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The number of amputated finger replantation has declined in the USA and Germany in recent years; however, there have been no reports on recent trends in Japan. We examined the current practices, attempts, and success factors of digit replantation in Japan. We hypothesized that the rates of digit replantation and success rates were consistently standardized in Japan. The diagnosis procedure combination database was used to analyze 14004 cases from April 2014 to March 2020, excluding multiple-digit amputations, thus focusing on 13484 patients. We evaluated replantation success rates and identified factors influencing replantation decisions using multiple logistic regression analysis. The key findings included a higher frequency of replantation in thumb cases and surgeries during overtime hours, on Sundays, and in educational institutions. Success rates were notably higher for thumb replantations and patients under 20 years of age. Patients over 65 years of age treated with urokinase showed higher failure rates, unrelated to regional or hospital case volumes. The number of amputated digit replantation surgeries in Japan was high during overtime hours, on Sundays, and in educational institutions. Region, hospital type, and hospital case volume were not associated with a low success rate across Japan. [ABSTRACT FROM AUTHOR]

Drosophila male germline stem cells (GSCs) reside at the tip of the testis and surround a cluster of niche cells. Decapentaplegic (Dpp) is one of the well-established ligands and has a major role in maintaining stem cells located in close proximity. However, the existence and the role of the diffusible fraction of Dpp outside of the niche have been unclear. Here, using genetically-encoded nanobodies called Morphotraps, we physically block Dpp diffusion without interfering with niche-stem cell signaling and find that a diffusible fraction of Dpp is required to ensure differentiation of GSC daughter cells, opposite of its role in maintenance of GSC in the niche. Our work provides an example in which a soluble niche ligand induces opposed cellular responses in stem cells versus in differentiating descendants to ensure spatial control of the niche. This may be a common mechanism to regulate tissue homeostasis.The activity of Drosophila male germline stem cells is tightly regulated by a cluster of somatic niche cells. Here they find that Dpp induces opposed cellular responses in stem cells versus in differentiating descendants, thereby ensuring spatial control of the niche with a single factor. [ABSTRACT FROM AUTHOR]

Aims: We aimed to determine the rate of high-frequency HbA1c testing among older Japanese patients (≥ 75 years) with type 2 diabetes who did not have diabetic complications and were not using insulin, and to explore its influencing factors and association with the number of hospital admissions. Methods: A retrospective, longitudinal observation study design based on medical claims data between 2015 and 2020 was adopted. We tracked patients for 3 years to describe the annual rate and determine factors associated with high-frequency HbA1c testing using a hierarchical logistical model. We employed a zero-inflated Poisson model to examine the association between frequency of HbA1c testing and the number of hospitalizations. Results: Among 6594 patients included (mean age 80.4 years), the rates of high-frequency HbA1c testing in the first, second, and third year were 10.2%, 4.8%, and 4.7%, respectively. Follow-up year [odds ratio (OR) = 0.54, 95% confidence interval (CI) = 0.49–0.59];insulin use (OR = 1.63, 95% CI = 1.26–2.11); multi facility for HbA1c testing (OR = 5.51, 95% CI = 4.66–6.51); more than 48 outpatient days per year (OR = 2.13, 95% CI = 1.81–2.51); hospitalizations (OR = 0.66, 95% CI = 0.55–0.79); two or more classes of antidiabetic agents at baseline (OR = 1.32, 95% CI = 1.11–1.56); and dementia at baseline (OR = 0.70, 95% CI = 0.51–0.97) were significantly associated with high-frequency HbA1c testing. No significant association between frequent HbA1c testing and the number of all-cause hospitalizations was found. Conclusions: We revealed a high rate of HbA1c testing among older Japanese patients with type 2 diabetes in ambulatory care and indicated that high-frequency HbA1c testing was more likely to result from the decentralized healthcare system and its structure. [ABSTRACT FROM AUTHOR]

Background: In the present study, we aimed to evaluate the clinical outcomes of cholecystectomy in older individuals. Methods: In this retrospective study, data from the Japanese Diagnosis Procedure Combination database on 96,620 patients who had undergone cholecystectomy at 1060 hospitals from 2018 to 2020 were analyzed. Patients were divided into five age groups: < 75, 75–79, 80–84, 85–89, and ≥ 90 years. Associations between postoperative outcomes and age group were investigated by logistic regression analysis. Mean differences between age groups in time to postoperative recovery and cost were also compared. Results: Older patients had higher rates of poor scores for activities of daily living and preoperative comorbidity. Compared with the youngest age group (< 75 years), the odds ratios for in-hospital mortality were 3.00 (95% confidence interval, 1.74–5.19), 7.54 (4.73–12.01), 13.47 (8.21–22.14), and 27.64 (15.56–49.09), in the 75–79, 80–84, 85–89, and ≥ 90-year-old age group, respectively (all p < 0.001). Furthermore, the length of postoperative hospital stay and rates of postoperative complications, postoperative reintubation, and reoperation with general anesthesia increased significantly in parallel with increasing age, the highest rates being in the ≥ 90 year-old age group. Conclusions: Our real-world data highlight the worse postoperative outcomes, including a higher mortality rate, in older patients undergoing cholecystectomy. Care should be taken when considering the indications for surgery in such patients. [ABSTRACT FROM AUTHOR]

