Publications by authors named "Hiroki Matsui"

470 Publications

Treatments and outcomes of generalized pustular psoriasis: a cohort of 1516 patients in a nationwide inpatient database in Japan.

J Am Acad Dermatol 2021 Jun 8. Epub 2021 Jun 8.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Background: Because generalized pustular psoriasis (GPP) is uncommon, there are few studies reporting treatments and outcomes for large numbers of patients.

Objective: To report treatments and outcomes in a large cohort of hospitalized patients with GPP.

Methods: Using a Japanese national inpatient database, we identified 1516 patients with GPP who required hospitalization from July 2010 to March 2019. We categorized patients into three medication groups: biologics (n = 294), oral agents without biologics (n = 948), or systemic corticosteroids only (n = 274). We investigated their characteristics, treatments, and outcomes.

Results: Mean age was 66 years (interquartile range: 52-77 years); 50 patients (3.3%) were admitted to the intensive care unit, 125 (8.2%) required blood pressure support, and 63 (4.2%) died. Patients receiving biologics were younger and had fewer comorbidities and lower in-hospital mortality (1.0% [biologics group] vs. 3.7% [oral-agents group] vs. 9.1% [corticosteroids-only group], p < .001) and morbidity (5.4% vs. 8.2% vs. 12%, p = .02). Among those who received biologics, IL-17 inhibitor use increased over time and showed comparable in-hospital mortality and morbidity to that of TNF inhibitors.

Limitations: Retrospective study design. Some patients received multiple medications.

Conclusion: Biologic treatments showed favorable outcomes compared with other treatments.
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http://dx.doi.org/10.1016/j.jaad.2021.06.008DOI Listing
June 2021

Safety of topical ophthalmic antibiotics in pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis: propensity score analyses.

Eye (Lond) 2021 May 25. Epub 2021 May 25.

Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.

Objective: To investigate the association between exposure to topical ophthalmic antibiotics during pregnancy and adverse neonatal outcomes.

Methods: In this retrospective cohort study, we identified pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis from 2005 to 2018 using the Japanese Medical Data Centre Claims Database. From the eligible women, we extracted women who were dispensed no topical antibiotics during the first trimester (non-antibiotic group), women who were dispensed topical fluoroquinolones alone at least once (fluoroquinolone alone group), and women who were dispensed any single type of antibiotic (single-antibiotic group). We compared the frequency of congenital anomalies (CA), preterm birth (PB), low birth weight (LBW), and the composite outcome of these three between the fluoroquinolone and non-antibiotic groups and between the single-antibiotic and non-antibiotic groups, using propensity score adjustment.

Results: A total of 891 eligible women were identified. In the fluoroquinolone (n = 409) and non-antibiotic (n = 309) groups, CA occurred in 6.8% and 6.8%, PB in 2.4% and 3.2%, LBW in 2.9% and 3.2%, and the composite outcome in 10.5% and 11.3%, respectively. Analysis using propensity score adjustment showed no significant difference between the groups in the frequency of CA (adjusted odds ratio, 1.15; 95% confidence interval, 0.61-2.18), PB (0.80; 0.30-2.17), LBW (1.08; 0.45-2.63), or the composite outcome (1.12; 0.67-1.87). Comparison of the single-antibiotic and non-antibiotic groups showed similar results.

Conclusions: Topical ophthalmic antibiotics for hordeola, chalazia, blepharitis, or bacterial conjunctivitis during the first trimester were not associated with increased adverse neonatal outcomes.
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http://dx.doi.org/10.1038/s41433-021-01586-yDOI Listing
May 2021

Associations between early parenteral nutrition and in-hospital outcomes in underweight patients with gastrointestinal surgery.

Clin Nutr ESPEN 2021 Jun 16;43:464-470. Epub 2021 Mar 16.

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. Electronic address:

Background & Aims: Guidelines recommend early parenteral nutrition for malnourished patients. However, the effectiveness of early parenteral nutrition in underweight patients has not been established. This study aimed to determine whether in-hospital outcomes were associated with early parenteral nutrition in underweight gastrointestinal surgery patients with short-term contraindications to early enteral nutrition.

Methods: We identified underweight adult gastrointestinal surgery patients with short-term contraindications to early enteral nutrition using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2018. We performed propensity-score overlap weighting to compare in-hospital outcomes between patients with and without early parenteral nutrition. The primary outcome was length of hospital stay. The secondary outcomes were total hospitalization cost, hospital-acquired pneumonia, hospital-acquired urinary tract infection, central line-associated bloodstream infection, and all-cause 28-day in-hospital mortality.

Results: We identified 31,898 eligible patients. Early parenteral nutrition was associated with longer hospital stay (19.2 vs. 18.4 days; difference, 0.7 days; 95% CI, 0.1 to 1.4). There were no differences between the patients with and without early parenteral nutrition in total hospitalization cost (difference, US$60; 95% CI, -277 to 397), hospital-acquired pneumonia (risk difference, -0.11%; 95% CI, -0.78 to 0.55), hospital-acquired urinary tract infection (risk difference, 0.03%; 95% CI, -0.08 to 0.14), central line-associated bloodstream infection (risk difference, 0.08%; 95% CI, -0.02 to 0.18), and all-cause 28-day in-hospital mortality (risk difference, 0.31%; 95% CI, -0.07 to 0.69).

Conclusions: Early parenteral nutrition for underweight gastrointestinal surgery patients with short-term contraindications to early enteral nutrition was associated with longer hospital stay.
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http://dx.doi.org/10.1016/j.clnesp.2021.03.005DOI Listing
June 2021

FABP5 Is a Sensitive Marker for Lipid-Rich Macrophages in the Luminal Side of Atherosclerotic Lesions.

Int Heart J 2021 May 15;62(3):666-676. Epub 2021 May 15.

Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine.

