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Background: Laparoscopic gastrectomy (LG) is an established minimally invasive procedure for gastric cancer. However, it is controversial whether LG is useful for patients with poor physical status classified into higher classes of the American Society of Anesthesiologists physical status (ASA-PS) classification. The aim of this study was to determine the feasibility of LG in patients with ASA-PS class ≥ 3. Methods: We extracted data for a total of 28,160 patients with an ASA-PS class ≥ 3 who underwent distal or total gastrectomy for gastric cancer between January 2013 and December 2017 from the National Clinical Database Japan society for gastroenterological surgery registry. We developed a propensity score model from baseline demographics and comorbidities and matched patients undergoing LG to those undergoing open gastrectomy (OG) using a 1:1 ratio. Mortality and morbidities (within 30 days and in-hospital) were compared between the 6998 matched patient pairs. Results: In-hospital mortality was significantly lower in patients undergoing LG than in those undergoing OG (2.3% vs. 3.0%, p = 0.01), while the 30-day mortality was similar (1.6% vs. 1.5%). The length of hospital stay was significantly shorter in the LG group (median, 14 days vs. 17 days, p < 0.001). The LG group had a significantly lower incidence of postoperative complications in patients with any grade complication (20.3% vs. 22.5%, p = 0.002) as well as those with ≥ grade 3 complications (8.7% vs. 9.8%, p = 0.03). Conclusion: LG was associated with decreased in-hospital mortality and a lower incidence of several postoperative complications when compared to OG among patients with poor physical condition. [ABSTRACT FROM AUTHOR]

Background: Adding taxane to an anthracycline-based regimen improves survival in node-positive breast cancer patients, as shown by clinical trials and meta-analyses. However, no studies have analyzed the number of metastatic lymph nodes in patients with estrogen receptor (ER)-positive cancer. This study investigated whether adding a taxane to an anthracycline-based regimen improved prognosis in node-positive, ER-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients in a real-world setting. Methods: Using Japanese Breast Cancer Society registry data, we compared disease-free survival (DFS) of patients with ER-positive, HER2-negative breast cancer, excluding those receiving neoadjuvant chemotherapy, between those who received an anthracycline-based regimen followed by a taxane-based regimen (A + T) and those who received only an anthracycline-based regimen (A w/o T), stratified by lymph node status. A Cox proportional hazards model was used to evaluate DFS in both groups. Results: There were 4566 eligible patients with ER-positive, HER2-negative breast cancer. During the median follow-up period of 60 months, there were 481 recurrences and 149 deaths. There was no significant difference in DFS between the A + T and A w/o T groups among patients with 1–3 positive nodes, while there was a significant difference among patients with ≥ 4 positive nodes. Conclusions: In patients with ER-positive, HER2-negative breast cancer, adding taxane to an anthracycline regimen did not improve DFS in patients with metastasis in 1–3 lymph nodes. We considered that the group without the addition of taxane might be present in patients with ER-positive, HER2-negative lymph node metastases. [ABSTRACT FROM AUTHOR]

Purpose: Recurrence risk management of patients with small (≤ 2 cm), node-negative, human epidermal growth factor receptor 2 (HER2)-positive breast cancer remains challenging. We studied the effects of adjuvant chemotherapy and/or trastuzumab and survival outcomes among these patients, using data from the population-based Japanese National Clinical Database (NCD). Methods: We identified a cohort of 2736 breast cancer patients with HER2+ pT1N0 disease: 489 pT1a, 642 pT1b, and 1623 pT1c. The median observation period was 76 months, and the 5-year follow-up rate was 48.2%. The number of events was 212 for disease-free survival (DFS), 40 for breast cancer-specific survival, and 84 for overall survival (OS). Results: There were 24.5% of pT1a, 51.9% of pT1b, and 63.3% of pT1c patients who were treated systemically after surgery. OS in pT1b (logrank test; p = 0.03) and DFS in pT1c (logrank test; p < 0.001) were significantly improved in treated compared with untreated patients. In the Cox proportional hazards model, treated patients had significantly longer OS than untreated patients in pT1b (hazard ratio (HR) 0.20) and pT1c (HR 0.54) groups. Estrogen receptor-negative tumors was also a significant predictor of survival in pT1c (HR 2.01) but not pT1ab patients. Furthermore, HR was greater in patients aged ≤ 35 years (3.18) compared to that in patients aged 50–69 years in the pT1b group. Conclusions: NCD data revealed that systemic treatment improved OS in pT1bc but not in pT1a node-negative HER2+ breast cancer patients. Future observational research using big-sized data is expected to play an important role in optimizing treatment for patients with early-stage breast cancer. [ABSTRACT FROM AUTHOR]