How morphogen gradients control patterning and growth in developing tissues remains largely unknown due to lack of tools manipulating morphogen gradients. Here, we generate two membrane-tethered protein binders that manipulate different aspects of Decapentaplegic (Dpp), a morphogen required for overall patterning and growth of the Drosophila wing. One is "HA trap" based on a single-chain variable fragment (scFv) against the HA tag that traps HA-Dpp to mainly block its dispersal, the other is "Dpp trap" based on a Designed Ankyrin Repeat Protein (DARPin) against Dpp that traps Dpp to block both its dispersal and signaling. Using these tools, we found that, while posterior patterning and growth require Dpp dispersal, anterior patterning and growth largely proceed without Dpp dispersal. We show that dpp transcriptional refinement from an initially uniform to a localized expression and persistent signaling in transient dpp source cells render the anterior compartment robust against the absence of Dpp dispersal. Furthermore, despite a critical requirement of dpp for the overall wing growth, neither Dpp dispersal nor direct signaling is critical for lateral wing growth after wing pouch specification. These results challenge the long-standing dogma that Dpp dispersal is strictly required to control and coordinate overall wing patterning and growth. Morphogens disperse to pattern tissues and control their growth during development, allowing for the specification of multiple fates across space. Here the authors block dispersal of a morphogen Dpp (BMP2/4) and show that the requirement for Dpp dispersal is much lower than previously thought. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence of rhegmatogenous retinal detachments (RRDs) and proliferative vitreoretinopathies (PVRs) and their distribution by age and sex in hospitalized patients in Japan. Study design: Retrospective nationwide observational study. Methods: Information on the number of inpatients primarily diagnosed with RRD or PVR and their age and sex were collected from the Diagnosis Procedure Combination (DPC) database for 2014 and 2015. The incidence was determined using the Japanese population report published by the Public Management Ministry's Statistics Bureau. Results: The incidence of RRD in these hospitalized patients was 10.9/100,000, with 15.0/100,000 in men and 7.1/100,000 in women, and that of PVR was 2.1/100,000, with 2.9/100,000 in men and 1.3/100,000 in women. The incidence in men was twice that in women for both RRD and PVR. The distribution of RRD by age was monophasic, with a peak at 50 years for both sexes, and that of PVR was at peak in the 60 s for men and in the 70 s for women. PVR was more common than RRD in children aged younger than 10 years, but the incidence of RRD was higher in the other age groups. Conclusion: A study of the DPC database can provide useful information on the incidences of RRD and PVR in hospitalized patients in Japan. [ABSTRACT FROM AUTHOR]

Background: To combat coronavirus disease 2019 (COVID-19), many countries have used contact tracing apps, including Japan's voluntary-use contact-confirming application (COCOA). The current study aimed to identify industry and workplace characteristics associated with the downloading of this COVID-19 contact tracing app. Methods: This cross-sectional study of full-time workers used an online survey. Multiple logistic regression analysis was used to evaluate the associations of industry and workplace characteristics with contact tracing app use. Results: Of the 27,036 participants, 25.1% had downloaded the COCOA. Workers in the public service (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] 1.14–1.45) and information technology (aOR = 1.38, 95% CI 1.20–1.58) industries were more likely to use the app than were those in the manufacturing industry. In contrast, app usage was less common among workers in the retail and wholesale (aOR = 0.87, 95% CI 0.76–0.99) and food/beverage (aOR = 0.81, 95% CI 0.70–0.94) industries, but further adjustment for company size attenuated these associations. Workers at larger companies were more likely to use the app. Compared with permanent employees, the odds of using the app were higher for managers and civil servants but lower for those who were self-employed. Conclusions: Downloading of COCOA among Japanese workers was insufficient; thus, the mitigating effect of COCOA on the COVID-19 pandemic is considered to be limited. One possible reason for the under-implementation of the contact tracing app in the retail and wholesale and food/beverage industries is small company size, as suggested by the fully adjusted model results. An awareness campaign should be conducted to promote the widespread use of the contact tracing app in these industries. [ABSTRACT FROM AUTHOR]

Purpose: There is little evidence to demonstrate the impact of heparin bridging (HB) in major surgery. This study aimed to evaluate the benefits and risks of HB in lung cancer surgery by comparing HB and non-HB (NHB) groups. Methods: We extracted patients who were taking an anticoagulant, were diagnosed with lung cancer, and underwent lung resection between April 2014 and March 2018 from a nationwide database in Japan. We compared the HB and NHB groups to determine the benefits and risks of HB. The proportion of postoperative thromboembolism and bleeding events between the HB and NHB groups was the primary outcome. We performed propensity score matching to remove any HB assignment bias. Results: We selected 2416 patients, and among these, 1068 patients had HB and 1348 did not. Propensity score matching extracted 1500 patients: 750 with HB and 750 without HB. After matching, a Chi-square test showed no significant difference in the incidence of postoperative thromboembolism (1.5% vs 0.9%, p value = 0.343) and bleeding events (5.9% vs 4.0%, p value = 0.124) between the two groups. Conclusions: There was no significant difference in the incidence of postoperative thromboembolism and bleeding in the patients with and those without HB. [ABSTRACT FROM AUTHOR]