Lipid-rich macrophages in atherosclerotic lesions are thought to be derived from myeloid and vascular smooth muscle cells. A series of studies with genetic and pharmacological inhibition of fatty acid binding protein 4 (FABP4) and FABP5 and bone marrow transplant experiments with FABP4/5 deficient cells in mice have demonstrated that these play an important role in the development of atherosclerosis. However, it is still uncertain about the differential cell-type specificity and distribution between FABP4- and FABP5-expressing cells in early- and late-stage atherosclerotic lesions. In this study, we first explored spatial distribution of FABP4/5 in atherosclerotic lesions in apolipoprotein E deficient (ApoE) mice. FABP4 was only marginally detected in early and advanced lesions, whereas FABP5 was abundantly expressed in these lesions. In advanced lesions, the FABP5-positive area was mostly restricted to the foam cell layer adjacent to the lumen above collagen and elastic fibers with a high signal/noise ratio. Oil red O (ORO) staining revealed that FABP5-positive cells were lipid-rich in early and advanced lesions. Together, most of lipid-rich FABP5-positive cells reside adjacent to the lumen above collagen and elastic fibers. We next studied involvement of FABP5 in lesion formation of atherosclerosis using ApoE FABP5 mice. However, deletion of FABP5 did not affect the development of atherosclerosis. These findings, along with previous reports, suggest a novel notion that FABP5 is a sensitive marker for bone marrow-derived lipid-rich macrophages in the luminal side of atherosclerotic lesions, although its functional significance remains elusive.
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http://dx.doi.org/10.1536/ihj.20-676DOI Listing
May 2021

Prophylactic steroid administration and complications after transsphenoidal pituitary surgery: a nationwide inpatient database study in Japan.

Br J Anaesth 2021 May 12. Epub 2021 May 12.

Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.bja.2021.04.006DOI Listing
May 2021

Transperineal total mesorectal excision for rectal cancer on the residual rectum after multiple abdominal surgeries in a patient with Crohn's disease: a case report.

Surg Case Rep 2021 May 13;7(1):122. Epub 2021 May 13.

Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.

Background: The improved prognosis of Crohn's disease may increase the opportunities of surgical treatment for patients with Crohn's disease and the risk of development of colorectal cancer. We herein describe a patient with Crohn's disease and a history of multiple surgeries who developed rectal stump carcinoma that was treated laparoscopically and transperineally.

Case Presentation: A 51-year-old man had been diagnosed with Crohn's disease 35 years earlier and had undergone several operations for treatment of Crohn's colitis. Colonoscopic examination was performed and revealed rectal cancer at the residual rectum. The patient was then referred to our department. The tumor was diagnosed as clinical T2N0M0, Stage I. We treated the tumor by combination of laparoscopic surgery and concomitant transperineal resection of the rectum. While the intra-abdominal adhesion was dissected laparoscopically, rectal dissection in the correct plane progressed by the transperineal approach. The rectal cancer was resected without involvement of the resection margin. The duration of the operation was 3 h 48 min, the blood loss volume was 50 mL, and no intraoperative complications occurred. The pathological diagnosis of the tumor was type 5 well- and moderately differentiated adenocarcinoma, pT2N0, Stage I. No recurrence was evident 3 months after the operation, and no adjuvant chemotherapy was performed.

Conclusion: The transperineal approach might be useful in patients with Crohn's disease who develop rectal cancer after multiple abdominal surgeries.
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http://dx.doi.org/10.1186/s40792-021-01206-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119543PMC
May 2021

Prognosis and treatment of myositis-associated severe interstitial lung disease: A descriptive study using a nation-wide inpatient database in Japan.

Arthritis Care Res (Hoboken) 2021 May 10. Epub 2021 May 10.

Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

Objectives: The aim of this study was to determine the prognosis, clinical course, and current management of severe interstitial lung disease (ILD) associated with myositis in Japan.

Methods: We conducted a retrospective descriptive study using a nation-wide database for inpatient care of acute illness in Japan. Among a total of approximately 66 million inpatient admissions, we identified patients with severe ILD associated with polymyositis (PM) or dermatomyositis (DM) which required mechanical ventilation and methylprednisolone pulse therapy (≥1g/day usage of methylprednisolone) from July 2010 to March 2018.

Results: We identified 155 patients with PM and 394 with DM who fulfilled the above criteria. The median age of patients was 65 years old; DM patients were significantly younger than PM patients (64 vs. 68 years old; p<0.001). The numbers of patients who were treated with calcineurin inhibitors, intravenous cyclophosphamide and Polymyxin B immobilized fiber column direct hemoperfusion (PMX-DHP) were 403 (73.4%), 318 (57.9%) and 78 (14.2%), respectively. All these treatments were given significantly more frequently to the patients with DM compared with those with PM. The uses of other treatment options were much less frequent. The median hospital days of initiating methylprednisolone pulse therapy, calcineurin inhibitors, mechanical ventilation, intravenous cyclophosphamide, PMX-DHP, and in-hospital death among patients with DM were 2, 4, 7, 8, 17, and 36, respectively. In-hospital mortality was significantly higher in patients with DM than in those with PM (76.6% vs. 56.8%, p<0.001).

Conclusion: The mortality of patients with myositis-associated severe ILD that requires mechanical ventilation is extremely high despite aggressive and prompt interventions.
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http://dx.doi.org/10.1002/acr.24646DOI Listing
May 2021

Sodium-containing versus sodium-trace preparations of IVIG for children with Kawasaki disease in the acute phase.