Background: The role of postmastectomy radiotherapy (PMRT) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is controversial. We aimed to evaluate the effectiveness of radiotherapy in patients treated with NAC and mastectomy in the Japanese Breast Cancer Registry. Methods: We enrolled patients who received NAC and mastectomy for cT1–4 cN0–2 M0 breast cancer. We evaluated the association between radiotherapy and outcomes, locoregional recurrence (LRR), distant disease-free survival (DDFS), and overall survival (OS) based on ypN status by multivariable analysis. Results: Of the 145,530 patients, we identified 3226 who met the inclusion criteria. Among ypN1 patients, no differences were found in LRR, DDFS, or OS between groups with and without radiotherapy (p = 0.72, p = 0.29, and p = 0.36, respectively). Radiotherapy was associated with improved LRR-free survival (p < 0.001), DDFS (p = 0.01), and OS (p < 0.001) in patients with ypN2–3. Multivariable analysis demonstrated that use of radiotherapy was independently associated with improved LRR [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.45–0.82, p = 0.001] and OS [HR 0.69, 95% CI 0.53–0.89, p = 0.004) for ypN2–3 patients only. The association between radiotherapy and OS was not statistically significant among ypN0 (p = 0.22) and ypN1 patients (p = 0.51). Conclusions: The results from this nationwide database study did not show significant associations between PMRT and improved survival among ypN0 and ypN1 patients. Radiotherapy may be beneficial only for ypN2–3 breast cancer patients who receive NAC and mastectomy in the modern era. [ABSTRACT FROM AUTHOR]

Objective: Regionalization directs patients to high-volume hospitals for specialized care. We investigated regionalization trends and outcomes in pediatric cardiac surgery.Data Sources/study Setting: Statewide inpatient data from eleven states between 2000 and 2012.Study Design: Mortality, length of stay (LOS), and cost were assessed using multivariable hierarchical regression with state and year fixed effects. Primary predictor was hospital case-volume, categorized into low-, medium-, and high-volume tertiles.Data Collection/extraction Methods: We used Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) to select pediatric cardiac surgery discharges.Principal Findings: In total, 2841 (8.5 percent), 8348 (25.1 percent), and 22 099 (66.4 percent) patients underwent heart surgeries in low-, medium-, and high-volume hospitals. Mortality decreased over time, but remained higher in low- and medium-volume hospitals. High-volume hospitals had lower odds of mortality and cost than low-volume hospitals (odds ratio [OR] 0.59, P < 0.01, and relative risk [RR] 0.91, P < 0.01, respectively). LOS was longer for high- and medium-volume hospitals, compared to low-volume hospitals (high-volume: RR 1.18, P < 0.01; medium-volume: RR 1.05, P < 0.01).Conclusions: Regionalization reduced mortality and cost, indicating fewer complications, but paradoxically increased LOS. Further research is needed to explore the full impact on health care utilization. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic gastrectomy (LG) might have greater clinical benefits for elderly patients as less invasive surgery; however, there is still little evidence to support its benefit. We evaluated the surgical outcomes of elderly patients in a nationwide prospective cohort study. Methods: One hundred and sixty-nine participating institutions were identified by stratified random sampling, and were adjusted for hospital volume, type and location. During 1 year from 2014 to 2015, consecutive patients who underwent gastrectomy for gastric cancer were prospectively enrolled. 'Elderly' was defined as ≥ 75 years of age, based on the prevalence of comorbidities and the activities of daily living of patients of this age. We compared the surgical outcomes of LG to those of open gastrectomy (OG) in non-elderly and elderly patients. The primary outcome was the incidence of severe morbidities (Grade ≥ 3). Results: Eight thousand nine hundred and twenty-seven patients were enrolled [non-elderly, n = 6090 (OG, n = 2602; LG, n = 3488); elderly, n = 2837 (OG, n = 1471; LG, n = 1366)]. Grade ≥ 3 complications occurred in 161 (10.9%) patients who underwent OG and 98 (7.2%) who underwent LG (p < 0.001). After adjusting for confounding factors, we confirmed that laparoscopic surgery was not an independent risk factor (odds ratio = 0.81, 0.60–1.09). OG was associated with a significantly longer median length of postoperative stay in comparison to LG (16 versus 12 days, p < 0.001). There were no significant differences in the incidence of other postoperative comorbidities. Conclusion: The safety of LG in elderly patients was demonstrated. LG shortened the length of postoperative hospital stay. [ABSTRACT FROM AUTHOR]

