I-III cancer between July and December 2010 were identified from a nationwide inpatient database in Japan. Multivariable logistic regression models for in-hospital mortality and postoperative complications, and a linear regression model for total costs were established, with adjustment for age, sex, co-morbidities, cancer stage and BMI. Restricted cubic spline functions were used to consider potential non-linear associations between BMI and the outcomes. RESULTS Among 30 765 eligible patients, associations between BMI and the outcomes were U-shaped, with the lowest mortality, morbidity and total costs in patients with a BMI of around 23·0 kg/m(2) . A BMI of 18·5 kg/m(2) was associated with significantly greater mortality (odds ratio (OR) 2·04, 95 per cent confidence interval 1·64 to 2·55), postoperative complications (OR 1·10, 1·03 to 1·18) and total costs (difference €1389, 1139 to 1640) compared with a BMI of 23·0 kg/m(2) . Patients with a BMI exceeding 30·0 kg/m(2) had significantly higher rates of postoperative complications and total costs than those with a BMI of 23·0 kg/m(2) , but no significant association was evident between a BMI of more than 23·0 kg/m(2) and in-hospital death. CONCLUSION Unlike previous studies in the USA, in the present national Japanese cohort of patients undergoing surgery for gastrointestinal cancer, those who were either underweight or overweight had more postoperative complications and greater perioperative costs than those of normal weight.
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Affiliation(s)
- H Yasunaga
- Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Matsubara T, Wataoka I, Urakawa H, Yasunaga H. Effect of reaction pH and CuSO4addition on the formation of catechinone due to oxidation of (+)-catechin. Int J Cosmet Sci 2013; 35:362-7. [DOI: 10.1111/ics.12051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- T. Matsubara
- Department of Biobased Materials Science; Kyoto Institute of Technology; Kyoto Sakyo-ku Matugasaki Gosyokaido-tyo 606-8585 Japan
| | - I. Wataoka
- Department of Biobased Materials Science; Kyoto Institute of Technology; Kyoto Sakyo-ku Matugasaki Gosyokaido-tyo 606-8585 Japan
| | - H. Urakawa
- Department of Biobased Materials Science; Kyoto Institute of Technology; Kyoto Sakyo-ku Matugasaki Gosyokaido-tyo 606-8585 Japan
| | - H. Yasunaga
- Department of Biobased Materials Science; Kyoto Institute of Technology; Kyoto Sakyo-ku Matugasaki Gosyokaido-tyo 606-8585 Japan
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Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S, Fushimi K. The burden of Clostridium difficile-associated disease following digestive tract surgery in Japan. J Hosp Infect 2012; 82:175-80. [PMID: 23021129 DOI: 10.1016/j.jhin.2012.07.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 07/17/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although surgery is considered a risk for Clostridium difficile-associated disease (CDAD), large-scale data on outcomes of postsurgical CDAD are rare. AIM Using the Japanese Diagnosis Procedure Combination inpatient database, we analysed factors affecting the occurrence of CDAD and the outcomes of CDAD following digestive tract surgery. METHODS We identified patients postoperatively diagnosed with CDAD among patients undergoing oesophagectomy, gastrectomy, and colorectal resection for cancer from 2007 to 2010. We performed logistic regression analyses for the occurrence of CDAD and in-hospital mortality, and multiple linear regressions and one-to-one propensity-matched analyses for postoperative length of stay and total costs, with adjustment for patient backgrounds and hospital factors. FINDINGS Of 143,652 patients undergoing digestive tract surgery, 409 (0.28%) CDAD patients were identified. Higher Charlson comorbidity index, longer preoperative length of stay and non-academic hospitals were significantly associated with higher occurrence of CDAD. In-hospital mortality was higher in the CDAD patients compared with non-CDAD patients [3.4% vs 1.6%; odds ratio: 1.83; 95% confidence interval (CI): 1.07-3.13; P = 0.027]. Attributable postoperative length of stay and total costs related to CDAD were 12.4 days (95% CI: 9.7-15.0; P < 0.001) and US$6,576 (3,753-9,398; P < 0.001) in the linear regressions and 9 days (P < 0.001) and US$6,724 (P < 0.001) in the propensity-matched paired analyses. CONCLUSIONS High mortality, long hospital stay and high costs were associated with postsurgical CDAD. The results indicate the necessity of further CDAD control measures for patients undergoing digestive tract surgery.