Eur J Pediatr 2021 May 10. Epub 2021 May 10.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Kawasaki disease (KD) is an acute systemic vasculitis that most commonly causes acquired cardiac disease in children in developed countries. The most highly recommended treatment for KD is 2 g/kg intravenous immunoglobulin (IVIG). There are two types of IVIG, sodium-containing (high-Na) and sodium-trace (low-Na) preparations. However, few studies have compared the effects of these two preparations for superiority. The purpose of this study was to compare outcomes between high and low-Na IVIG preparations in KD children using a national inpatient database in Japan. We used the Diagnostic Procedure Combination database to identify KD patients treated with IVIG between 2010 and 2017. We identified those receiving high and low-Na preparations of IVIG as an initial treatment. Outcomes included proportion of coronary artery abnormalities (CAA), IVIG resistance, adverse effects, length of stay, and medical cost. Propensity score-matched analyses were conducted to compare the outcomes between the two groups. Instrumental variable analyses were performed to confirm the results. We identified 42,345 patients with KD. There were significant differences in proportions of CAA (2.8% vs. 3.2%; p = 0.031) and IVIG resistance (17% vs. 18%, p = 0.001) between the two groups. However, there were no significant differences in length of stay or medical cost. The instrumental variable analysis confirmed the same results as the propensity score analysis.Conclusion: The present study suggests that high-Na IVIG is potentially effective for reducing the proportion of CAA in KD patients. Prospective studies are warranted to confirm the effectiveness observed in this study. What is Known: • For treatments of Kawasaki Disease in acute phase, intravenous immunoglobulin have been the most recommended to reduce fever early and prevent complications of coronary artery abnormalities. There are two types of IVIG preparations, sodium-containing IVIG and sodium-trace IVIG. However, few studies have performed comparisons to determine which preparation of IVIG is superior. What is New: • The present findings suggest that high-Na IVIG is associated with reductions in the proportions of CAAs and IVIG resistance in KD patients.
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http://dx.doi.org/10.1007/s00431-021-04096-xDOI Listing
May 2021

Clinical features and early post-operative complications of isolated C2 odontoid fractures: a retrospective analysis using a national inpatient database in Japan.

Eur Spine J 2021 May 6. Epub 2021 May 6.

Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.

Purpose: To examine the clinical features and post-treatment complications in patients with isolated C2 odontoid fractures.

Methods: We extracted data for all patients who were admitted with C2 odontoid fractures from the Japanese Diagnosis Procedure Combination database between July 2010 and March 2017. We then compared the post-treatment complications during hospitalization according to treatment types: conservative treatment (with or without use of halo-vest) and surgery (anterior or posterior spinal fixation).

Results: A total of 3167 patients (1533 men, 1634 women; mean age, 70 years) with isolated C2 odontoid fractures were identified, including 1124 patients (35%) aged ≥ 80 years. Among the total patients, 2476 (78%) received conservative treatment (with halo-vest, 728; without halo-vest, 1748). The remaining 691 patients (22%) underwent surgery (anterior surgery, 129; posterior surgery, 556; combined surgery, 6). There were no differences between the conservative treatment and surgery groups in baseline characteristics and preexisting comorbid conditions except for age (71 vs. 69 years, p = 0.042). In-hospital death occurred in 136 patients (4.3%). There was no significant difference in in-hospital mortality between the two groups (overall, conservative treatment 4.6% vs. surgery 3.0%, p = 0.066; age ≥ 80 years, conservative treatment 7.2% vs. surgery 5.4%, p = 0.34). Use of halo-vest was not associated with increased mortality (with halo-vest 3.7% vs. without halo-vest 5.0%, p = 0.15).

Conclusion: The great majority of isolated odontoid fractures occurred in elderly patients. Conservative treatment and surgery had similarly low in-hospital mortality. Use of halo-vest was not associated with an increase in mortality.
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http://dx.doi.org/10.1007/s00586-021-06862-9DOI Listing
May 2021

Impact of proton pump inhibitors on mortality and severe esophageal injury after catheter ablation for atrial fibrillation: a nationwide retrospective study using propensity score matching.

Heart Vessels 2021 Apr 30. Epub 2021 Apr 30.

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.

Studies on the protective effects of proton pump inhibitors (PPIs) on mortality and severe esophageal injury after catheter ablation for atrial fibrillation are lacking. However, some reports have recommended use of PPIs for prophylaxis against esophageal injury. We investigated the effects of PPIs on mortality and severe esophageal injury after ablation. We retrospectively extracted data for adult in-patients who received catheter ablation with a diagnosis of atrial fibrillation from July 2010 to March 2018. The patients were divided into two groups: with PPI (PPI group) and without PPI (non-PPI group) administration before or on the day of ablation. The primary composite outcome was all-cause 30-day mortality and incidence of severe esophageal injury with complication (cardiac tamponade, ischemic stroke, or sepsis) within 30 days of ablation. Secondary outcomes included incidence of cardiac tamponade, ischemic stroke, and sepsis within 30 days of ablation. Propensity score matching was performed to compare the primary and secondary outcomes between the two groups. We identified 141,649 eligible patients, comprising 62,558 in the PPI group and 79,091 in the non-PPI group. Propensity score-matching analysis showed that PPI use was not associated with reduced proportion of the primary outcome (adjusted odds ratio 1.02; 95% confidence interval 0.71-1.47). PPI use may not be beneficial for reducing mortality or severe complications.
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http://dx.doi.org/10.1007/s00380-021-01860-9DOI Listing
April 2021

Factors associated with the occurrence of stomal stenosis after tracheostomy in adults.

Auris Nasus Larynx 2021 Oct 26;48(5):973-977. Epub 2021 Apr 26.

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.

Objective: Although tracheal stomal stenosis can be life-threatening, factors associated with the occurrence of stomal stenosis remain unknown. This study was performed to evaluate these factors in adult patients.

Methods: We retrospectively identified adult patients who underwent tracheostomy from 2010 to 2016 using a Japanese national inpatient and outpatient database. We performed Cox proportional hazard regression analyses to evaluate factors associated with the occurrence of tracheal stomal stenosis.

Results: We obtained data on 25,436 eligible patients. The proportion of tracheal stomal stenosis was 0.9%. Tracheal stomal stenosis was significantly less likely to occur in patients with regular use of oral steroids [hazard ratio (HR), 0.28; 95% confidence interval (CI), 0.09-0.88; P = 0.03] and in male patients (HR, 0.75; 95% CI, 0.57-0.97; P = 0.03). The occurrence of tracheal stomal stenosis was significantly associated with use of a mechanical ventilator at home (HR, 2.54; 95% CI, 1.55-4.15; P < 0.001) and a body mass index of <18.5 kg/m (HR, 1.45; 95% CI, 1.06-1.99; P = 0.02).

Conclusion: Our study revealed several factors that are associated with tracheal stomal stenosis. These findings may help physicians to manage tracheal stomas.
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http://dx.doi.org/10.1016/j.anl.2021.03.023DOI Listing
October 2021

Risk of drug-induced interstitial lung disease in hospitalised patients: a nested case-control study.