Reference 1 Miyoshi T. Long-term prognosis and clinical course of choking-induced cardiac arrest in patients without the return of spontaneous circulation at hospital arrival: a population-based community study from the Shizuoka Kokuho Database. B Correction: BMC Emerg Med 22, 120 (2022) b B https://doi.org/10.1186/s12873-022-00676-8 b The original article [[1]] contained errors in the order of the references in the article which have since been corrected.

The study objective was to report the clinical outcomes of open surgery for acute aortic dissection by using the Japan Cardiovascular Database. Between 2013 and 2018, a total of 29,486 patients with acute aortic dissection who underwent open surgery were registered in the Japan Cardiovascular Database. Some 50% of patients were male. Age of patients at surgery was 59.8 ± 14.2 years; 61% of patients were aged less than 65 years, and 21% of patients were aged more than 75 years. Connective tissue disease was found in 1.2% of patients. Some 13% of patients had disturbed consciousness, and 12% of patients had cardiogenic shock. Some 11% of patients had moderate or severe aortic valve regurgitation, and 2.3% of patients had acute myocardial infarction. Some 94% of patients underwent surgery within 24 hours after diagnosis. Antegrade cerebral perfusion was used in 74% of patients, hypothermic circulatory arrest with retrograde cerebral perfusion was used in 17.1% of patients, and deep hypothermic circulatory arrest was used in 9.4% of patients. Cardiopulmonary bypass time was 216 ± 90 minutes, and cardiac ischemic time was 132 ± 60 minutes. Lowest body temperature was 24.6°C ± 3.2°C. Replacement of the ascending aorta (zone I) was performed in 69% of patients, and total arch replacement (zone 0 to zone II, III-) was performed in 29% of patients. The aortic valve was replaced in 7.9% of patients and repaired in 4.4% of patients. The 30-day mortality was 9.2%, and in-hospital mortality was 11%. The number of operations has increased through the study periods. The in-hospital mortality has been stable or in a decreasing trend. Major complications consisted of stroke in 12% of patients, new hemodialysis in 7.3% of patients, spinal cord ischemia in 3.9% of patients, and prolonged ventilation in 15% of patients. Approximately 30,000 patients with acute aortic dissection in the recent 6 years (2013 - 2018) underwent open surgery according to the nationwide Japanese database. The number of operations has increased, and in-hospital mortality has been stable or in a decreasing trend. Although the early outcomes are acceptable, there is still room for improvement in patients with preoperative comorbidities. Nationwide analysis of acute AAD using the JCVSD 2013 to 2018. From left top to right bottom : patient enrollment, patient age at surgery, urgency of surgery, yearly number of surgery and hospital death, yearly number of postoperative complications, range of replacing aorta, aortic valve procedures, and mode of brain protection. CABG , Coronary artery bypass grafting; CHD , congestive heart disease; LV , left ventricle; VAD , ventricular assist device; SCI , spinal cord ischemia; HD , hemodialysis. [Display omitted] [ABSTRACT FROM AUTHOR]

