Clinical evidence on whether acute cholangitis accelerates early stent failure via rapid bacterial adhesion and biofilm formation remains limited. We assessed the influence of pre-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis on time to recurrent biliary obstruction (TRBO) and early post-ERCP infection in patients with distal malignant biliary obstruction (DMBO). We retrospectively reviewed consecutive patients with DMBO who underwent their first ERCP-guided stenting at five Japanese centers (January 2020–August 2024). Patients were classified by pre-ERCP cholangitis status and matched at a 2:1 ratio of noncholangitis to cholangitis using propensity scores (PSM). The primary outcome was TRBO; secondary outcomes were post-ERCP infection, clinical success, and RBO rates. TRBO was analyzed using Kaplan–Meier, log-rank, and multivariable Cox analyses; sensitivity analyses yielded concordant results. Of 588 eligible patients, 508 had no cholangitis. PSM yielded 136 and 68 patients in well-balanced groups. The median TRBO was 140 vs. 114 d (p = 0.939). In the Cox models, nonpancreatic etiology lowered RBO risk (hazard ratio [HR]: 0.59, p = 0.04); plastic stents carried a higher risk than metal (HR: 4.71, p < 0.001), and pre-ERCP cholangitis was not associated with RBO (HR: 1.20, p = 0.46). Infections occurred in 9.6 and 4.4
Recently, nutritional status has been reported to be associated with the prognosis of various diseases. Methods to assess nutritional status using common blood-testing parameters include the prognostic nutritional index (PNI), hemoglobin-albumin-lymphocyte-platelet (HALP) score, and controlling nutritional status (CONUT) score. This study aimed to clarify the utility of these scores in patients with locally advanced oral cancer. A total of 106 patients with stage 3 or 4 oral squamous cell carcinoma, who underwent surgery between June 2007 and January 2020, were included. Preoperative PNI, HALP, and CONUT scores were calculated, and cut-off values were set using time-dependent receiver operating characteristic curves. The patients were divided into two arms. Cox proportional hazards analysis was used to identify the factors associated with disease-specific 5-year survival rates. Among the three preoperative scores (PNI, HALP, and CONUT), only PNI showed a significant difference between the preoperative score and disease-specific 5-year survival. The PNI score of 46.5 was set as the cut-off value, and the disease-specific 5-year survival rate was 62.0% in the PNI-low group and 76.0% in the PNI-high group (P = 0.027). In the Cox proportional hazards analysis with PNI-high/low and cancer cell differentiation as variables, the hazard ratio for PNI-high/low was 0.41 (95% confidence interval: 0.19-0.94, P = 0.034). The preoperative PNI score was correlated with disease-specific survival rates and was considered a prognostic factor in patients with locally advanced oral cancer. This suggests the usefulness of nutritional assessment using the PNI in patients with oral cancer.
ABSTRACT Introduction Postoperative small bowel obstruction (SBO) is a major complication following colorectal cancer surgery, yet evidence‐based prevention strategies remain unclear. We aimed to clarify site‐specific risk factors for SBO and evaluate the effectiveness of laparoscopic surgery and adhesion prevention materials (APMs) in preventing SBO after colorectal cancer surgery. Methods This retrospective cohort study analyzed 5458 patients who underwent colorectal cancer surgery at 32 Japanese institutions between 2012 and 2014. The primary endpoint was the 5‐year risk of SBO. We evaluated the effects of laparoscopic surgery, APM use, and stoma creation on SBO risk. Clinical variables included demographics, tumor site, operative approach, operative details, and postoperative complications. Hospital‐level clustering was addressed using mixed‐effects logistic regression. Results Overall SBO incidence was 5.2% ( n = 283). Rectal cancer had the highest risk, whereas all colonic sites except the descending colon showed significantly lower odds. Laparoscopic surgery was associated with a 42% reduction in odds (OR 0.58; 95% CI 0.45–0.74; p < 0.001), with significant reductions in ascending (NNT = 22.2, p = 0.001) and sigmoid colon surgery (NNT = 30.2, p = 0.003). APMs showed no protective effect (OR 1.01; 95% CI 0.78–1.32; p = 0.94). Stoma creation significantly increased SBO risk (OR 1.84; 95% CI 1.35–2.51; p < 0.001). Secondary analysis identified reoperation and postoperative ileus as additional independent risk factors. Discussion Laparoscopic surgery was associated with reduced long‐term SBO risk, with significant benefits in ascending and sigmoid colon surgery. APMs showed no measurable benefit. Stoma creation increased SBO risk, with no observed difference between ileostomy and colostomy.
BACKGROUND:Dietary intake is critical for the prevention and management of physical and mental disorders and may also be influenced by genetic predispositions for anxiety disorders and major depressive disorder (MDD). This study examined the effects of polygenic risk scores (PRSs) for anxiety disorders and MDD on current dietary intake in older patients with lifestyle-related diseases. METHODS:Current dietary intake was assessed across 8 categories: miso soup, Japanese tea, green and yellow vegetables, light-colored vegetables, fruits, pickles, meats, and soybeans in 730 older outpatients diagnosed with or suspected of having lifestyle-related diseases, such as hypertension, diabetes mellitus, and cancer, at Iwata City Hospital, Shizuoka, Japan, during the recruitment period from 2003 to 2008. Polygenic risk scores for anxiety disorders and MDD were calculated using large-scale genome-wide association studies datasets, and their correlations with dietary intake patterns in these patients were investigated. Furthermore, genetic correlations between these disorders and specific dietary intake were explored in an independent general cohort from the UK Biobank. RESULTS:Higher PRSs for anxiety disorders were significantly correlated with increased fruit intake (R2 = 0.010, P = 2.62 × 10-3) in these patients. Conversely, higher PRSs for MDD were nominally correlated with decreased intake of fruits (R2 = 0.0056, P = .021), Japanese tea (R2 = 0.0069, P = .014), green vegetables (R2 = 0.0076, P = 7.82 × 10-3), light-colored vegetables (R2 = 0.0049, P = .029), and soybeans (R2 = 0.0054, P = .025) and with increased intake of meats (R2 = 0.0082, P = 8.02 × 10-3). In contrast, in the independent general cohort, both disorders were commonly genetically correlated with decreased fruit intake (anxiety disorders: rg = -0.10, P = 2.10 × 10-3; MDD: rg = -0.17, P = 2.01 × 10-9). CONCLUSIONS:Our findings suggest that genetic factors related to anxiety disorders may shape dietary habits, potentially influencing compensatory healthy dietary behaviors in response to anxiety and worry related to physical health issues. Significance statement Genetic predispositions for anxiety disorders may contribute to compensatory healthy dietary behaviors in response to physical health-related anxiety, whereas those for major depressive disorder (MDD) may be related to unhealthy eating patterns in patients with lifestyle-related diseases. Genetic factors for anxiety disorders and MDD distinctly influence dietary behaviors.