Thorax 2021 Apr 22. Epub 2021 Apr 22.

Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Introduction: Information on drug-induced interstitial lung disease (DILD) is limited due to its low incidence. This study investigated the frequencies of drug categories with potential risk in patients developing DILD during hospitalisation and analysed the risk of developing DILD associated with each of these drugs.

Methods: Using a Japanese national inpatient database, we identified patients without interstitial pneumonia on admission who developed DILD and required corticosteroid therapy during hospitalisation from July 2010 to March 2016. We conducted a nested case-control study; four controls from the entire non-DILD patient cohort were matched to each DILD case on age, sex, main diagnosis, admission year and hospital. We defined 42 classified categories of drugs with 216 generic names as drugs with potential risk of DILD, and we identified the use of these drugs during hospitalisation for each patient. We analysed the association between each drug category and DILD development using conditional logistic regression analyses.

Results: We retrospectively identified 2342 patients who developed DILD. After one-to-four case-control matching, 1541 case patients were matched with 5677 control patients. Six drug categories were significantly associated with the increased occurrence of DILD. These included epidermal growth factor receptor inhibitors (OR: 16.84, 95% CI 9.32 to 30.41) and class III antiarrhythmic drugs (OR: 7.01, 95% CI 3.86 to 12.73). Statins were associated with reduced risk of DILD (OR: 0.68, 95% CI 0.50 to 0.92).

Conclusions: We demonstrated significant associations between various drug categories and DILD. Our findings provide useful information on drug categories with potential risk to help physicians prevent and treat DILD.
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http://dx.doi.org/10.1136/thoraxjnl-2020-215824DOI Listing
April 2021

Interrupted time-series analyses of routine vaccination program for elderly pneumonia patients in Japan; an ecological study using aggregated nationwide inpatient data.

Hum Vaccin Immunother 2021 Apr 20:1-9. Epub 2021 Apr 20.

Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.

A national routine pneumococcal pneumonia immunization program started in Japan in 2014. It targeted the population aged ≥65 years and used a 23-valent pneumococcal polysaccharide vaccine; PPSV23. However, its effectiveness was not well defined because of the lack of a comprehensive database on the PPSV23 vaccination status of each subject. We used interrupted time-series analyses to assess the changes in the incidence and prognosis of elderly patients hospitalized for pneumonia before and after initiation of the program. First, we estimated the PPSV23 coverage rates in subjects aged ≥65 years based on the number of shipped PPSV23 syringes and the estimated population in each prefecture. The estimated coverage rates reached around 40% in 2014 for the 3 Tohoku prefectures, while those in the other prefectures remained below 20%. After the national routine immunization program started, the estimated coverage rate increased significantly in every prefecture and exceeded 40% in 2017. Next, we aggregated the data extracted from the Japanese Diagnosis Procedure Combination database from April 2011 through February 2017 for hospitalized pneumonia patients aged ≥65 years. The data included data from 655,746 patients, excluding those in the 3 Tohoku prefectures. Interrupted time-series analyses found no change in the incidence of hospitalized pneumonia patients and in-hospital mortality after the vaccination program, but there was a decrease in the in-hospital mortality of pneumonia patients with severe comorbidities defined by the modified Charlson comorbidity index. These results suggest an association between the vaccination program and an improved outcome in hospitalized elderly pneumonia patients with severe comorbidities in Japan.
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http://dx.doi.org/10.1080/21645515.2021.1875760DOI Listing
April 2021

Preoperative use of pirfenidone and reduced risk of postoperative severe respiratory complications in patients with idiopathic pulmonary fibrosis: Propensity score-matched analysis using a nationwide database in Japan.

Respirology 2021 Jun 18;26(6):590-596. Epub 2021 Apr 18.

Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Background And Objective: Patients with idiopathic pulmonary fibrosis (IPF) often develop postoperative severe respiratory complications such as acute exacerbation. Pirfenidone, an oral anti-fibrotic drug, may reduce the incidence of such complications. However, the preventive effect of pirfenidone on postoperative severe respiratory complications remains unclear.

Methods: We identified patients with IPF who underwent surgery with general anaesthesia from July 2010 to March 2018 using the Diagnosis Procedure Combination database. We compared the occurrence of postoperative severe respiratory complications (receiving mechanical ventilation under endotracheal intubation and/or intravenous infusion of a high-dose corticosteroid and in-hospital death within 30 days after surgery) between patients who did and did not receive preoperative treatment with pirfenidone. Pearson's chi-square test and logistic regression analysis fitted with a generalized estimating equation were conducted in 1:4 propensity score-matched patients.

Results: Among 631 patients identified, 19% were treated with pirfenidone before surgery. The 30-day mortality rate was 3.1% and 1.7% in the control patients (n = 510) and pirfenidone-treated patients (n = 121), respectively. In the propensity score-matched population, preoperative treatment with pirfenidone was significantly associated with a lower proportion of postoperative severe respiratory complications (OR: 0.24; 95% CI: 0.07-0.76; p = 0.015).

Conclusion: In this Japanese nationwide cohort, preoperative treatment with pirfenidone was significantly associated with a lower risk of postoperative severe respiratory complications in patients with IPF. Preoperative pirfenidone may thus be useful in preventing postoperative severe respiratory complications in patients with IPF who are planning to undergo surgery with general anaesthesia.
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http://dx.doi.org/10.1111/resp.14044DOI Listing
June 2021

Efficacy of recombinant human soluble thrombomodulin in induction therapy for acute promyelocytic leukemia.

Thromb Res 2021 Jun 9;202:173-175. Epub 2021 Apr 9.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

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http://dx.doi.org/10.1016/j.thromres.2021.04.003DOI Listing
June 2021

Early Electroconvulsive Therapy in Patients With Major Depressive Disorder: A Propensity Score-Matched Analysis Using a Nationwide Inpatient Database in Japan.

J ECT 2021 Apr 9. Epub 2021 Apr 9.

From the Department of Psychiatry, The Jikei University School of Medicine Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.

Objectives: This study aimed to evaluate whether early electroconvulsive therapy (ECT) can reduce length of hospital stay and total hospitalization costs in major depressive disorder (MDD) patients.