Postmastectomy radiotherapy (PMRT) is the standard treatment for locally advanced breast cancer. However, the effectiveness of PMRT in patients with pT1-2 and N1 tumours remains controversial. Therefore, this study aimed to determine the prognostic impact of PMRT in patients with breast cancer and with pT1-2 and 1–3 lymph node metastases. Using data from the Japanese National Clinical Database from 2004 to 2012, we evaluated the association of PMRT with locoregional recurrence (LRR), any recurrence, and mortality. We enrolled patients who had undergone mastectomy and axillary node dissection and were diagnosed with pT1-2 and N1. We compared clinicopathological factors and prognosis between patients who received (PMRT group) and those who did not receive (No-PMRT group) PMRT. Among 8914 patients enrolled, 492 patients belonged to the PMRT group and 8422 to the No-PMRT group. The median observation time was 6.3 years. There was no significant difference in the incidences of LRR (4.0% versus 5.0%, P = 0.61), recurrence (13.8% versus 11.8%, P = 0.23) and breast cancer death (6.0% versus 4.3%, P = 0.08) at 5 years between the groups. Multivariable analysis revealed that LRR was significantly associated with tumour size, number of node metastases and triple-negative subtype but not with PMRT. The LRR rate in the No-PMRT group was 5.0% at 5 years among patients with T1-2 and N1. PMRT did not significantly influence LRR in patients with T1-2 and N1. However, PMRT administration should be tailored considering the individual risks of tumour size, 3 node metastases and triple-negative subtype. • LRR was significantly associated with tumour size, node metastases and TN subtype. • LRR showed no significant association with postmastectomy radiotherapy (PMRT). • There was no significant difference in the 5-year LRR and survival rate by PMRT. • PMRT must be chosen based on tumour size, number of node metastases and TN subtype. [ABSTRACT FROM AUTHOR]

Purpose: The association between advanced age and postoperative morbidity and mortality after major gastroenterological surgeries remains unclear. This study aimed to assess the association between old age and the short-term postoperative outcomes of gastroenterological surgeries. Methods: We evaluated 327,642 patients who underwent any of the seven major gastroenterological surgeries—esophagectomy, total gastrectomy, distal gastrectomy, right hemicolectomy, low anterior resection, hepatectomy, and pancreatoduodenectomy—and were registered with the Japanese national surgical registry between January 2011 and December 2013. Perioperative characteristics, frequency/nature of postoperative morbidities, and postoperative mortality were compared according to age at the time of surgery. Results: Overall, 18% (59,182/327,642) of the entire cohort were aged ≥ 80 years. The overall mortality rates in the entire cohort and in those aged ≥ 80 years were 1.7% and 3.3%, respectively. The postoperative mortality increased with increasing age for all procedures, with the trend persisting even after adjusting for various confounding factors. The incidence of postoperative pneumonia increased with increasing age, and with all procedures, except esophagectomy, subjects aged ≥ 80 years had a markedly higher risk of developing postoperative pneumonia than those aged < 60 years. Conclusion: Advanced age is associated with significantly worse short-term outcomes in older patients undergoing gastroenterological surgeries. However, we could not identify any distinct cutoff age beyond which major gastroenterological surgery could be considered as being contraindicated. The mortality risk should be carefully considered before recommending major gastroenterological surgeries for older patients. [ABSTRACT FROM AUTHOR]

Background: Western guidelines often recommend biguanides as the first-line treatment for diabetes. However, dipeptidyl peptidase-4 (DPP-4) inhibitors, alongside biguanides, are increasingly used as the first-line therapy for type 2 diabetes (T2DM) in Japan. However, there have been few studies comparing the effectiveness of biguanides and DPP-4 inhibitors with respect to diabetes-related complications and cardio-cerebrovascular events over the long term, as well as the costs associated. Objective: We aimed to compare the outcomes of patients with T2DM who initiate treatment with a biguanide versus a DPP-4 inhibitor and the long-term costs associated. Methods: We performed a cohort study between 2012 and 2021 using a new-user design and the Shizuoka Kokuho database. Patients were included if they were diagnosed with T2DM. The primary outcome was the incidence of cardio-cerebrovascular events or mortality from the initial month of treatment; and the secondary outcomes were the incidences of related complications (nephropathy, renal failure, retinopathy, and peripheral neuropathy) and the daily cost of the drugs used. Individuals who had experienced prior events during the preceding year were excluded, and events within 6 months of the start of the study period were censored. Propensity score matching was performed to compare between two groups. Results: The matched 1:5 cohort comprised 529 and 2,116 patients who were initially treated with a biguanide or a DPP-4 inhibitor, respectively. Although there were no significant differences in the incidence of cardio-cerebrovascular events or mortality and T2DM-related complications between the two groups (p = 0.139 and p = 0.595), daily biguanide administration was significantly cheaper (mean daily cost for biguanides, 61.1 JPY; for DPP-4 inhibitors, 122.7 JPY; p<0.001). Conclusion: In patients with T2DM who initiate pharmacotherapy, there were no differences in the long-term incidences of cardio-cerebrovascular events or complications associated with biguanide or DPP-4 use, but the former was less costly. [ABSTRACT FROM AUTHOR]