Purpose: To compare the short-term outcomes of conventional open colectomy with those of laparoscopic colectomy for colon cancer. Methods: We retrieved data between January 2014 and March 2016 from the Diagnosis Procedure Combination database. A total of 69,418 patients who underwent colectomy for colon cancer were analyzed from among 15,901,766 cases of colorectal cancer. We applied a multilevel logistic regression model using a 2-level structure of individuals nested from 1065 hospitals. Results: A total of 22,440 open colectomy and 46,978 laparoscopic colectomy procedures were performed. The in-hospital mortality rate was significantly lower in the laparoscopic group than in the open group (0.28% vs. 0.06%, odds ratio [OR] 0.40, p < 0.001). Similarly, the 30-day postoperative mortality rate (0.14% vs. 0.03%, OR 0.47, p = 0.019) and surgical morbidity rate (43.0% vs. 25.3%, OR 0.47, p < 0.001) were significantly lower in the laparoscopic group than in the open group. The postoperative length of stay was significantly longer in the open group (mean difference − 5.6 days, p < 0.001) than in the open group. The admission cost was significantly greater in the open group than in the laparoscopic group (mean difference − 95,080 yen, p < 0.001). Conclusions: Laparoscopic colectomy is safe and effective in the short term. [ABSTRACT FROM AUTHOR]

This paper presents a theoretical approach to determine the dynamic fatigue strength characteristics of ceramics under variable loading rates on the basis of the slow crack growth (SCG) concept. First, a probabilistic effective inert strength model was derived on the basis of the SCG concept in conjunction with the Weibull distribution for ceramics subjected to multi-stage loading. Second, a four-point bending test was conducted on Al2O3 under constant and two-stage variable loading rates, and the fracture surface was then observed. The experimental data that depend on loading rates can be unifiedly evaluated after converting the data to the effective inert strength, obeying the three-parameter Weibull distribution. In addition, the Weibull plots of the inert strength, which were calculated from the inclusion size on the fracture surface using the grain fracture model, showed good agreement with the three-parameter Weibull distribution for the converted effective inert strength. These analytical results theoretically indicate that dynamic fatigue under variable loading rates occurs by obeying SCG at the inclusion. Further, the inert strength and its scatter depend on the size and distribution of inclusions. [ABSTRACT FROM AUTHOR]

The aim of this study was to clarify the fracture characteristics of ceramic balls, as used in bearings, when subjected to thermal shock. First, water-quench tests were performed on ceramic balls of a range of sizes. The fracture morphology and fracture surface were then observed. The crack propagation and branching behaviors were observed on the surfaces of the ceramic balls after they had been subjected to thermal shock. Manufacturing flaws were then observed on the surface of the fractures in the ruptured ceramic balls. Next, the relationship between the fracture strength, as calculated using a FEM analysis of the temperature difference at thermal shock fracture initiation and the equivalent crack length calculated from the manufacturing flaw size, was theoretically discussed to introduce a virtual crack model. As a result, it was concluded that the relationship can be estimated by applying a virtual crack model based on experimental data obtained from fracture strength tests for the difference fracture type, i.e., the temperature difference depends on the size of the manufacturing flaw. Finally, the temperature difference scatter was theoretically discussed based on the results of the two-parameter Weibull distribution in conjunction with a virtual crack model. [ABSTRACT FROM AUTHOR]

Background: Little information is available on the effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer disease at the population level. Aims: This study aimed to investigate the effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer based on a national administrative database. Methods: A total of 14,569 elderly patients (≥80 years) who were treated by endoscopic hemostasis for hemorrhagic peptic ulcer were referred to 1073 hospitals between 2010 and 2012 in Japan. We collected patients' data from the administrative database to compare clinical and medical economic outcomes of elderly patients with hemorrhagic peptic ulcers. Patients were divided into two groups according to the presence of dementia: patients with dementia ( n = 695) and those without dementia ( n = 13,874). Results: There were no significant differences in in-hospital mortality within 30 days and overall mortality between the groups (odds ratio; OR 1.00, 95 % confidence interval; CI 0.68-1.46, p = 0.986 and OR 1.02, 95 % CI 0.74-1.41, p = 0.877). However, the length of stay (LOS) and medical costs during hospitalization were significantly higher in patients with dementia compared with those without dementia. The unstandardized coefficient for LOS was 3.12 days (95 % CI 1.58-4.67 days, p < 0.001), whereas that for medical costs was 1171.7 US dollars (95 % CI 533.8-1809.5 US dollars, p < 0.001). Conclusions: Length of stay and medical costs during hospitalization are significantly increased in elderly patients with dementia undergoing endoscopic hemostasis for hemorrhagic peptic ulcer disease. [ABSTRACT FROM AUTHOR]