Methods: Using the Japanese Diagnosis Procedure Combination inpatient database from April 2011 to March 2018 linked with the Annual Report for Functions of Medical Institutions, we identified patients admitted for MDD. Patients who received ECT within 8 days of admission were assigned to the early ECT group and the remaining patients to the control group. The primary outcomes were length of hospital stay and total hospitalization costs. The secondary outcomes were in-hospital mortality and fatal adverse events. Propensity score-matched analyses were performed to compare the outcomes between the 2 groups.

Results: We identified 41,248 eligible patients, comprising 1169 in the early ECT group and 40,079 in the control group. After 1:1 propensity score matching, patients in the early ECT group had significantly shorter length of hospital stay than those in the control group (difference: -12.6 days; 95% confidence interval: -17.4 to -7.7 days). There was no significant difference in total hospitalization costs between the 2 groups. Early ECT was not significantly associated with increased in-hospital mortality or fatal adverse events.

Conclusions: Early ECT may reduce length of hospital stay without increasing total hospitalization costs or fatal adverse events in patients with MDD.
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http://dx.doi.org/10.1097/YCT.0000000000000763DOI Listing
April 2021

Intensive care unit occupancy in Japan, 2015-2018: a nationwide inpatient database study.

J Epidemiol 2021 Apr 10. Epub 2021 Apr 10.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.

Background: Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning.

Methods: We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies.

Results: Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively.

Conclusion: Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.
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http://dx.doi.org/10.2188/jea.JE20210016DOI Listing
April 2021

Comparisons of postoperative outcomes after breast cancer surgery in patients with and without renal replacement therapy: a matched-pair cohort study using a Japanese nationwide inpatient database.

Breast Cancer 2021 Apr 10. Epub 2021 Apr 10.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Background: Although patients receiving renal replacement therapy (RRT) have more comorbidities and higher mortality and morbidity risks than the general population, surgery during breast cancer treatment is crucial because of limitations in anticancer agents for patients with renal insufficiency. We aimed to compare the short-term postoperative outcomes between patients with and without RRT.

Methods: Patients who underwent surgery for stages 0-III breast cancer between July 2010 and March 2017 were retrospectively identified in a Japanese nationwide inpatient database and divided into those with RRT (RRT group, n = 1547) and those without RRT (control group, n = 364,047). We generated a 1:4 matched-pair cohort matched for age, institution, and fiscal year at admission. We conducted multivariable regression analyses to compare postoperative complications, 30-day readmission, and anesthesia duration between the two groups.

Results: The RRT group was more likely to have comorbidities (95.0% vs. 24.1%) and undergo total mastectomy (64.2% vs. 47.0%) than the control group. The RRT group was not significantly associated with complications (odds ratio 1.18; 95% confidence interval [CI] 0.89-1.56) and 30-day readmission (odds ratio 0.88; 95% CI 0.65-1.18), but was associated with shorter anesthesia duration (difference, - 6.8 min; 95% CI - 10.7 to - 3.0 min) compared with the control group.

Conclusions: The matched-pair cohort analyses revealed no significant differences in postoperative complications after breast cancer surgery between patients with and without RRT. Breast cancer surgery in patients with RRT may be as safe as that in patients without RRT, if comorbidities other than chronic renal failure are adequately addressed.
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http://dx.doi.org/10.1007/s12282-021-01248-7DOI Listing
April 2021

Outcomes of Nonoperative Treatment for Gastroduodenal Ulcer Perforation: a Nationwide Study of 14,918 Inpatients in Japan.

J Gastrointest Surg 2021 Apr 6. Epub 2021 Apr 6.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Background: Gastroduodenal ulcer perforation is a common abdominal emergency that may be curable without surgical repair in non-elderly patients with localized and stable symptoms. However, the outcomes of nonoperative approaches have rarely been described.

Methods: Using a Japanese national inpatient database, we identified 14,918 patients with gastroduodenal ulcer perforation who were hospitalized and received nonoperative treatment from July 2010 to March 2017. We categorized these patients into three groups according to age: 18 to 64 years (young group, n=8407), 65 to 74 years (old group, n=2616), and ≥75 years (old-old group, n=3895). We investigated the characteristics, treatments, and outcomes in each group.

Results: Most of the patients were men (71%), and the median patient age was 62 years (interquartile range, 47-75 years). The old and old-old groups had more comorbidities than the young group. Whereas most patients were administered proton pump inhibitors and various antibiotics (96% and 90%, respectively), only 58% of patients underwent gastric tube placement. Surgical repair >3 days after admission was performed in 7.1% of all patients (6.3% vs. 7.9% vs. 5.5%, P<0.001). The old and old-old groups showed higher mortality (1.4% vs. 8.3% vs. 18%, P<0.001) and morbidity (6.6% vs. 15% vs. 17%, P<0.001) than the young group. The median length of stay was almost 2 weeks (13 vs. 17 vs. 20 days, P<0.001).

Discussion: Unlike previous studies, many patients aged >65 years received nonoperative treatment in this nationwide cohort. Our findings provide useful information for clinicians and patients hospitalized for gastric ulcer perforation.
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http://dx.doi.org/10.1007/s11605-021-05003-3DOI Listing
April 2021

Snowfall reduces the risk of chronic subdural hematoma onset: Analysis of an administrative database in Japan.

Surg Neurol Int 2021 23;12:69. Epub 2021 Feb 23.

Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Japan.

Background: Chronic subdural hematoma (CSDH) is a frequently observed disease in neurosurgical practice. Although first snowfall has been considered to increase the onset of CSDH, few reports have assessed the relationship between snowfall and CSDH. In this study, we aimed to investigate the relationship between CSDH onset and first snowfall events.

Methods: This retrospective study was based on the Japanese Diagnosis Procedure Combination inpatient database from July 1, 2010, to March 31, 2016, and on the global observation of snowfall events in Japan obtained from the Japan Meteorological Agency. We used a binomial approximation to evaluate the average number of CSDH patients after first snowfall events compared with that before first snowfall events. We calculated the odds ratio of CSDH onset on the first snowfall.