Background: Use of combinations of long-acting β2 agonists/long-acting muscarinic antagonists (LABA/LAMA) in patients with chronic obstructive pulmonary disease (COPD) is increasing. Nevertheless, existing evidence on cardiovascular risk associated with LABA/LAMA versus another dual combination, LABA/inhaled corticosteroids (ICS), was limited and discrepant. Aim: The present cohort study aimed to examine comparative cardiovascular safety of LABA/LAMA and LABA/ICS with a target trial emulation framework, focusing on dual fixed-dose combination (FDC) therapies. Methods: We identified patients with COPD who initiated LABA/LAMA FDC or LABA/ICS FDC from a nationwide Taiwanese database during 2017–2020. The outcome of interest was a hospitalized composite cardiovascular events of acute myocardial infarction, unstable angina, heart failure, cardiac dysrhythmia, and ischemic stroke. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for composite and individual cardiovascular events after matching up to five LABA/LAMA FDC initiators to one LABA/ICS FDC initiator using propensity scores (PS). Results: Among 75,926 PS-matched patients, use of LABA/LAMA FDC did not show a higher cardiovascular risk compared to use of LABA/ICS FDC, with a HR of 0.89 (95% CI, 0.78–1.01) for the composite events, 0.80 (95% CI, 0.61–1.05) for acute myocardial infarction, 1.48 (95% CI, 0.68–3.25) for unstable angina, 1.00 (95% CI, 0.80–1.24) for congestive heart failure, 0.62 (95% CI, 0.37–1.05) for cardiac dysrhythmia, and 0.82 (95% CI, 0.66–1.02) for ischemic stroke. The results did not vary substantially in several pre-specified sensitivity and subgroup analyses. Conclusion: Our findings provide important reassurance about comparative cardiovascular safety of LABA/LAMA FDC treatment among patients with COPD. [ABSTRACT FROM AUTHOR]

Purpose: A research subgroup was established by the Japanese Society of Gastroenterological Surgery to improve the health care quality in the Chushikoku area of Western Japan. Methods: The records of four surgical procedures were extracted from the Japanese National Clinical Database and analyzed retrospectively to establish the association between hospital characteristics, defined using a combination of hospital case-volume and patients' hospital travel distance, and the incidences of perioperative complications of ≥ Grade 3 of the Clavien–Dindo classification after gastroenterological surgery. Results: This study analyzed 11,515 cases of distal gastrectomy for gastric cancer, 4,705 cases of total gastrectomy for gastric cancer, 4,996 cases of right hemicolectomy for colon cancer, and 5,243 cases of lower anterior resection for rectal cancer, with composite outcome incidences of 5.6%, 10.2%, 5.5%, and 10.7%, respectively. After adjusting for patient characteristics and surgical procedures, no association was identified between the hospital category and surgical outcomes. Conclusion: The findings of our study of the Chushikoku region did not provide positive support for the consolidation and centralization of hospitals, based solely on hospital case volume. Our grouping was unique in that we included patient travel distance in the analysis, but further investigations from other perspectives are needed. [ABSTRACT FROM AUTHOR]