Background There have been no studies comparing the effects of antithrombin (AT-III) and recombinant human soluble thrombomodulin (rhs-TM) on outcomes in patients with disseminated intravascular coagulation (DIC) associated with infectious diseases. Objective The aim of this observational study is to compare AT-III and rhs-TM in terms of outcomes such as mortality, length of hospitalization, and medical costs in patients with DIC associated with infectious diseases based on a Japanese administrative database. Setting A total of 7,535 patients with DIC associated with infectious diseases in 886 hospitals from 2010 to 2012 in Japan. Methods We collected patients' data from the administrative database to compare clinical and medical economic outcomes of patients with DIC. Patients were divided into two groups according to treatment of DIC: AT-III ( n = 3,601) and rhs-TM ( n = 3,934). Main outcomes measure In-hospital mortality (within 14 days, within 28 days, and overall mortality), length of stay (LOS), and medical costs during hospitalization. Results Multilevel logistic regression analysis showed that there were no significant differences with regard to in-hospital mortality between AT-III and rhs-TM within 14 days (odds ratio (OR) of rhs-TM 0.97, 95 % confidence interval (CI) 0.85-1.11, p = 0.744), within 28 days (OR 1.00, 95 % CI 0.89-1.13, p = 0.919), and overall (OR 0.95, 95 % CI 0.85-1.07, p = 0.470). However, multilevel linear regression analysis revealed that use of rhs-TM significantly decreased LOS and medical costs during hospitalization. The coefficient for LOS was −2.92 days (95 % CI −4.79 to −1.04 days; p = 0.002) whereas that for medical costs during hospitalization was −798.3 Euro (95 % CI −1,515.7 to −81.0 Euro; p = 0.029). Conclusion This study demonstrated no significant difference in in-hospital mortality between AT-III and rhs-TM. However, use of rhs-TM was significantly associated with decreased LOS and medical costs during hospitalization in patients with DIC associated with infectious diseases. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the recent trend over time of outcomes of patients with disseminated intravascular coagulation (DIC) based on the Japanese administrative database. A total of 34,711 patients with DIC had been referred to 1,092 hospitals from 2010 to 2012 in Japan. We collected patients' data from the administrative database to compare in-hospital mortality within 14 and 28 days between periods. The study periods were categorized into three groups: 2010 ( n = 8,382), 2011 ( n = 13,372), and 2012 ( n = 12,957). These analyses were performed according to the underlying diseases associated with DIC. The in-hospital mortality within 14 or 28 days of DIC patients with infectious diseases decreased between 2010 and 2012 (within 14 days: 20.4 vs. 18.1 vs. 17.9 %, P = 0.009; within 28 days: 31.1 vs. 28.7 vs. 27.7 %, P = 0.003; respectively). Multiple logistic regressions also showed that the period was associated with in-hospital mortality of DIC patients with infectious diseases. The odds ratios of 2011 and 2012 for in-hospital mortality within 14 days were 0.86 [95 % confidence intervals (CI) 0.77-0.97] and 0.84 (95 % CI 0.75-0.94) whereas those for in-hospital mortality within 28 days were 0.89 (95 % CI 0.81-0.98) and 0.83 (95 % CI 0.76-0.92), respectively. However, there were no significant differences in mortality of patients with DIC associated with other underlying diseases between 2010 and 2012. This study demonstrated that in-hospital mortality of DIC patients with infectious diseases gradually improved between 2010 and 2012 in Japan. [ABSTRACT FROM AUTHOR]

Background: Little information is available on the analysis of chronological changes in medical economic outcomes of endoscopic submucosal dissection (ESD) for gastric cancer. This study aimed to investigate the recent time trend of medical economic outcomes of ESD for gastric cancer based on the Japanese administrative database. Methods: A total of 32,943 patients treated with ESD for gastric cancer were referred to 907 hospitals from 2009 to 2011 in Japan. We collected patients' data from the administrative database to compare ESD-related complications, risk-adjusted length of stay (LOS), and medical costs during hospitalization. The study periods were categorized into three groups: 2009 ( n = 9,727), 2010 ( n = 11,052), and 2011 ( n = 12,164). Results: No significant difference was observed in ESD-related complications between three study periods ( p = 0.496). However, mean LOS and medical costs during hospitalization of patients with ESD were significantly lower in 2011 than in 2009 and 2010 ( p < 0.001). Multiple linear regression analysis showed that patients who received ESD in 2011 had a significantly shorter LOS and lower medical costs during hospitalization compared with those in 2009. The unstandardized coefficient of patients with ESD in 2011 for LOS was −0.78 days [95 % confidence interval (CI), −0.89 to −0.65; p ≤ 0.001], while that of those for medical costs during hospitalization was −290.5 US dollars (95 % CI, −392.3 to −188.8; p ≤ 0.001). Conclusions: This study showed that the complication rate of ESD was stable, whereas the LOS and medical costs of patients were significantly reduced from 2009 to 2011. [ABSTRACT FROM AUTHOR]