Results: We identified 8526 CSDH patients from the database. A total of 5573 (65.4%) were observed before first snowfall events, and 2953 (34.6%) after first snowfall events. The first snowfall of winter was significantly associated with a reduction in the occurrence of CSDH (odds ratio, 0.53; 95% confidence interval; 0.51-0.55). In subgroup analysis, only the first snowfall in October was not associated with reduction in the occurrence of CSDH.

Conclusion: First snowfall events did not affect the onset of CSDH in Japan.
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http://dx.doi.org/10.25259/SNI_882_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982109PMC
February 2021

Efficacy of Prophylactic Antibiotics during Extracorporeal Membrane Oxygenation: A Nationwide Cohort Study.

Ann Am Thorac Soc 2021 Mar 25. Epub 2021 Mar 25.

School of Public Health, The University of Tokyo, Department of Health Economics and Epidemiology Research, Tokyo, Japan.

Rationale: Extracorporeal membrane oxygenation (ECMO) is widely used worldwide, and many hospitals consider using antibiotics to prevent nosocomial infection in ECMO patients. However, the efficacy of antimicrobial prophylaxis for patients receiving ECMO remains unclear.

Objective: This study aimed to evaluate the efficacy of prophylactic antibiotics for ECMO patients.

Methods: This retrospective cohort study was performed using data recorded in the Japanese Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2017. We compared in-hospital mortality, nosocomial pneumonia, acute kidney injury, and diarrhea between patients receiving prophylactic antibiotics (prophylaxis group) and those not receiving antibiotics (control group) using propensity score matching, multivariable logistic regression models fitted using generalized estimating equation, stabilized inverse probability of treatment weighting, and instrumental variable analysis.

Results: We identified 9615 eligible patients and classified them into the prophylaxis (n = 5552) and control (n = 4063) groups. In the propensity score-matched analysis, 3650 pairs were generated. Significant differences between the prophylaxis group and the control group were detected in in-hospital mortality (56.4% vs 59.8%, risk difference: -3.7%, 95% confidence interval [CI]: -6.0 to -1.3) and nosocomial pneumonia (12.9% vs. 15.3%, risk difference: -2.4%, 95% CI: -4.3 to -0.6). In the multivariable logistic regression models fitted using generalized estimating equation, stabilized inverse probability of treatment weighting, and instrumental variable analysis, the point estimates a suggested similar direction to that found in the propensity score analysis. The proportions of patients with acute kidney injury or diarrhea did not significantly increase with the use of prophylactic antibiotics.

Conclusion: Using prophylactic antibiotics during ECMO was associated with reduced in-hospital mortality and lower proportions of patients with nosocomial pneumonia. Future prospective studies are needed to validate these results.
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http://dx.doi.org/10.1513/AnnalsATS.202008-974OCDOI Listing
March 2021

Low muscle mass affect hip fracture treatment outcomes in older individuals: a single-institution case-control study.

BMC Musculoskelet Disord 2021 Mar 9;22(1):259. Epub 2021 Mar 9.

Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

Background: Although sarcopenia has been known as a risk factor for hip fracture, only a few reports have described the impact of muscle mass on hip fracture treatment outcomes. The current study aimed to investigate the impact of muscle mass on hip fracture treatment outcomes.

Methods: This case-control study involved 337 patients (67 males and 270 females) with hip fracture aged ≥65 years (mean age: 84.1 ± 7.1 years) who underwent orthopedic surgery from January 2013 to June 2019. The mean follow-up period was 17.1 (1-60) months. Upon admission, all patients were assessed for low muscle mass according to the Asian Working Group for Sarcopenia criteria (male, SMI < 7.00 kg/m; female, SMI < 5.40 kg/m) using dual-energy X-ray absorptiometry. Treatment outcomes (stays at acute care institutions, hospital mortality, the Barthel index at discharge, and home discharge rates, and one-year mortality) were compared between patients with and without low muscle mass by Student's t-test, Mann-Whitney U test and the Pearson Chi-Square test. A multivariate logistic regression model was used to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for factors related to low muscle mass. Kaplan-Meier survival curves on one-year mortality of hip fracture patients for those with and without low muscle mass were prepared, and log-rank tests were performed. Furthermore, we determined whether low muscle mass was a risk factor for one-year mortality in hip fracture patients using a Cox proportional hazards model.

Results: The prevalence of low muscle mass in patients with hip fracture was 231(68.5%). Those with low muscle mass had a lower Barthel index (P < 0.0001), hospital discharge rate (P = 0.035) and higher one-year mortality (P = 0.010). Cox proportional hazards regression analysis adjusted for age and sex found that low muscle mass was a risk factor for one-year mortality (hazard ratio, 3.182, 95% confidence interval, 1.097-9.226, P = 0.033).

Conclusions: Patients with hip fracture who had low muscle mass had a lower Barthel index, lower home discharge rate, and higher one-year mortality. Moreover, low muscle mass was identified as a risk factor for one-year mortality among those with hip fracture. The aforementioned findings may help clinicians better manage those with hip fracture.
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http://dx.doi.org/10.1186/s12891-021-04143-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7945055PMC
March 2021

Difference of preventing effects of G-CSF according to age in patients with malignant lymphoma: A nation-wide analysis in Japan.

J Infect Chemother 2021 Aug 18;27(8):1151-1155. Epub 2021 Mar 18.

Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Introduction: There has been no comprehensive analysis of the age-specific efficacy of G-CSF to prevent febrile neutropenia (FN). We evaluated factors associated with FN occurrence according to patient age in rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone (R-CHOP) treatment.

Methods: We retrospectively reviewed diffuse large B-cell lymphoma (DLBCL) patients aged ≥50 years, who underwent the first R-CHOP cycle between July 2010 and March 2017, using a Japanese inpatient database. Multivariable logistic regression analysis was performed to identify the factors associated with FN.