Background: The risk of choking increases with aging, and the number of cases of choking-induced cardiac arrest is increasing. However, few studies have examined the prognosis of choking-induced cardiac arrest. The aim of this study was to reveal the rates of survival and dependence on devices in the long term after choking-induced cardiac arrest. Methods: We analyzed data from the Shizuoka Kokuho Database, which consists of claims data of approximately 2.2 million people, from April 2012 to September 2018. We selected patients with choking-induced cardiac arrest who received cardiopulmonary resuscitation in the hospital. Patients were excluded if they were less than 20 years old, had an upper airway tumor, received ventilation assistance, or received enteral nutrition in the month prior to cardiac arrest. The primary outcome was death, and the secondary outcomes were the rates of survival at 3-months and independence on devices. Descriptive statistics are presented and compared among age groups (20–64 years, 65–74 years, 75–84 years, 85 years and older), and survival time analysis (Kaplan-Meier method) was performed. Results: In total, 268 patients were analyzed, including 26 patients in the 20–64 age group, 33 patients in the 65–74 age group, 70 patients in the 75–84 age group, and 139 patients in the ≥85 age group. The overall 3-month survival rate was 5.6% (15/268). The 3-month survival rates were 3.8% (1/26) in the 20–64 age group, 15.2% (5/33) in the 65–74 age group, 8.6% (6/70) in the 75–84 age group, and 2.2% (3/139) in the ≥85 age group. The overall 12-month survival rate was 2.6% (7/268). Of the 7 patients who survived for 12 months, 3 received ventilation management and 5 received tube or intravenous feedings at 3 months. These survivors were still receiving ventilation assistance and tube feedings in the hospital and had not been discharged at 12 months. Conclusions: The prognosis of choking-induced cardiac arrest was extremely poor when patients were not resuscitated before hospital arrival. Those who survived were mostly dependent on assistive devices. Additionally, none of the survivors dependent on assistive devices had discontinued the use of the devices at the long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Hemoglobin A1c (HbA1c) levels are routinely measured during health check-ups and are used as an indicator of glycemic control in Japan. However, only a few studies have followed up individuals to assess the risk of diabetes development and worsening based on HbA1c screening results. This study evaluated the relationship between HbA1c screening results and the risk of diabetes development and worsening.Methods: Data were collected from the Shizuoka Kokuho Database, a Japanese administrative claims database of insured individuals aged > 40 years. We included individuals available for follow-up from April 2012 to March 2018 who had not received any diabetes treatment before March 2014. HbA1c screening results were categorized into 4 groups based on the HbA1c levels at the 2012 and 2013 health check-ups: group A, those whose HbA1c levels were < 6.5% in 2012 and 2013; group B, those whose HbA1c levels > 6.5% in 2012 but < 6.5% in 2013; group C, those whose HbA1c levels were > 6.5% in 2012 and 2013; and group D, those whose HbA1c levels were < 6.5% in 2012 and > 6.5% in 2013. Logistic regression models were used to analyze diabetes development and worsening, defined as the initiation of diabetes treatment by March 2018 and the use of injection drugs by participants who initiated diabetes treatment by March 2018.Results: Overall, 137,852 individuals were analyzed. After adjusting for covariates, compared with group A, group B was more likely to initiate treatment within 4 years (odds ratio: 22.64; 95% confidence interval: 14.66-34.99). In patients who initiated diabetes treatment by March 2018, injection drugs were less likely used by group D than by group A (odds ratio: 0.28; 95% confidence interval: 0.12-0.61).Conclusions: Our study suggests that although HbA1c levels measured during health check-ups were correlated with the risk of diabetes development and worsening, HbA1c levels in a single year may not necessarily provide sufficient information to consider these future risks. [ABSTRACT FROM AUTHOR]

