Makoto Fujii

Aim: Clinical benefits of robot‐assisted colectomy over laparoscopic colectomy for colon cancer remain uncertain, and real‐world data are limited. We evaluated the short‐term outcomes of robot‐assisted colectomy versus laparoscopic colectomy in patients with colon cancer. Methods: This single‐center, retrospective cohort study evaluated patients who underwent minimally invasive colectomies for colon cancer at Osaka General Medical Center from January 2014 to November 2024. Short‐term outcomes were compared after 1:1 propensity score matching to minimize confounding by indication. Results: In total, 480 patients underwent laparoscopic colectomies and 282 underwent robot‐assisted colectomies, with 218 matched pairs. Baseline characteristics were well‐balanced. Surgical procedure distribution was similar between the groups ( P = 0.897). Mean operative times were significantly longer (212 vs. 200 min, P = 0.040), mean intraoperative blood loss was significantly lower (22.8 vs. 37.5 mL, P < 0.001), rates of conversion to open surgery were significantly lower (0.0% vs. 2.3%, P = 0.026), and mean hospital stays were significantly shorter (7.0 vs. 11.3 d, P < 0.001) in the robot‐assisted colectomy group. The number of lymph node dissections ( P = 0.27) and local R0 resection rates ( P = 0.34) were comparable. Overall complication rates were significantly lower in the robot‐assisted colectomies (11.0% vs. 17.9%, P = 0.007), whereas clinically meaningful complication rates (Clavien–Dindo grades ≥ II) were comparable ( P = 0.150). Conclusions: These findings provide real‐world data supporting the feasibility of robot‐assisted colectomy for colon cancer treatment. Further research should evaluate the long‐term oncologic outcomes and cost‐effectiveness.

Background: Steatotic liver disease (SLD) is a hepatic phenotype of metabolic syndrome (MetS). However, little is known about the relationship between SLD and the onset of each MetS‐related disease (type 2 diabetes [T2D], hypertension, and dyslipidemia). In this study, we examined the relationship between the onset of MetS‐related diseases and SLD using health checkup data at baseline and 7 years later. Methods: A total of 2167 individuals who underwent a health examination were initially recruited to the study. After excluding cases with a history of hepatic disease, a total of 714 subjects were selected and received an abdominal ultrasound test at baseline and again 7 years later. New‐onset cases were defined as subjects who were free of each disease at baseline but developed one by the 7‐year follow‐up. Logistic regression analysis was used to estimate odds ratios and quantify the impact of SLD on the development of MetS‐related diseases. Results: We found the following results: (1) SLD at baseline is an independent risk factor for the incidence of MetS‐related disease 7 years later. (2) T2D and hypertension are not independent risk factors for the incidence of SLD 7 years later. Dyslipidemia and obesity are independent risk factors for the incidence of SLD. Obesity is the only independent risk factor for the new development of SLD within 7 years. (3) No individual MetS‐related disease is an independent risk factor for the development of SLD. Conclusion: The presence of SLD is more associated with the incidence of MetS‐related diseases than obesity.

Introduction/Objectives: In Japan, novice nurses are assigned to intensive care units immediately after graduation and are expected to become independent within about a year. Therefore, in addition to long-term, comprehensive educational programs, establishing an educational system that allows novice nurses to learn intensive care unit nursing while working is necessary. This study explored senior nurses’ expectations for novice nurses working independently in the intensive care unit after one year and identified the foundational skills needed for novice nurses to achieve this independence. Methods: The research collaborators were eight senior nurses working in the intensive care unit of an acute care hospital. They were recruited from four facilities and had five or more years of clinical experience. The study used semi-structured interviews to generate data about the reports, contacts, and consultations they would expect from novice nurses to determine their readiness to become independent. Results: This study clarified the circumstances under which novice nurses with no practical experience should voluntarily seek support to work as independent nurses one year after being assigned to an intensive care unit. It reflects the characteristics of patients who require intensive management, such as “assistance with central line insertion and removal” and “evaluation of vital signs,” as well as other advanced procedures. Conclusion: This study clarified the basic skills required for novice nurses and identified the areas in which they should seek support. In the future, this method may be utilized in the early stages of novice nurse education.