Background: Little information is available about the relationship between hospital volume and the clinical outcome of endoscopic submucosal dissection (ESD) for gastric cancer. The purpose of this study was to investigate the influence of hospital volume on clinical outcomes of ESD using a national administrative database. Methods: A total of 27,385 patients treated with ESD for gastric cancer were referred to 867 hospitals between 2009 and 2011 in Japan. We collected patients' data from the administrative database to compare ESD-related complications and length of stay (LOS) in relation to hospital volume. Hospital volume was categorized into three groups based on the number of cases treated over the study period: low-volume hospitals (LVHs, <50 cases), medium-volume hospitals (MVHs, 50-100 cases), and high-volume hospitals (HVHs, >100 cases). These analyses were performed for each location of gastric cancer [upper (cardia and fundus), middle (body), and lower third (antrum and pylorus)]. Results: Significant differences in ESD-related complications among the three hospital volume categories were observed for upper gastric cancer (6.5 % in LVHs vs. 5.2 % in MVHs vs. 3.4 % in HVHs; p = 0.017). Multiple logistic regression revealed that HVHs were significantly associated with decreased relative risk of ESD-related complications in upper gastric cancer (odds ratio for HVHs 0.51; 95 % confidence interval, 0.31-0.83, p = 0.007). However, no significant differences for ESD-related complications were seen for middle and lower gastric cancers among the different hospital volume categories ( p > 0.05). Additionally, hospital volume was significantly associated with a decreasing LOS for all locations of gastric cancers ( p < 0.001). Conclusions: The present study has demonstrated that hospital volume was mainly associated with clinical outcome in patients with ESD for upper gastric cancer. Further studies for successive monitoring of outcomes of ESD should be conducted in the near future. [ABSTRACT FROM AUTHOR]

Background: Accurate data on the incidence of acute liver disease (ALD) is lacking in most countries. We investigated the incidence of ALD-related admission in Japan using a large sample in a nationwide Japanese database. Methods: Data from the Diagnosis Procedure Combination database were analyzed for 1 July to 31 December 2007-2010. Patient characteristics, in-hospital mortality, and clinical practices, including drugs and procedures during hospitalization, were analyzed. Results: We identified 10509 patients with ALD from a total of 11.61 million inpatients in the database. The median age was 53 years and 54.7 % were male. The annual incidence of ALD-related hospital admission was estimated to be 131.1 cases/1 million people. The overall mortality rate was 5.9 % (622 cases). The infant (0-3 years), child (4-18 years), and adult in-hospital mortality rates were 2.7 % (7/261), 1.0 % (5/494), and 6.3 % (610/9754), respectively. The infant and child mortality rates were significantly lower than the adult mortality rate (Chi square test: P = 0.03 and P < 0.001, respectively). Hepatitis A virus- and hepatitis C virus-induced ALD had favorable outcomes, with in-hospital mortality rates of approximately 2 %. Plasma exchange and continuous hemodiafiltration were performed in 5.3 % (556 cases) and 3.4 % (360 cases) of all ALD cases, respectively. Conclusions: In-hospital mortality of ALD in Japan was acceptably low, and was affected by the etiology and patient background characteristics. The present study adds important information on the incidence and prognosis of ALD in Japan. Improvement of public health surveillance systems is necessary for population-based patient monitoring. [ABSTRACT FROM AUTHOR]

Background: Despite increasing interest in minimally invasive surgery, prevalence data are completely absent. Our objective was to analyze clinico-epidemiological variations of surgery for renal malignancy in Japan with emphasis on annual trends and regional gaps, and to analyze factors affecting choice of open versus minimally invasive surgery. Methods: We identified patients who underwent open ( n = 8646), laparoscopic ( n = 5932), or minimum incision endoscopic surgery (MIES) ( n = 381) nephrectomy for renal malignancy, using the Japanese Diagnosis Procedure Combination database, 2007-2010. Clinical and regional variations in these three approaches were determined, and the annual per-population incidence of nephrectomy was estimated. Multivariate logistic regression was used to analyze factors affecting choice of minimally invasive surgery (laparoscopy or MIES). Results: The proportion of open nephrectomy decreased from 65.3 % in 2007 to 51.6 % in 2010. Laparoscopic nephrectomy accounted for 51.0 % of procedures for T1 tumors. The estimated incidence of nephrectomy in males and females was 14.3 and 6.1 per 100,000 person-years, respectively. Multivariate analysis showed that minimally invasive nephrectomy was more likely to be selected for patients in their 30-50s who had less comorbidity, better performance status, or lower TNM stage, in high-volume or academic hospitals, especially in western Japan. Hemodialysis use was a favorable factor. Conclusion: Despite differences between eastern and western Japan, minimally invasive surgery is becoming widespread throughout Japan, especially for patients with low operative risks and early-stage cancer who are hospitalized in high-volume institutes. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an established procedure for the pathological diagnosis of gastrointestinal submucosal tumors (SMTs). Although bleeding and perforation are potentially severe complications of EUS-FNA, the incidences and severities of these complications have not yet been fully evaluated because of their relative rarity. Aim: The purpose of this study was to evaluate the incidences and mortality of severe bleeding and perforation in patients who underwent EUS-FNA for SMTs. Methods: The records of 1,135 consecutive patients who underwent EUS-FNA for SMTs at 219 hospitals, with low- to high-volume, were reviewed using a Japanese nationwide administrative database. Results: Of the targeted lesions 73.5 % were located in the stomach, 13.4 % in the esophagus, 8.2 % in the duodenum, and 4.9 % at other sites. Five patients (0.44 %) experienced severe bleeding requiring red blood cell transfusion or endoscopic treatment, with none experiencing perforation. Only one patient (0.09 %) died in-hospital within 30 days of EUS-FNA (0.09 %), with death not associated with bleeding or perforation. Conclusions: EUS-FNA is safe in evaluating SMTs, with low risks of bleeding and perforation. [ABSTRACT FROM AUTHOR]