This is an annual report by the Japanese Breast Cancer Society, which provides statistics on the clinical data on breast cancer in Japan, extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR). This report includes an update of 102,453 breast cancer cases at 1339 institutions registered in the NCD-BCR in 2022. Among the 101,793 female patients, the median age at cancer diagnosis was 62 years (interquartile range, 50-73 years), and 29.4% of the patients were premenopausal. Of these patients, 15,437 (15.2%) and 42,936 (42.2%) were diagnosed with stage 0 and I disease, respectively. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) were positive in 78.7%, 69.4%, and 12.8% of the patients, respectively. Of the 97,154 patients without distant metastasis, 40,521 (41.7%) underwent breast-conserving surgery, and 5780 (5.9%) patients underwent some form of breast reconstruction procedures at the time of mastectomy. A total of 66,894 (68.9%) patients were treated with sentinel lymph node biopsy and 7155 (7.4%) patients were treated with sentinel lymph node biopsy followed by axillary node dissection. In the group of patients treated with breast-conserving surgery (n = 40,521), 29,500 (72.8%) received whole-breast irradiation. In the group of patients who underwent mastectomy (n = 54,476), 6226 (11.4%) received radiation therapy to the chest wall. Of the 13,950 patients receiving preoperative chemotherapy with or without molecular targeted therapy, 4308 (30.9%) achieved a pathological complete response, with the highest rate of 60.5% in patients with the hormone receptor-negative/HER2-positive subtype., Competing Interests: Declarations. Conflicts of interest: Grants or contracts from any entity–MK: Nippon Kayaku, Kyowa Kirin, Advalife Science, Guardant Health AMEA, Shimadzu and GL Sciences; S Sasada: Daiichi Sankyo, Chugai, Eli Lilly, Gilead Sciences, and Nipro; S Saji: Taiho, Eisai, Chugai, Takeda, MSD, Astra Zeneca, Daiichi Sankyo, Gilead, Eli Lilly, and Sanofi; NN: Chugai, Pfizer, Eisai, Mochida, Daiichi Sankyo, and Novartis. Consulting fees–HK: EPS corporation; MY: Roche Japan. Payment or honoraria for lectures—MN: AstraZeneca, Chugai, Daiichi Sankyo, Denka, Eisai, Eli Lilly, Kyowa-Kirin, MSD, Novartis, Pfizer, and Taiho; HK: Novartis; MK: Guardant Health AMEA, Chugai, Daiichi Sankyo, Pfizer Japan, Eisai, Taiho Pharmaceutical, and Devicor Medical Japan; YS: Pfizer, Astra Zeneca, Daiichi Sankyo, Eisai, Eli Lily, Chugai, MSD, Nippon Kayaku, Kyowa Kirin, Sysmex, Celltrion, and Healthcare Japan; S Saji: Chugai, Kyowa Kirin, MSD, Novartis, Eisai, Takeda, Daiichi Sankyo, Eli Lilly, Astra Zeneca, Pfizer, Taiho, Ono, Nipponkayaku, Gilead, and Exact Sciences; NN: Chugai, Eli Lilly, MSD, Daiichi-Sankyo, AstraZeneca, and Pfizer; MM: Chugai, AstraZeneca, Eli Lilly, Pfizer, MSD, Taiho, Daiichi Sankyo, and Eisai; MY: Roche Japan, Agilent Technologies, Chugai pharma, Ono Yakuhin, MSD, and Daiichi Sankyo. Participation on a Data Safety Monitoring Board or Advisory Board–S Saji: Chugai/Roche, Astra Zeneca, Eli Lilly, Pfizer, Kyowa Kirin, Daiichi Sankyo, MSD; MY: Daiichi Sankyo. Leadership or fiduciary role–S Saji: JBCRG, JBCS, JSMO, and BIG. Other financial or non-financial interests–HK and NK: affiliation with a social collaboration department at the University of Tokyo supported by the National Clinical Database, Johnson & Johnson K.K., Nipro corporation, and Intuitive Surgical Sarl. MK: participation in the clinical trials led by JBCRG, Roche, Eli Lilly, and Merck. Ethical approval: This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards., (© 2025. The Author(s).)

Competing Interests: Declarations. Conflict of interest: Hiroyuki Yamamoto and Hiraku Kumamaru are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation and Intuitive Surgical Sàrl.