Results: A total of 16,399 patients with untreated DLBCL were identified. Primary prophylaxis with pegfilgrastim was significantly associated with the lower occurrence of FN (odds ratio: 0.71 [95% confidence interval: 0.51-0.99]). Subgroup analysis according to age was then performed. Although there was no significance, primary prophylaxis with pegfilgrastim tended to have a lower odds ratio for the occurrence of FN in patients aged 50-60 years (0.86 [0.39-1.89]) and 61-70 years (0.64 [0.36-1.13]). In patients aged 71-80 years, primary prophylaxis with pegfilgrastim was significantly associated with reduced FN occurrence (0.46 [0.26-0.80]). Notably, in patients aged >80 years, the use of pegfilgrastim tended to be associated with a rather higher occurrence of FN (1.55 [0.84-2.87]).

Conclusions: Preventing effect of G-CSF may be limited in patients aged >80 years.
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http://dx.doi.org/10.1016/j.jiac.2021.03.004DOI Listing
August 2021

Outcomes of a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals: A difference-in-differences analysis of a nationwide retrospective cohort study in Japan.

Int J Geriatr Psychiatry 2021 Mar 17. Epub 2021 Mar 17.

Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.

Objectives: The quality of care for dementia in acute-care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short-term outcomes (in-hospital mortality and 30-day readmission).

Design And Methods: Using a Japanese nationwide inpatient database, we identified older adult patients with moderate-to-severe dementia admitted for pneumonia, heart failure, cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to March 2018. We selected 180 propensity score-matched pairs of hospitals that adopted (n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We then conducted a patient-level difference-in-differences analysis. In a sensitivity analysis, we restricted the postintervention group to patients who actually received dementia care.

Results: There was no association between a hospital's adoption of the incentive scheme and in-hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88-1.06; p = 0.48) or 30-day readmission (aOR: 1.04; 95% CI: 0.95-1.14; p = 0.37). Only 29% of patients in hospitals adopting the scheme actually received dementia care. The sensitivity analysis showed that receiving dementia care was associated with decreased in-hospital mortality.

Conclusions: The financial incentive scheme to enhance dementia care by dementia specialist teams in Japan may not be working effectively, but the results do suggest that individual dementia care was associated with decreased in-hospital mortality.
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http://dx.doi.org/10.1002/gps.5537DOI Listing
March 2021

Ischemic proctitis 6 months after laparoscopic sigmoidectomy: a case report.

Surg Case Rep 2021 Feb 22;7(1):54. Epub 2021 Feb 22.

Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan.

Background: Ischemic colitis is a common disease; however, its pathophysiology remains unclear, especially in ischemic proctitis after sigmoidectomy. We present a rare case of ischemic proctitis 6 months after laparoscopic sigmoidectomy.

Case Presentation: The patient was a 60-year-old man with hypertension, type 2 diabetes, and hyperlipidemia. He was a smoker. He underwent laparoscopic sigmoidectomy for pathological stage I sigmoid colon cancer and was followed up without any adjuvant therapy. Six months after his surgery, he complained of lower abdominal discomfort, bloody stools, and tenesmus. Colonoscopy showed extensive rectal ulcers between the anastomotic site and the anal canal, which was particularly severe on the anal side several centimeters beyond the anastomosis. We provided non-surgical management, including hyperbaric oxygen therapy. The rectal ulcers had healed 48 days after the therapeutic intervention. He has not experienced any recurrence for 3.5 years.

Conclusions: While performing sigmoidectomy, it is important to consider the blood backflow from the anal side of the bowel carefully, especially for patients with risk factors of ischemic proctitis.
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http://dx.doi.org/10.1186/s40792-021-01133-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900365PMC
February 2021

Small-bore feeding tube versus large-bore sump tube for early enteral nutrition in mechanically ventilated patients: A nationwide inpatient database study.

Clin Nutr 2021 Feb 6. Epub 2021 Feb 6.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan. Electronic address:

Background & Aims: When physicians start nasogastric tube feeding in mechanically ventilated patients, they have two choices of feeding tube device: a large-bore sump tube or a small-bore feeding tube. Some physicians may prefer to initiate enteral nutrition via the large-bore sump tube that is already in place, and others may prefer to use the small-bore feeding tube. However, it remains unknown whether small-bore feeding tubes or large-bore sump tubes are better for early enteral nutrition. The present study aimed to compare outcomes between these two types of feeding tubes in mechanically ventilated patients.

Methods: Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified adult patients who underwent invasive mechanical ventilation for ≥2 days in intensive care units and received nasogastric tube feeding within 2 days of starting mechanical ventilation. We categorized these patients as receiving early enteral nutrition via small-bore feeding tube (8- to 12-Fr single-lumen tubes) or via large-bore sump tube. Propensity score-matched analyses were performed to compare 28-day in-hospital mortality and hospital-acquired pneumonia between the two groups.

Results: A total of 79,656 patients were included. Of these patients, 20,178 (25%) were in the small-bore feeding tube group. One-to-one propensity score matching created 20,061 matched pairs. Compared with those in the large-bore sump tube group, patients in the small-bore feeding tube group had significantly higher 28-day in-hospital mortality (17.0% versus 15.6%; hazard ratio, 1.08; 95% confidence interval, 1.03 to 1.14) and a significantly higher prevalence of hospital-acquired pneumonia (9.3% versus 8.5%; odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21).

Conclusions: This nationwide observational study suggests that small-bore feeding tubes may not be associated with better clinical outcomes but rather with increased mortality and hospital-acquired pneumonia. Because of the uncertainty regarding the mechanism of our findings, further studies are warranted.
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http://dx.doi.org/10.1016/j.clnu.2021.02.003DOI Listing
February 2021

Sodium-glucose cotransporter-2 inhibitors and the risk of urinary tract infection among diabetic patients in Japan: Target trial emulation using a nationwide administrative claims database.

Diabetes Obes Metab 2021 Jun 8;23(6):1379-1388. Epub 2021 Mar 8.

Department of Biostatistics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Aim: To assess the risk of urinary tract infection (UTI) occurrence associated with sodium-glucose cotransporter-2 (SGLT2) inhibitor use relative to biguanide use in diabetes in a population-based cohort study using a target trial emulation framework.