Post-procedure hemodynamic management for aneurysmal subarachnoid hemorrhage is controversial because of the paucity of studied patients. Using a Japanese administrative database, we tested whether increased albumin, catecholamine, and volumes of fluid administered between the procedure and the 4th post-procedure day would be associated with outcomes of mortality, consciousness deterioration at discharge and re-intubation between the 5th and 14th post-procedure days. Across 550 hospitals, 5,400 patients were identified who received clipping, wrapping and endovascular coiling within 48 h after admission in 2010. Patient characteristics and the administration of albumin, catecholamine, and volume of fluid normalized by body weight were analyzed among the groups and categorized according to the presence of albumin and catecholamine administered between the procedure and the 4th post-procedure day. The association of early hemodynamic management with outcomes was measured using logistic regression models, through controlling for the preference of early administration of albumin and catecholamine. For the patients, 9.3 % received albumin only, 14.4 % catecholamine only, and 4.9 % both between the procedure and the 4th post-procedure day, while 16.5 % received albumin or catecholamine on other days. Variation in albumin and catecholamine administration was observed. Higher normalized fluid volume, commenced before the 4th post-procedure day, was associated with increased mortality and re-intubation (although with decreased complications), and vice versa between the 4th and 14th post-procedure days. Catecholamine administration was associated with worsened outcomes. Hypervolemic and hypertensive therapies commenced before the 4th post-procedure day require further research to determine whether their associations with outcomes in this administrative data base are causal or not. [ABSTRACT FROM AUTHOR]

Background: Reported mortalities and morbidities of therapeutic procedures for liver tumors vary between studies, because of different designs and small sample sizes. We investigated the mortalities and complication rates for hepatectomy, radiofrequency ablation (RFA), and trans-catheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) in a large sample, using a nationwide Japanese database (the Diagnosis Procedure Combination database). Methods: Data from the Diagnosis Procedure Combination database were analyzed for July 1 to December 31, 2007 and the same period in 2008. We identified 54,145 patients with HCC who underwent hepatectomy ( n = 5,270), RFA ( n = 11,688), or TAE ( n = 37,187). In-hospital mortality and morbidity were analyzed for each procedure. The relationships between mortality and factors including patient characteristics and procedural backgrounds were assessed. Results: In-hospital mortalities associated with hepatectomy, RFA, and TAE were 2.6 % [95 % confidence interval (CI) 2.2-3.1], 0.3 % (0.2-0.4), and 1.0 % (0.9-1.1), and post-procedural complication rates were 14.5 % (13.5-15.5), 4.5 % (4.2-4.9), and 4.5 % (4.3-4.7), respectively. Increased mortality following hepatectomy was significantly associated with older age, extended lobectomy (vs. partial hepatectomy; odds ratio [OR] 3.80, p < 0.001), lower hospital volume (OR 2.74, p < 0.001), and renal comorbidity (OR 3.01, p = 0.02). Older age and cardiac comorbidity (OR 5.14, p = 0.001) were significantly associated with RFA-related mortality, and lower hospital volume was significantly associated with TAE-related mortality (OR 1.60, p < 0.001). Conclusions: Mortalities and morbidities associated with therapeutic procedures for liver tumors were acceptably low in Japan, but were affected by patient and institutional characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, but data about its effects on postoperative recovery and mortality are currently lacking. Methods: Using the Japanese Diagnosis Procedure Combination database in 2007, we selected patients who underwent elective brain tumor resection with open craniotomy under general anesthesia using either remifentanil or fentanyl and divided them into two categories: remifentanil patients and non-remifentanil patients. After propensity score matching for potential confounders, we compared the in-hospital mortality and postoperative length of stay (LOS) between the two groups. For comparison, the same endpoints were evaluated for patients underwent rectal cancer surgery under general anesthesia with intraoperative epidural anesthesia. Results: In patients who underwent brain tumor resection (936 pairs), remifentanil patients had significantly lower in-hospital mortality (1.5 % vs. 3.0 %; P = 0.029). Logistic regression analysis revealed that the odds ratio for use of remifentanil for in-hospital mortality was 0.47 (95 % confidence interval, 0.25-0.91; P = 0.025). Remifentanil patients also showed earlier discharge from hospital (median LOS, 17 vs. 19 days; hazard ratio, 1.19, 95 % confidence interval, 1.08-1.30; P < 0.001). In contrast, in 2,756 pairs of patients undergoing rectal cancer surgery, no significant difference was seen in either in-hospital morality (1.2 % vs. 1.3 %; P = 0.518) or median LOS (19 vs. 19 days; P = 0.148) between the two groups. Conclusions: Our data suggest a possible association between use of remifentanil and better early postoperative recovery for patients undergoing neurosurgery with craniotomy. Further studies, including a randomized controlled trial, are required to confirm the present results. [ABSTRACT FROM AUTHOR]