Purpose: Although minimally invasive cardiac surgery (MICS) procedures are widely performed throughout Japan, nationwide data regarding treated cases are limited. Up-to-date results for cardiovascular surgery are vital for quality control in clinical practice. Presented here is the 2021 annual report based on data from the Japan Cardiovascular Surgery Database (JCVSD)., Methods: Records noted in the JCVSD of patients who underwent mitral valve surgery, aortic valve replacement (AVR), coronary artery bypass grafting (CABG), atrial septum defect (ASD) closure, or cardiac tumor resection via right or left minithoracotomy, as well as thoracoscopic- or port-assisted, or robotic-assisted approaches, in 2021 were examined. Perioperative parameters including mortality and morbidity was evaluated., Results: The 30-day and in-hospital mortalities for isolated mitral valve repair (n = 1211) were 0.1% and 0.2%, respectively, while those for all mitral valve repair (n = 2017) were 0.05% and 0.2%, respectively. More than 100 facilities were found to perform fewer than five MICS mitral valve surgery cases per year. As for MICS-AVR, 30-day and in-hospital mortalities for isolated AVR (n = 818) were 0.5% and 0.5%, respectively, while those for all AVR (n = 987) were 0.6% and 1.1%, respectively. Additionally, those for MICS-CABG (n = 400) were 0.8% and 0.5%, respectively. Those for ASD (n = 183) and cardiac tumor (n = 96), were 0.5% and 0.5%, respectively, and 0% and 1.0%, respectively., Conclusion: This is the first report of MICS results of procedures performed in Japan based on the 2021 JCVSD data. Additional results obtained with a similar data collection method are expected and details on MICS are being collected starting 2024., Competing Interests: Declarations. Conflict of interest: HK reports receiving consultation fee from EPS Corporation, and speaker fee from Chugai Pharmaceutical Co., Ltd. HK reports receiving research funding from Amgen K.K. on an unrelated topic. HK is affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo, a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro corporation, and Intuitive Surgical Sàrl. The other authors declare that they have no. conflict of interest., (© 2024. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Objective: Investigate whether deaf or hard of hearing (D/HH) patients with COVID-19 exhibited different hospitalisation outcomes compared with hearing patients with COVID-19., Design: Cohort study SETTING: Statewide Inpatient Databases for Florida, Maryland, New York and Washington, for the year 2020., Participants: Records of patients aged 18-64 years with COVID-19 PRIMARY OUTCOMES AND MEASURES: Differences in in-hospital death, 90-day readmission, length of stay, hospitalisation cost, hospitalisation cost per day, intensive care unit (ICU) or coronary care unit (CCU) utilisation and ventilation use were evaluated. Adjustment variables included patient basic characteristics, socioeconomic factors, and clinical factors., Results: The analyses included 347 D/HH patients and 72 882 non-D/HH patients. Multivariable log-transformed linear regression models found an association of patients' hearing loss status with longer length of stay (adjusted mean ratio (aMR) 1.15, 95% CI 1.04 to 1.27, p<0.01), higher hospitalisation cost (aMR 0.96, 95% CI 1.00 to 1.22, p=0.049) and lower hospitalisation cost per day (aMR 0.96, 95% CI 0.92 to 1.00, p=0.04). We did not detect any significant relationships with other outcomes., Conclusions: Our findings suggest that higher hospitalisation costs were attributed to prolonged stays rather than costly interventions, such as ICU care. Communication barriers between healthcare providers and D/HH patients, coupled with providers' cautious approach to discharging D/HH patients, may explain our findings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Intimate partner violence (IPV) and homelessness can have devastating health consequences for pregnant women. Using the Pregnancy Risk Assessment Monitoring System, we assessed differences in the association of physical IPV before and/or during pregnancy with adverse health outcomes between women experiencing homelessness (WEH) and domiciled women. Among 186,891 respondents, representing an estimated 11,489,161 women, 27.1% and 3.4% of WEH and domiciled women, respectively, reported experiencing physical IPV. Physical IPV was associated with higher odds of having postpartum depression and preterm birth and lower odds of having a postpartum checkup among domiciled women (adjusted odds ratio [aOR] 1.83, 95% confidence interval [CI] 1.62 - 2.08 for postpartum depression, aOR 1.29, 95%CI 1.08 - 1.53 for preterm birth, and aOR 0.56, 95%CI 0.49 -0.64 for postpartum checkup). The differences in these outcomes between women who experienced physical IPV and those who did not were smaller among WEH, as indicated by aORs of interaction terms (aOR 0.74, 95%CI 0.58 - 0.94 for postpartum depression, aOR 0.68, 95%CI 0.49 - 0.93 for preterm birth, and aOR 1.32, 95%CI 1.01 - 1.74 for postpartum checkup). Further research is needed to identify factors that may offer WEH a protective effect against the negative impacts of IPV., (© The Author(s) 2025. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)