Background: Uniportal thoracoscopic surgery has gained popularity as a minimally invasive approach for anatomical lung resection. While outcomes from high-volume centers have been reported, evidence describing nationwide real-world practice across institutions with varying experience is scarce. This study aimed to evaluate the current status and perioperative outcomes of uniportal thoracoscopic anatomical pulmonary resections in Japan. Methods: We conducted a multicenter retrospective study under the Japanese Uniportal Video-assisted Thoracoscopic Surgery Interest Group. Patients with primary lung cancer who underwent uniportal thoracoscopic lobectomy or segmentectomy in Japan between April 2018 and March 2023 were included. Clinical information was collected from participating institutions, and patient characteristics, operative variables, and perioperative outcomes were evaluated. The primary outcome was the incidence of procedurerelated complications, with secondary outcomes including operative time and other perioperative parameters. Results: A total of 3,546 patients were analyzed, comprising 2,780 lobectomies and 766 segmentectomies. The proportion of segmentectomies gradually increased during the study period. In the lobectomy group, the median operative time was 170 min, with prolonged air leak in 7.6% and significant vessel injury in 3.4%. In the segmentectomy group, the median operative time was 154 min, with prolonged air leak in 4.6% and significant vessel injury in 3.5%. Thirty-day mortality was 0.3% in both groups, and conversion to multiport or thoracotomy occurred in 1.8-3.6% of cases. Conclusions: This nationwide analysis indicates that uniportal thoracoscopic anatomical pulmonary resection is performed safely in Japan, with perioperative outcomes comparable to those reported internationally. Although operative times were slightly longer than those in single-institution series, complication rates remained low, indicating that uniportal thoracoscopic anatomical pulmonary resection is being conducted with acceptable perioperative outcomes in real-world practice.
Purpose To investigate whether adverse life experiences are associated with postpartum depressive symptoms at 1 month, and to examine dose–response relationships and specific types of adversity. Methods We conducted a retrospective cohort study at a tertiary perinatal center in Japan. Women who delivered at ≥ 22 weeks’ gestation between 2018 and 2024 were eligible. At the first prenatal visit, women completed a routine questionnaire assessing adverse life experiences. For analysis, the experiences were grouped into seven categories. Postpartum depressive symptoms were assessed at the routine 1-month postpartum visit using the Edinburgh Postnatal Depression Scale (EPDS), with a score ≥ 9 indicating depressive symptoms. Multivariable logistic regression models were fitted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for covariates. Results Among 6,559 women included in the primary analysis, 4,197 (63.1%) reported at least one adverse life experience. Postpartum depressive symptoms occurred in 7.2% of women with any adverse life experience compared with 4.5% of those with none. Any adverse life experience was associated with higher odds of postpartum depressive symptoms (aOR 1.55, 95% CI 1.24–1.96). A clear dose–response relationship was observed, with increasing odds of postpartum depressive symptoms as the number of adverse experience categories increased (P for trend < 0.001). Personal health problems were independently associated with postpartum depressive symptoms (aORs 1.60, 95% CI 1.16–2.20). Conclusions Adverse life experiences were associated with an increased risk of postpartum depressive symptoms in a dose-dependent manner. In particular, personal health problems were associated with postpartum depressive symptoms.
Discussing prognosis and end-of-life (EOL) care with patients and physicians is a sensitive and critical aspect of EOL care. However, the association between prognostic awareness and EOL discussions and the quality of death and dying (QOD) remains uncertain. This study aimed to describe prognostic awareness and participation in EOL discussions among patients with common causes of death and to clarify their association with QOD. Retrospective nationwide mortality follow-back survey in Japan (Feb 2019; Feb 2020). Bereaved families of patients who died in hospitals or at home from cancer, heart disease, cerebrovascular disease, pneumonia, or renal failure. The primary outcome was family-reported QOD. Exposures of interest included family-reported prognostic awareness and EOL discussions, including care settings and code statuses. Analyses were conducted separately by disease category and place of death. Logistic regression and generalized linear models were used for analysis. Of the 115,861 family members who were sent the questionnaires, we finally analyzed 50,641 responses. Accurate patient prognostic awareness ranged from 56.8
This study aimed to assess the clinical utility of serum interferon-lambda 3 (IFN-λ3) as a sequential biomarker for treatment response and disease control in patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM)-associated interstitial lung disease (ILD). Serum IFN-λ3 levels were measured in 24 patients with anti-MDA5 antibody-positive DM-ILD at diagnosis and 1 month after initiating immunosuppressive therapy. Patients were categorized into two groups based on clinical outcomes: a good control group (n = 16; survived without relapse for ≥ 1 year) and a poor control group (n = 8; died from ILD progression or relapse within 1 year). Changes in serum IFN-λ3 levels and differences between groups were analyzed. In the good control group, serum IFN-λ3 levels significantly decreased from 94.6 to 12.7 pg/mL (p < 0.001), whereas no significant change was observed in the poor control group (129.0 to 118.8 pg/mL). Furthermore, serum IFN-λ3 levels at 1 month were significantly lower in the good control group than in the poor control group (p = 0.004). Serum IFN-λ3 levels may reflect short-term treatment response and could serve as a useful sequential biomarker for assessing disease control in patients with anti-MDA5 antibody-positive DM-ILD.
Background Pneumocystis jirovecii pneumonia (PCP) is a severe opportunistic infection. Trimethoprim-sulfamethoxazole (SXT) is the first-choice treatment for PCP in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients. However, the high incidence of adverse events makes treatment with SXT difficult. The risk factors for these adverse events in patients with non-HIV PCP remain unclear. Methods In this multicenter, retrospective, observational cohort study, we investigated these risk factors by analyzing data from patients with non-HIV PCP treated with SXT between June 2006 and March 2021 across three institutions. Patients were divided into two groups based on the presence of grade 3 or higher adverse events according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0: the adverse event (n = 74) and no adverse event (n = 62) groups. Patient characteristics were compared, and multivariate regression analysis was used to identify factors contributing to adverse events. We also investigated the relationship between treatment failure and adverse events. Results Baseline characteristics showed notable variations between the groups, notably in serum sodium, serum potassium levels, and the initial trimethoprim dose per weight. Logistic regression analysis revealed significant associations among adverse events and these three baseline variables. In the treatment failure group, the most frequent adverse events included skin rashes, hyponatremia, and hyperkalemia. Conclusions Pretreatment serum sodium and potassium levels and the initial SXT dose per weight were identified as independent risk factors for developing CTCAE grade 3 or higher adverse events associated with SXT treatment for non-HIV PCP. Further large-scale, prospective studies are essential to confirm these results.
