Intravenous immunoglobulin (IVIG) at 2 g/kg is the standard first-line therapy for acute Kawasaki disease (KD), yet a subset of patients remains febrile after treatment. Whether IVIG non-response is primarily explained by a low early post-infusion IgG concentration remains uncertain. We retrospectively reviewed consecutive patients with KD at a single center (2009–2019). Patients receiving initial IVIG 2 g/kg without adjunctive therapy were included (N = 109; responders = 86, non-responders = 23). Serum IgG was measured at admission and within 24 h after completion of IVIG. Associations with non-response were examined using multivariable Firth penalized logistic regression, with IgG scaled per 100 mg/dL and adjustment for prespecified clinical covariates. Sensitivity analyses included additional adjustment for the Kobayashi score and exclusion of one non-responder treated without meeting the objective fever criterion. Baseline IgG was correlated with early post-IVIG IgG (Spearman’s ρ = 0.481, P < 0.001). In multivariable Firth penalized logistic regression model, higher post-IVIG IgG was independently associated with non-response (OR 1.26 per 100 mg/dL; 95
BACKGROUND:The number of robotic rectal surgeries being performed in Japan is rapidly increasing. Therefore, the training of young surgeons in robotic rectal surgery has received significant attention. We herein examined the safety and short-term clinical outcomes of robotic rectal surgery performed by young non-Endoscopic Surgical Skill Qualification System (ESSQS)-qualified surgeons. METHODS:Patients who underwent robotic surgery for rectal cancer between November 2019 and October 2023 were included. Robot-assisted rectal surgeries were performed from February 2022 by two young non-ESSQS-qualified surgeons. Young surgeons were defined as those within 12 years after medical graduation. The clinical outcomes of robotic rectal surgery performed by non-ESSQS-qualified surgeons and by qualified surgeons were evaluated. Patients who received preoperative chemoradiotherapy or required complex procedures were excluded. RESULTS:A total of 269 patients underwent robotic surgery for rectal cancer, and 178 were investigated. We included 35 (19.7%) and 143 (80.3%) patients who underwent robotic surgery by non-ESSQS-qualified surgeons and qualified surgeons, respectively. Median total operative time was longer in the non-qualified group (334 vs. 285 minutes, p<0.001), but postoperative complication rates (6% vs. 10%, p=0.67) and hospital stay (10 vs. 10 days, p=0.85) were similar. CONCLUSIONS:Robotic rectal surgery by young non-ESSQS-qualified surgeons appears feasible with acceptable short-term outcomes, though longer operative times and the need for proctor supervision should be considered.
Background: Acute coronary syndrome (ACS) is the critical situation caused by decreased blood flow of the coronary arteries. The most recent clinical guideline compiled by the Japanese Circulation Society (JCS) recommends lowering low-density lipoprotein cholesterol (LDL-C) to <70 mg/dL in patients with ACS, because of the lack of clinical evidence. It has been shown that there are substantial numbers of patients with familial hypercholesterolemia (FH) among ACS patients. On this basis, we intend assembling a multicenter registry to establish the evidence for lowering LDL-C <55 mg/dL while also clarifying the proportion of FH patients among Japanese ACS patients using a prespecified clinical pathway. Methods and Results: The Hokuriku-plus ACS registry is a prospective, observational, multicenter cohort study, enrolling consecutive ACS patients from 14 participating hospitals in Hokuriku region of Japan from October 2025 to September 2027. A total of 1,000 patients will be enrolled followed over 1 year. The primary endpoint is the proportion of patients who attain LDL-C <55 mg/dL at 4 weeks. This study has been registered at the Japan Registry of Clinical Trials (jRCT1040250123). Conclusions: We will disseminate the final results at international conferences and in a peer-reviewed journal.