Purpose: The introduction of new medicine can change clinical practice patterns and may affect patient outcomes. In the present study, we investigated whether introduction of remifentanil in Japan affected the practice patterns of anesthesia. Methods: Using the Japanese Diagnosis Procedure Combination database, we extracted records of 423,491 patients who underwent surgery with general anesthesia in 243 hospitals before (2006) and after (2007) the introduction of remifentanil, and identified anesthetic agents used for each patient. A hierarchical mixed-effects logistic regression analysis was performed to analyze the factors that affected selection of remifentanil. Further, we compared postoperative length of stay (LOS), in-hospital mortality, and total costs between 2006 and 2007. Results: In 2007, remifentanil was used for up to 41.4% of all general anesthesia, accompanied by a reduction in nitrous oxide use and an increase in total intravenous anesthesia. Female gender, increasing age, and preoperative comorbidities including diabetes mellitus, hypertension, liver cirrhosis, and chronic renal failure were positively associated with the use of remifentanil, whereas accompanying cardiac disease and co-application of epidural anesthesia were negatively associated. In 2007, a similar in-hospital death rate, similar or decreased total costs, slightly reduced duration of anesthesia, and substantially reduced postoperative LOS were seen compared to those in 2006. Conclusions: Our data revealed rapid changes in practice patterns in anesthesia after the introduction of remifentanil in Japan. Remifentanil was used more often in patients with comorbidities and without epidural anesthesia, and its introduction did not affect increase in total medical costs. [ABSTRACT FROM AUTHOR]

This paper aims to statistically estimate the dynamic fatigue strength in brittle materials under a wide range of stress rates. First, two probabilistic models were derived on the basis of the slow crack growth (SCG) concept in conjunction with two-parameter Weibull distribution. The first model, Model I, is a conventional probabilistic delayed-fracture model based on a concept wherein the length of the critical crack growth due to SCG is enough larger than the initial crack length. For the second model, Model II, a new probabilistic model is derived on the basis of a concept wherein the critical cracks have widely ranging lengths. Next, a four-point bending test using a wide range of stress rates was performed for soda glass and alumina ceramics. We constructed fracture probability-strength-time diagrams (F-S-T diagrams) with the experimental results of both materials using both models. The F-S-T diagrams described using Model II were in good agreement with plots of the fracture strength and the fracture time of both materials more so than Model I. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine the relationship between hospital volume and the clinical outcomes of endoscopic biliary drainage for acute cholangitis, using the Japanese administrative database associated with the diagnosis procedure combination (DPC) system. Methods: A total of 8698 patients with endoscopic biliary drainage were referred to 654 hospitals. We corrected patients' data from the database to compare risk-adjusted length of stay (LOS) and drainage-related complications in relation to the hospital volume. Hospital volume was categorized into three groups based on number of cases during the study period: low-volume hospitals (LVHs; <16 cases), medium-volume hospitals (MVHs; 16-32 cases), and high-volume hospitals (HVHs; >32 cases). Results: Significant variation in mean LOS was observed between hospital volume categories (26.8 ± 22.6 days in LVHs vs. 23.3 ± 21.5 days in MVHs vs. 19.7 ± 17.2 days in HVHs, P < 0.001). There was a significant difference with regard to complications of endoscopic biliary drainage (5.6% in LVHs vs. 4.3% in MVHs vs. 3.2% in HVHs, P < 0.001). Multiple linear regression analysis revealed that hospital volume was most significantly associated with a decrease in risk-adjusted LOS. The standardized coefficient of MVHs was −0.155, whereas that of HVHs was −0.802. Multiple logistic regression analysis showed that hospital volume decreased the relative risk of drainage-related complications. The odds ratio (OR) of MVHs was 0.764 [95% confidence interval (CI), 0.604-0.965], whereas the OR of HVHs was 0.561 (95% CI, 0.434-0.725). Conclusions: There was a significant association between hospital volume and the clinical outcomes of endoscopic biliary drainage for acute cholangitis. [ABSTRACT FROM AUTHOR]

The article reports on the study on the association of the number of comorbidity and complication (CC) with the length of hospital stay (LOS) and hospital mortality, as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDC). It shows that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. It also reveals that mortality rates were not associated with CC for eye-diseases, soft tissue diseases and mental disorders.