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Affiliation(s)
- H Yasunaga
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Sugihara T, Yasunaga H, Horiguchi H, Nishimatsu H, Matsuda S, Homma Y. Incidence and clinical features of priapism in Japan: 46 cases from the Japanese diagnosis procedure combination database 2006–2008. Int J Impot Res 2011; 23:76-80. [DOI: 10.1038/ijir.2011.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Yasunaga H, Ishii Y, Komoda T, Shinkawa T, Kajiwara K, Urakawa H. Function of surfactants in hair dyeing by oxidation dyes 2. Effect on formation of oxidation dyes by p-aminophenol and 5-amino-o-cresol in dye bath(1). Int J Cosmet Sci 2008; 29:301-9. [PMID: 18489358 DOI: 10.1111/j.1467-2494.2007.00384.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effect of surfactants on an oxidation-hair-dye-formation reaction in a dye bath was studied in order to learn the mechanism of the effect of surfactants on the dyeability of hair by the oxidation dye. The dye-formation behaviours for the p-aminophenol and 5-amino-o-cresol system with the surfactants, of which the hydrophilic parts have different charges, were compared changing the concentration of surfactants. It was found that the same dyes are produced, regardless of the charge of surfactants added, and the rate of dye produced in the dyebath is increased in the presence of surfactants. The order of the production rate is, with an anionic surfactant > with non-ionic surfactant > with cationic surfactant > without surfactant. The relation between the dyeability of hair and the rate of dye produced in the dyebath in the presence of surfactants is not found. The major factor governing the dyeability of hair is different from the mechanism of the increased dye in the solution. It was also found that the dye-formation rate is increased by immersing hair into the reaction solution, and hair works as an accelerator for the dye-formation reaction.
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Affiliation(s)
- H Yasunaga
- Department of Chemistry and Materials Technology, Kyoto Institute of Technology, Kyoto Sakyo-ku, Matugasaki, Japan.
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Abstract
Estimating the cost of hospital infection has become a matter of increasing interest in terms of health economics. This study aimed to assess the accuracy of economic studies on hospital infections, using surgical site infection (SSI) as an example. A search was performed for original articles reporting the cost of SSI, published in the English language between 1996 and 2005. For the critical review, the period of cost tracking, classification of costs and cost counting methods were noted. Fifteen articles met the inclusion criteria. The costs of SSI vary according to surgical procedures, country, publication year, study design and accounting method. Only two studies estimated the additional cost of SSI after discharge. All 15 studies included healthcare costs and none measured patient/family resources. In 10 studies, the costs were calculated based on accounting. Three studies used estimated costs from the ratio of costs to charges and two studies used charge data in place of cost data. It will become increasingly important for future studies to perform multi-centre prospective surveys, establish a standard method for cost accounting, include the cost of healthcare services following hospitalization and consider the morbidity cost to patients themselves from a societal perspective.
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Affiliation(s)
- H Yasunaga
- Department of Planning, Information and Management, University of Tokyo Hospital, Japan.
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Sakamoto T, Yasunaga H, Yokota S, Ando M. Differential display of skin mRNAs regulated under varying environmental conditions in a mudskipper. J Comp Physiol B 2002; 172:447-53. [PMID: 12122461 DOI: 10.1007/s00360-002-0274-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2002] [Indexed: 10/27/2022]
Abstract
To understand the molecular mechanisms underlying the terrestrial adaptation, as well as adaptation to different salinities, of the euryhaline and amphibious mudskipper ( Periophthalmus modestus), we have looked for the skin mRNAs that change during varying environmental conditions. Using differential mRNA display polymerase chain reaction, we compared skin mRNAs in mudskipper transferred from isotonic 30% seawater to fresh water or to seawater for 1 day and 7 days, as well as those kept out of water for 1 day. At the end of these periods, poly(A(+))RNA was prepared from the Cl(-)-secreting pectoral skins and also from the outer opercular skins where ion transport is negligible, and analyzed by differential display. We identified four cDNA products expressed differently under various environments as homologues of known genes. A further 34 cDNAs were expressed differentially, but they have no significant homology to identified sequences in GenBank. Northern blots demonstrate that mRNA levels of the actin-binding protein and the platelet-activating factor acetylhydrolase increased in the pectoral skins during seawater acclimation. The mRNA of the 90 kDa heat shock protein was down-regulated in water-deprived and freshwater fish, whose plasma cortisol levels were high. The aldolase mRNA was induced in both skins after desiccation. These four genes may be involved in the environmental adaptations.
