Endoscopic submucosal dissection (ESD) is considered the standard treatment for gastric epithelial neoplasms (GEN). However, the waiting time between the diagnosis of GEN and undergoing ESD varies among patients, and its effect on clinical outcomes remains to be elucidated. This study aimed to assess the impact of waiting time on clinical outcomes in patients undergoing ESD for GEN. This retrospective study included 797 patients with 994 lesions who underwent ESD for GEN between April 2013 and March 2018. Waiting time was defined as the period between endoscopic diagnosis and ESD. Patients were divided into two groups based on waiting time: < 90 days (short group) and ≥ 90 days (long group). The primary outcome was disease-specific survival, and secondary outcomes included overall survival, the cumulative incidence of metachronous GEN, and curative resection rates. Prolonged waiting time was associated with ASA PS III and a preoperative histological diagnosis of non-cancer. Short-term outcomes were unaffected by waiting time. Specially, the odds of non-curative resection did not significantly change for 30-day increments in waiting time (OR 1.09; 95
Postoperative delirium (POD) is a frequent complication after surgery, especially in elderly patients undergoing head and neck cancer surgery with free flap reconstruction. This study aimed to assess the associations between intraoperative hypotension (IOH), its duration, and occurrence of POD. This retrospective study included 239 patients aged 65 years or older who underwent head and neck cancer surgery with free flap reconstruction. IOH was defined at seven mean arterial pressure (MAP) thresholds, ranging from 55 to 85 mmHg, in 5 mmHg increments. The duration of each IOH was compared between patients with or without POD before and after initiation of microsurgery. Multivariate analysis was conducted to assess the independent association of each IOH duration with the risk of POD. POD occurred in 43 (18.0
OBJECTIVE:This study aimed to evaluate the impact of the medical fee revisions related to polypharmacy in Japan on the long-term hypnotic prescriptions in older patients. METHODS:We utilized the JMDC medical institution database. Outpatients and inpatients aged ≥ 50 years were included. The target hypnotics included benzodiazepines (BZDs), z-drugs, and ramelteon and orexin receptor antagonists (ramelteon/ORAs). The incidence rates of the newly initiated ≥ 4 weeks of prescriptions per 10 000 outpatients and inpatients (LP-rate) in each month from 2015 to 2022 were calculated. An interrupted time-series analysis was conducted with the intervention point of April 2020 when the medical fees were revised. RESULTS:The average number of outpatients and inpatients in the database from 2015 to 2022 was 828,510/month. The LP-rates of BZDs and z-drugs gradually decreased from 210 to 125 and 111 to 78.6, respectively, from January 2015 to December 2022, whereas that of ramelteon/ORAs increased from 7.41 to 54.4. In the LP-rate of BZDs and z-drugs, although the level significantly increased by factors of 1.08 [95% confidence interval (CI): 1.02-1.13] and 1.12 [95% CI: 1.08-1.16], respectively, at the intervention time, the slope change significantly decreased after the intervention (0.990 [95% CI: 0.988-0.992] and 0.994 [95% CI: 0.993-0.996]). In ramelteon/ORAs, the slope change with the increasing trend was significantly attenuated after the intervention (0.991 [95% CI: 0.986-0.995]). CONCLUSIONS:The medical fee revisions related to polypharmacy significantly redirected the long-term prescription trends of BZDs, z-drugs, and ramelteon/ORAs toward a decline.
Protein-losing enteropathy (PLE) is a rare complication of systemic lupus erythematosus (SLE). A 38-year-old woman with well-controlled SLE developed abdominal pain, lower-extremity edema, anemia, and hypoalbuminemia. The patient was then diagnosed with PLE. Despite treatment with glucocorticoids and cyclophosphamide, persistent hypoalbuminemia was observed. A biopsy was performed using double-balloon enteroscopy due to small bowel lesions, which confirmed the diagnosis of diffuse large B-cell lymphoma. To the best of our knowledge, this is the first reported case of diffuse large B-cell lymphoma mimicking PLE associated with SLE. The possibility of malignant lymphoma should be considered in cases of treatmentresistant PLEs associated with SLE.