In this article the grant number 310030 192659 relating to SNSF for Markus Affolter was omitted. The original article can be found online at https://doi.org/10.1038/s41467-021-26726-6. [Extracted from the article]

The relationships among the income (expenditures) level, expenditure for education and tobacco consumption were analyzed based on the data of workers households reported in Family Income and Expenditure Survey of Japan between 1980 and 1995. For all the observed years, elasticities of tobacco to living expenditure were less than -0.4 and the deviation from zero point had increased (-0.41 in 1980, and -0.95 in 1995). By contrast, elasticities of education to living expenditure were over 1.5 for the observed period. In the case of income elasticity, values of tobacco were negative with the same chronological tendency as in elasticity to living expenditure and those of education were around 1.10. The findings regarding the relationship between income level and tobacco consumption was quite different from most of the studies conducted in western countries, which suggested a positive elasticity between the two. According to the present results, we discussed two strategies in order to reduce the smoking prevalence rate in Japan: education and an increase in the cigarette price by higher cigarette taxes. [ABSTRACT FROM AUTHOR]

In order to establish the effective strategies to reduce the smoking prevalence among teenagers in Japan, the author evaluated opinions of the 30 male medical students with smoking habit by the Analytic Hierarchy Process (AHP) method. In the AHP model, the six factors are considered to be important for the onset of teenagers smoking; smoking habit of peers, smoking habit of family members, tobacco advertising, convenience to buy cigarettes, social acceptance of smoking and knowledge of harmful effects of smoking, and the five strategies are proposed; tobacco advertising ban, higher pricing of tobacco, promotion of antismoking education, regulation on tobacco sales, and regulation on smoking area. According to the medical students’ perspective, the strategy of “higher pricing of tobacco” was considered to be the most effective strategy to reduce the smoking incidence of the teenagers, followed by “regulation on tobacco sales”, “promotion of anti-smoking education”, “regulation on smoking area”, and “tobacco advertising ban” [ABSTRACT FROM AUTHOR]

After independence, the Vietnamese government made an enormous effort to construct a comprehensive health care network from the central down to the grass roots levels, however, the health situation of the population has not improved as much as was expected. The most fundamental cause is poverty, as it is in other developing countries. Because of poverty, the means to achieve a safer environment such as sanitation, safe drinking, water and adequate nutrition, is often absent. Inefficient administration due to the sectionalism among different organizations makes the situation worse. With the introduction of a market policy in 1986, privatization has been introduced into the health sector in order to address some of the inadequacies inherent in the current system. Although privatization might reduce public health expenditures by reducing utilization pressure on public facilities, it deprives the most vulnerable inhabitants of health services. [ABSTRACT FROM AUTHOR]

Opinions regarding gender roles and family were investigated among 389 urban dwellers in Vietnam using a questionnaire composed of eitht items. As far as gender role is concerned, about 60% of men and 70-80% of women considered that a woman should be responsible for most of the household affairs, even if she is working outside. About 30% of respondents showed a positive response to the idea of child labor. Almost all of the respondents considered it quite natural that children must take care of their elderly parents. For the education of chldren, about 90% thought that children must be offered an opportunity to receive as much education possible, regardless of the gender of the child. For the education of girls, people with higher educational levels showed a more positive response. The present analysis has clarified that traditional beliefs regarding gender roles and family still remain strong even among people with high education level in urban areas of Vietnam. [ABSTRACT FROM AUTHOR]

Socioeconomic factors associated with the fertility level in Vietnam were investigated using the data of 44 provinces derived from the 1989 census. According to simple correlation analysis, variables that significantly correlated with the total fertility rate (TFR) at a 5% risk level, were the proportion married among women of reproducitive age (r=0.634), the literacy rate among women of reproductive age (r=-0.796), the proportion of the urban population (r=-0.394), the proportion of women of reproductive age in the labor force (r=0.349), the population engaged in primary industries (r=0.547), the infant and early childhood mortality rate (r=0.679), the percentage of communes with communal health stations (r=-0.571), the average age at the first marriage of women (r=-0.743) and the sex ratio (male/female)(r=0.399). In multiple regression analysis (stepwise method), four variables were included in the equation as factors with statistical significance. While the literacy rate among women of reproductive age showed a negative relation with TFR (β =-0.499), the infant and early childhood mortality rate (β =0.338), the proportion married among women of reproductive age (β =0.283), and the total migration rate (β =0.174) showed a positive relation with TFR. These four variables explained 80.0% of the total variance in the observed TFR. These results suggest that the replacement or hoarding theory is applicable to Vietnamese reproductive behavior. [ABSTRACT FROM AUTHOR]

Observations were made on the succession and growth rates of crustose coralline algae growing in situ on artificial substrata in a shallow fore-reef environment on Ishigaki Island, Ryukyu Islands. Succession in well-illuminated environments manifests itself as a gradual replacement of species having very thin thalli by those having larger and thicker thalli. The species Porolithon onkodes, Paragoniolithon conicum and Lithophyllum insipidum achieved dominance by competitive interactions of overgrowing margins. The thicker species recruit quickly (within the first few months), but because of their slow growth rate do not displace the pioneer species that have very thin thalli until after the latter begin to die. Regardless of seasonal temperature fluctuations, which exceed 10 °C, the coralline algal succession is the same for each season. The maximum lateral growth rates of the major species range between 2.9 and 3.9 mm/month. Vertical growth rates of Porolithon onkodes, the thickest species, are the most rapid (more than 2 mm/year at maximum) relative to those of other species. Accretion rates of entire coralline algal cover on ungrazed substrata range from 1.0 to 1.2 mm/year (not allowing any lag time for recruitment), whereas those of grazed substrata are lower. These results are consistent with species which are ecological equivalents and live in similar environments on Caribbean reefs. [ABSTRACT FROM AUTHOR]