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Affiliation(s)
- T Sakamoto
- Faculty of Integrated Arts and Sciences, Hiroshima University, Higashi-hiroshima 739-8521, Japan.
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45
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Kawano T, Ishii M, Takagi J, Maeno Y, Eto G, Sugahara Y, Toshima T, Yasunaga H, Kawara T, Todo K, Kato H. Three-dimensional helical computed tomographic angiography in neonates and infants with complex congenital heart disease. Am Heart J 2000; 139:654-660. [PMID: 10740148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND For the clinical management of patients with complex congenital heart disease (CHD), accurate evaluation of their morphologic conditions is critical. Three-dimensional (3D) helical computed tomography (CT) angiography has been used to assess the vascular system in adult patients; the indication for complex CHD, especially in the neonatal period, has not yet been defined. Therefore the purposes of our study were to determine the quality and limitations of current 3D helical CT angiography for neonates and infants with complex CHD and to assess the clinical utility of this technique. METHODS AND RESULTS 3D helical CT angiography was performed in 17 patients with various types of complex CHD. Their median age was 41 days (range 3 days to 9 months), and mean body weight was 3.6 kg (range 2.2 to 8.5 kg). All 3D images were produced with the 3D reconstruction algorithm of shaded-surface display. Oral sedation was required in only 4 infants during the procedure. 3D helical CT angiography clearly demonstrated the shape and spatial relation of great arteries, proximal branch pulmonary arteries, anomalous pulmonary venous connections, the patent ductus arteriosus, and a shunt. The 3D information of extracardiac morphologic characteristics and 3D anatomic relation of each extracardiac structure were easily recognized by this imaging process. However, intracardiac structure could not be visualized because of blurred and/or unclear edges of the ventricular wall caused by respiratory movement. CONCLUSIONS 3D helical CT angiography represents an important additional diagnostic tool and may become an alternative method to angiography or other noninvasive techniques used in the evaluation of extracardiac anomalies in neonates and infants with complex CHD.
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Affiliation(s)
- T Kawano
- Department of Pediatrics and the Cardiovascular Research Institute, Kurume University School of Medicine, Japan
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46
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Ariyoshi M, Sonoda K, Nagata K, Mashima T, Zenmyo M, Paku C, Takamiya Y, Yoshimatsu H, Hirai Y, Yasunaga H, Akashi H, Imayama H, Shimokobe T, Inoue A, Mutoh Y. Efficacy of aquatic exercises for patients with low-back pain. Kurume Med J 1999; 46:91-6. [PMID: 10410527 DOI: 10.2739/kurumemedj.46.91] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We have studied 35 patients (25 female and 10 male) with low-back pain who were managed with aquatic exercises after an appropriate period of treatment for their condition in the medical institution. The exercises employed consisted of strengthening exercises for the abdominal, gluteal, and leg muscles, stretching of the back, hip, hamstrings, and calf muscles, walking in water, and swimming. All the patients had been participating in the exercise program for more than 6 months. The frequency of performing exercises was once a week for 7 patients, twice a week for 19, and 3 or more times a week for the remaining patients. The method used in this study was a survey questionnaire which was composed of questions about the patient's physical and psychological condition. Those patients who had performed exercises twice or more in a week showed a more significant improvement in the physical score than those who performed exercises only once a week. More than 90% of the patients felt they had improved after 6 months of participation in the program. The improvement in physical score was independent of the initial ability in swimming. The results obtained suggested that exercises in water may be one of the most useful modes of exercise for a patient with low-back pain.