Methods: Using a Japanese nationwide administrative claims database, we constructed a cohort of patients aged ≥40 years who were dispensed SGLT2 inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors or biguanides between April 2014 and March 2015. For computational ease, we randomly sampled 100% of SGLT2 inhibitor users, 3% of DPP-4 inhibitor users, and 20% of biguanide users; new antidiabetic drug initiators were analysed. We estimated the intention-to-treat (ITT) hazard ratios (HRs) of UTI with inverse probability of treatment (IPT)-weighted Cox's proportional hazards models that ignored subsequent treatment changes. Treatment weights were computed using patient sex, age, medications, medical history and hospitalization history. We also estimated per-protocol (PP) HRs using IPT- and inverse probability of censoring-weighted Cox's models that adjusted for nonrandom treatment changes.

Results: We analysed 11 364 SGLT2 inhibitor initiators, 9035 DPP-4 inhibitor initiators, and 10 359 biguanide initiators. When compared with biguanide initiators, SGLT2 inhibitor initiators had a crude HR of 1.14 (95% confidence interval [CI] 1.05-1.24), an ITT HR of 0.94 (95% CI 0.86-1.03), and a PP HR of 0.90 (95% CI 0.78-1.03); and DPP-4 inhibitor initiators had a crude HR of 1.13 (95% CI 1.04-1.23), an ITT HR of 0.85 (95% CI 0.77-0.94), and a PP HR of 0.83 (95% CI 0.71-0.95).

Conclusion: Use of SGLT2 inhibitors or DPP-4 inhibitors did not increase the risk of UTI compared with biguanide use. Accounting for treatment changes did not substantially influence the estimated effects.
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http://dx.doi.org/10.1111/dom.14353DOI Listing
June 2021

Effect of Early Rehabilitation on Physical Function in Patients Undergoing Coronary Artery Bypass Grafting: A Nationwide Inpatient Database Study.

J Clin Med 2021 Feb 6;10(4). Epub 2021 Feb 6.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.

It is unclear when to begin rehabilitation after coronary artery bypass grafting (CABG) in the intensive care unit (ICU). Using the Japanese Diagnosis Procedure Combination inpatient database from 2010 to 2018, we identified adult patients who underwent a CABG and who were admitted to the ICU for ≥3 consecutive days from the date of their CABG. Patients who started any rehabilitation program prescribed by physicians or therapists within 3 days of CABG were defined as the early rehabilitation group, and the remaining patients were defined as the usual care group. We identified 30,568 eligible patients, with 13,150 (43%) patients in the early rehabilitation group. An inverse probability of treatment weighting analyses showed that the Barthel Index score at discharge in the early rehabilitation group was significantly higher than that in the usual care group (difference: 3.2; 95% confidence interval: 1.5-4.8). The early rehabilitation group had significantly lower in-hospital mortality, total hospitalization costs, length of ICU stay, and hospital stay vs. the usual care group. Our results suggested that early rehabilitation by physicians or therapists beginning within 3 days of CABG was safe, as suggested by the low mortality and improved physical function in patients who underwent CABG.
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http://dx.doi.org/10.3390/jcm10040618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915420PMC
February 2021

Intermittent versus continuous neuromuscular blockade during target temperature management after cardiac arrest: A nationwide observational study.

J Crit Care 2021 Apr 14;62:276-282. Epub 2021 Jan 14.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Purpose: Whether intermittent or continuous neuromuscular-blocking agents (NMBAs) would be appropriate during target temperature management (TTM) after cardiac arrest remains unclear.

Materials And Methods: In this retrospective cohort study, we utilized the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018 and identified patients who received NMBAs during TTM after cardiac arrest on the day of admission. We compared the in-hospital mortality between the propensity-score-matched intermittent and continuous NMBA groups.

Results: We identified 5584 eligible patients; 1488 received intermittent NMBAs and 4096 received continuous NMBAs. After propensity score matching, there was no significant difference in the in-hospital mortality between the intermittent and continuous NMBA groups (32.9% vs. 33.1%; odds ratio, 0.98; 95% confidence interval, 0.82-1.18). In subgroup analyses, in-hospital mortality of the continuous NMBA group was significantly higher than that of the intermittent NMBA group in patients aged ≥65 years (p for interaction = 0.021).

Conclusions: This large retrospective study did not suggest that intermittent NMBAs may be inferior to continuous NMBAs in terms of mortality reduction in the overall population receiving TTM for cardiac arrest. However, continuous NMBAs may be inferior to intermittent NMBAs for reducing mortality in elderly patients.
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http://dx.doi.org/10.1016/j.jcrc.2021.01.002DOI Listing
April 2021

Potassium Concentration in Initial Fluid Therapy and In-Hospital Mortality of Patients with Diabetic Ketoacidosis.

J Clin Endocrinol Metab 2021 Apr;106(5):e2162-e2175

Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Context: Guidelines worldwide recommend potassium replacement of 10 to 40 mmol/L in the initial fluid therapy for patients with diabetic ketoacidosis. However, evidence is lacking as to the association between infused potassium concentration and mortality.

Objective: We aimed to determine the association between infused potassium concentration and in-hospital mortality.

Methods: Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified inpatients admitted for treatment of diabetic ketoacidosis from July 2010 to March 2018. Patients with kidney dysfunction or serum potassium abnormalities were excluded. We evaluated the association of the potassium concentration in the total infused solutions in the first 2 days of hospitalization with 28-day in-hospital mortality using multivariable regression analysis with a cubic spline model. We also assessed the association between potassium concentration and occurrence of hyperkalemia.

Results: We identified 14 216 patients with diabetic ketoacidosis and observed 261 deaths. The quartile cut-points for potassium concentration were 7.7, 11.4, and 16.1 mmol/L. Within the range of approximately 10 to 40 mmol/L, potassium concentration was not associated with occurrence of hyperkalemia or death. Lower potassium concentrations were associated with higher 28-day in-hospital mortality; the odds ratio for patients receiving 8 mmol/L was 1.69 (95% CI, 1.03 to 2.78; reference: 20 mmol/L), and the odds ratio increased monotonically as potassium concentration decreased further.

Conclusion: Patients receiving potassium replacement at concentrations of 10 to 40 mmol/L had similar in-hospital mortality rates, whereas lower concentrations were associated with higher mortality.
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http://dx.doi.org/10.1210/clinem/dgab029DOI Listing
April 2021