Gastric cancer remains a significant health burden, especially in Asia. Potassium-competitive acid blockers (P-CABs) provide stronger acid suppression than proton pump inhibitors (PPIs), but their long-term impact on metachronous gastric cancer (MGC) remains unclear. This study evaluated the incidence and duration-dependent risk of MGC in P-CAB/PPI users. This multicenter retrospective cohort study included patients from 15 institutions in Japan who underwent endoscopic or surgical resection for gastric cancer between 2014 and 2022. After exclusions, 7172 patients who had received H. pylori eradication were analyzed. Chronic use of P-CAB/PPI was defined as administration for more than 3 months. The primary outcome was the incidence of MGC. Cox regression models were used, along with subgroup analyses based on duration and initial treatment type (endoscopy versus surgery). During a median follow-up of 5.8 years, MGC developed in 342 patients. The incidence was highest among P-CAB users (20.9 per 1,000 person-years), followed by PPI users (13.5) and non-users (7.1). Both P-CAB and PPI use were independently associated with increased MGC risk (hazard ratio 3.89 and 1.75, respectively). The association between P-CAB use and MGC was stronger with longer durations of use (hazard ratio 3.44 for < 1 year, 3.95 for 1–3 years, and 9.36 for > 3 years) and was particularly evident in the post-endoscopic group (hazard ratio 4.22) in subgroup analyses. Chronic use of P-CAB/PPI were associated with MGC. Longer duration may be associated with increased risk of MGC. Further studies are warranted to validate these findings.
OBJECTIVE:The purpose of this study was to investigate the relationship between the presence of perceived leg-length discrepancy (PLLD) and spatiotemporal gait parameters in the early postoperative period following total hip arthroplasty (THA). METHODS:A total of 63 patients (age 73.19 ± 9.00 years) who underwent primary unilateral THA were included in the study. PLLD was assessed using the Block test, and spatiotemporal gait parameters were measured 3 weeks postoperatively with the Walkway MW-1000 system. Statistical analysis was performed using analysis of covariance (ANCOVA), adjusting for confounders such as height, muscle strength, and postoperative structural leg-length discrepancy, to examine the independent association between PLLD and spatiotemporal gait parameters. RESULTS:ANCOVA analysis revealed significant differences between the PLLD group and the non-PLLD group. The PLLD group exhibited longer operative single support time, longer non-operative double support time, and wider step width than the non-PLLD group. CONCLUSIONS:This study demonstrates the relationship between PLLD and spatiotemporal gait parameters. As such, it provides important insights for gait assessment and how this might be used in rehabilitation programmes following THA. Improving PLLD and gait symmetry may help to lower the risk of postoperative falls.
Background and study aims Superficial non-ampullary duodenal epithelial tumors (SNADETs) are being increasingly diagnosed, and accurate endoscopic diagnosis is essential for determining appropriate treatment strategies. However, no standardized diagnostic method currently exists. We developed a deep learning-based artificial intelligence (AI) classifier to distinguish between low-grade and high-grade neoplasia and evaluated its diagnostic performance. Patients and methods The training set of 85 SNADET cases (low-grade neoplasia, n = 41; high-grade neoplasia, n = 44; white-light images, n = 317) from Yamaguchi University were used to train the AI classifier. Validation was performed using a test set of 69 lesions (low-grade neoplasia, n = 31; high-grade neoplasia, n =38; images, n = 229) from three institutions. Three expert endoscopists also evaluated the test set using an endoscopic scoring system for comparison. Results The AI classifier achieved 78.3% accuracy, 92.1% sensitivity, 61.3% specificity, 74.5% positive predictive value (PPV), 86.4% negative predictive value (NPV), and an F1 measure of 0.824. In contrast, endoscopist diagnosis yielded 58.0% accuracy, 50.0% sensitivity, 67.7% specificity, 65.5% PPV, 52.5% NPV, and an F1 measure of 0.567. Diagnostic accuracy and sensitivity of the AI was significantly higher than that of the endoscopists ( P <0.05). Conclusions The AI classifier demonstrated higher sensitivity and overall diagnostic performance in comparison to endoscopists in differentiating high-grade neoplasia, suggesting its potential utility in guiding treatment decisions.
INTRODUCTION:In cases of metastatic and unresectable urothelial carcinoma with no disease progression after 4 cycles of chemotherapy, including platinum agents, treatment options include continuation of chemotherapy or switching to maintenance therapy with avelumab. This study compared the treatment outcomes of avelumab maintenance therapy with those of pembrolizumab in urothelial carcinoma using propensity score matching. PATIENTS AND METHODS:Between January 2017 and December 2022, 243 patients with metastatic and unresectable urothelial carcinoma were treated with either avelumab or pembrolizumab at the Yamaguchi University Hospital and its affiliated institutions. We retrospectively compared the oncological outcomes and adverse events by aligning patient characteristics and treatment backgrounds using propensity score matching. RESULTS:The analysis compared 36 cases receiving avelumab maintenance therapy after chemotherapy to 49 cases where patients, after receiving 4 courses of chemotherapy including platinum-based agents without disease progression, were subsequently administered pembrolizumab as a second-line treatment following disease progression. Using propensity score matching, 27 cases from each group were selected for comparison. From the initiation of prechemotherapy to disease progression on immune checkpoint inhibitors, the median progression-free survival was 20.7 and 23.3 months in the avelumab and pembrolizumab groups, respectively, with no statistically significant difference observed (P = .358). However, avelumab tended to have a lower rate of high-dose glucocorticoid treatment compared to pembrolizumab. CONCLUSION:Progression-free survival was similar for avelumab maintenance therapy and the sequence of continued chemotherapy followed by pembrolizumab after no disease progression at four chemotherapy courses. Avelumab may require less high-dose glucocorticoid treatment, potentially enhancing safety.