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Affiliation(s)
- M Ariyoshi
- Department of Surgery, Kyoritsu Hospital, Kitakyusyu, Japan
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Tanaka K, Yasunaga H, Egashira A, Kumate M, Kawara T, Kosuga K. [Aneurysm of the membranous ventricular septum with ventricular septal defect, mitral and tricuspid insufficiency]. Jpn J Thorac Cardiovasc Surg 1998; 46:1009-13. [PMID: 9847579 DOI: 10.1007/bf03217864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A seventy-year-old man was admitted at our hospital because of dyspnea. Echocardiogram and left ventriculogram showed an aneurysm formation of the membranous ventricular septum and small left-to-right shunt through ventricular septum defect and also severe mitral and tricuspid insufficiency. Operation was performed after medical therapy for congestive heart failure. During operation, mitral leaflets showed no organic lesions nor prolapse, but the annulus was dilated. The cause of mitral insufficiency, we thought, might be congenital, and the annulus dilatation was caused of mitral insufficiency, we thought, might be congenital, and the annulus dilatation was caused to produce tricuspid insufficiency secondary. The ventricular septal communication became small (diameter; 5 mm) and was associated with aneurysm formation of the remaining portion of the membranous septum. And the aneurysm, protruding to the septal leaflet of tricuspid valves, enhanced tricuspid insufficiency. It was reported by many authors that the aneurysm formation was related to spontaneous closure of ventricular septal defect. Patients with small ventricular septal defect, without any symptoms, must be followed intensively, or they might get cardiac complications, such as arrhythmia, right ventricular outflow obstruction, tricuspid insufficiency, and so on.
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Affiliation(s)
- K Tanaka
- Division of Cardiovascular Surgery, Munakata Suikokai General Hospital, Fukuoka, Japan
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Sugawara Y, Sato O, Miyata T, Kimura H, Yasunaga H, Suzuki S, Makuuchi M. Continuous hemodiafiltration during aortic arch aneurysm repair in chronic renal failure patient. Panminerva Med 1998; 40:63-5. [PMID: 9573758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report the successful repair of a distal aortic arch aneurysm in a patient with chronic renal failure following aneurysmectomy for a ruptured abdominal aorta. Perioperative use (during and up to 47 hrs after the operation) of continuous hemodiafiltration was useful for controlling fluid balance and uremia without any complicating hemodynamic instability. However, this should be restricted to the first two or three days after the operation, since it poses risk of significant thrombocytopenia.
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Affiliation(s)
- Y Sugawara
- II Department of Surgery, Faculty of Medicine, University of Tokyo, Japan
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49
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Fujito M, Natori A, Yasunaga H. Many-electron ground states in anisotropic parabolic quantum dots. Phys Rev B Condens Matter 1996; 53:9952-9958. [PMID: 9982559 DOI: 10.1103/physrevb.53.9952] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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50
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Tashiro T, Todo K, Haruta Y, Yasunaga H, Tachikawa Y. Coronary artery bypass grafting without cardiopulmonary bypass for high-risk patients. Cardiovasc Surg 1996; 4:207-11. [PMID: 8861439 DOI: 10.1016/0967-2109(96)82317-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Between January 1991 and June 1993, coronary artery bypass grafting was performed without either cardiopulmonary bypass or cardiac arrest in 23 patients. Most patients had several surgical risk factors, including age > or = 70 years, poor left ventricular function, left main coronary artery stenosis, chronic renal failure, and aortic aneurysm. Distal anastomoses were made under temporary interruption of coronary flow. A total of 37 distal anastomoses to the left anterior descending coronary artery and/or right coronary artery (mean 1.6 per patient) were made, 24 of which were internal thoracic arteries. The coronary occlusion time ranged from 7-14 min (mean 9.8 min). Combined cardiac or vascular operations were carried out in six patients (abdominal aortic aneurysm repair, thoracic aortic aneurysm repair, carotid endarterectomy, and coronary endarterectomy). There was one hospital death. Postoperative angiography was performed in 22 patients and showed a patency rate of 89%. In summary, coronary artery bypass grafting without cardiopulmonary bypass may improve the postoperative outcome of high-risk patients.
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Affiliation(s)
- T Tashiro
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Jyounanku, Fukuoka, Japan
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