OBJECTIVES:To determine whether key institutional and clinical differences exist between highly and moderately active hospitals in Japan with respect to brain-dead organ donation practices. DESIGN:Retrospective multicenter cohort study. SETTING:Sixteen tertiary emergency and critical care centers across Japan. PATIENTS:All brain-dead organ donors from participating institutions who had at least one organ procured and transplanted between July 17, 2010, and December 31, 2023. Hospitals were categorized as highly active (≥ 14 donations) or moderately active (≤ 13 donations) during the study period. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Institutional donation practices were compared, including donor management strategies, use of vasopressors and corticosteroids, time intervals in the donation process, and frequency of multidisciplinary team meetings. A total of 204 donors were included; the median age was 47 years (interquartile range, 37-56), and 92 (45.1%) were female. Donor characteristics were similar between groups. Vasopressin was used in nearly all donors, though dosing protocols varied. Corticosteroid use was significantly higher in highly active hospitals compared with moderately active ones (58.3% vs. 38.0%; p = 0.004). Time from admission to coordinator notification was similar; however, time to family consent (median, 8 vs. 5 d; p < 0.001) and time to organ procurement (median, 12 vs. 9 d; p = 0.006) were longer in highly active hospitals. These hospitals also conducted more multidisciplinary meetings during donor management (median, 2 vs. 0; p < 0.001). CONCLUSIONS:Highly active hospitals demonstrated more intensive donor management practices, longer timeframes for key donation steps, and greater multidisciplinary engagement. Standardization of donation practices may enhance efficiency and support broader dissemination of effective institutional strategies to improve brain-dead organ donation rates in Japan.
While neoadjuvant immunochemotherapy has improved outcomes of resectable nonsmall cell lung cancer (NSCLC), treatment-induced tissue changes can increase surgical complexity. This study aimed to identify preoperative predictors of technically challenging surgery following neoadjuvant immunochemotherapy. This multicenter retrospective analysis included 114 patients who underwent surgery after neoadjuvant nivolumab plus platinum-based chemotherapy at 29 institutions between March 2023 and July 2024. Challenging surgery was defined as one requiring bronchoplasty, pulmonary artery angioplasty, or pneumonectomy. Logistic regression was used to identify preoperative predictors for surgical complexity. Twenty-one patients (18.4
INTRODUCTION:Antibiotics and proton pump inhibitors (PPIs) have been associated with the reduced efficacy of immune checkpoint inhibitor (ICI) in patients with advanced non-small cell lung cancer (NSCLC). This study assessed the clinical impact of these medications in the neoadjuvant setting. PATIENTS AND METHODS:This multicenter retrospective study was conducted in 29 Japanese institutions. Between March 2023 and July 2024, 131 patients with resectable clinical stage II-III NSCLC who received neoadjuvant chemoimmunotherapy with nivolumab were enrolled. In total, 113 patients who underwent definitive surgery were included in the surgical outcome analysis. We investigated the association between the use of antibiotics and PPIs within 30 days before treatment initiation and clinicopathological factors, including the pathological complete response (pCR) and major pathological response (MPR). RESULTS:Among 113 patients, 5 (4.4%) had received antibiotics and 23 (20.4%) PPIs. Antibiotic and PPI use showed no significant differences in any clinicopathological factors. Antibiotic and PPI use was not significantly associated with the objective response rate (ORR), pCR, or MPR; antibiotic (use/non-use): 80.0%/70.4% (p = 1.000), 40.0%/35.8% (p = 1.000), 60.0%/59.6% (p = 1.000) and PPI (use/non-use): 78.3%/68.9% (p = 0.532), 43.5%/33.3% (p = 0.507), 60.9%/58.9% (p = 1.000). CONCLUSION:Prior use of antibiotics and PPIs was not significantly associated with radiological or pathological response of neoadjuvant ICI in patients with resectable NSCLC. Further studies with larger sample size and longer survival follow-up are needed.
Objective Infectious mononucleosis (IM) is most commonly caused by Epstein-Barr virus (EBV). However, recent epidemiological shifts have increased the proportion of adult cases attributable to cytomegalovirus (CMV). Early distinction of EBV-related IM (EBV-IM) using routine laboratory parameters may reduce unnecessary testing and facilitate timely counseling regarding activity restriction. This study aimed to identify the laboratory features that distinguish EBV-IM from non-EBV IM and to develop a simple diagnostic scoring system. Methods We retrospectively analyzed 39 consecutive patients with IM (EBV-IM, n = 22; non-EBV IM, n = 17, including CMV-IM, n =8). The laboratory parameters and inflammatory indices were compared between the groups, and receiver operating characteristic curve analyses were used to determine the optimal cutoff values for score development. Results EBV-IM patients had higher alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels than non-EBV IM patients, whereas the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels were lower in EBV-IM patients. Four variables were used for scoring: ALT ≥ 120 U/L, ALP ≥ 200 U/L, NLR ≤ 0.6, and CRP ≤ 2.0 mg/dL, collectively termed the EBV-IM Laboratory Score (EL-Score). A score ≥ 2 predicted EBV-IM with an area under the curve of 0.95 (95% confidence interval: 0.88-1.00), a sensitivity of 0.91, and a specificity of 0.94. Conclusions The EL-Score, based on routinely available laboratory parameters, may enable the early distinction between EBV-IM and non-EBV IM in internal medicine practice.
This study aimed to determine whether absolute baseline transcranial motor evoked potential (Tc-MEP) amplitude is associated with false-positive (FP) alerts during intraoperative neurophysiological monitoring and to estimate pathology-specific cutoff values. We retrospectively reviewed 307 high-risk spine surgery cases monitored with Tc-MEPs from 2018 to 2020. For waveform-level analysis, 1,748 muscle waveforms from 287 FP/true-negative cases were analyzed. Alerts were defined as final amplitude ≤ 30