Aim: Many Japanese nurses have moved to Australia, yet their experiences and perceived reasons for staying in Australia are understudied. This study identified why Japanese nurses who moved internationally to Australia continued to stay and work in Australia.Methods: Semi‐structured interviews were conducted with 15 Japanese nurses who hold Japanese nursing licenses and are registered as nurses in Australia. The transcripts were analyzed using thematic analysis.Results: Five themes emerged: (1) capability to take leave and holidays without feeling guilty, (2) set shifts creates a better work–life balance, (3) incentives give motivation to work hard, (4) safe and protective workplace for nurses, and (5) positive environment for pursuing a career.Conclusions: Japanese nurses were satisfied with the Australian work environment where their profession is well‐protected and highly respected, with more chances of career advancements. It suggests the need for a better working environment for nurses in Japan.

Objective: We investigated how Japanese D3 dissection with left colic artery (LCA) preservation affects anastomotic leakage after anterior resection with anastomosis for rectal cancer, based on the leak rate. The correlation between LCA preservation, survival, and cancer recurrence after resection was also analyzed.Summary and Background Data: It remains unclear how LCA preservation affects the anastomotic leak rate and oncological outcomes after resection remains unclear. Some reports suggested that anastomotic leakage increases local recurrence and decreases cancer‐specific survival.Methods: In this study, we enrolled and analyzed 457 patients who underwent radical resection of rectal cancer in the period October 2011 through December 2016. The attending surgeon decided preoperatively and registered whether to preserve the LCA. This trial was registered under the UMIN‐CTR Identifier UMIN000006160.Results: D3 with LCA preservation was successfully completed in 218 (89.3%) of the 244 patients registered in this group, whereas D3 without LCA preservation was successfully completed in all 213 patients registered in this group. After propensity score matching, the anastomotic leakage rate was 7.86% (11/140) after D3 with LCA preservation and 7.14% (10/140) after D3 without LCA preservation. The overall survival rates were 90.1% and 89.3%, and the recurrence‐free survival rates were 77.6% and 77.3%, respectively.Conclusions: Our findings suggest that LCA preservation has no effect on the incidence of anastomotic leakage after rectal resection with anastomosis using DST and that oncological outcomes may not be affected.

Background: The short-term outcomes of chemoradiotherapy (CRT) with S-1 (a combination of tegafur, gimeracil, and oteracil) following limited surgery for patients with T1 or T2 lower rectal cancer have shown encouraging results. Objectives: This study was designed to delve deeper into the long-term outcomes of CRT with S-1 after limited surgery, with the goal of evaluating both the long-term efficacy and potential risks associated with this treatment approach in patients diagnosed with T1 or T2 lower rectal cancer. Methods: This was conducted as a multicenter, single-arm, prospective phase II trial. The patient population consisted of individuals clinically diagnosed with either T1 or T2 lower rectal or anal canal cancer, with a maximum tumor diameter of 30 mm and classified as N0 or M0. Patients underwent local excision or endoscopic resection. After surgery, CRT with S-1 was administered to patients meeting several criteria, including the confirmation of well-differentiated or moderately differentiated adenocarcinoma, negative surgical margins, submucosal invasion depth of ≥1000 µm, and high tumor-budding grade (2/3). The primary endpoint of this study was relapse-free survival, while secondary endpoints included local recurrence-free survival, overall survival, anal sphincter preservation rate, and safety. Results: A total of 52 patients were included, with pathological diagnoses revealing T1 in 36 patients and T2 in 16 patients. The 3-year and 5-year relapse-free survival rates were 90.17% and 85.87%, respectively. The 3-year and 5-year local recurrence-free survival rates were 90.17% and 88.07%, respectively, while the 3-year and 5-year overall survival rates were 94.03% and 91.94%, respectively. Conclusions: CRT with S-1 after limited surgery for T1 lower rectal cancer demonstrated favorable outcomes in terms of recurrence, survival, and local control rates while effectively maintaining anal function in patients. However, further treatment approaches may be necessary to improve outcomes for patients diagnosed with stage T2 lower rectal cancer

Background: One life event that requires extensive resilience and adaptation is parenting. However, resilience and perceived support in child-rearing vary, making the real-world situation unclear, even with postpartum checkups. Objective: This study aimed to explore the psychosocial status of mothers during the child-rearing period from newborn to toddler, with a classifier based on data on the resilience and adaptation characteristics of mothers with newborns. Methods: A web-based cross-sectional survey was conducted. Mothers with newborns aged approximately 1 month (newborn cohort) were analyzed to construct an explainable machine learning classifier to stratify parenting-related resilience and adaptation characteristics and identify vulnerable populations. Explainable k-means clustering was used because of its high explanatory power and applicability. The classifier was applied to mothers with infants aged 2 months to 1 year (infant cohort) and mothers with toddlers aged >1 year to 2 years (toddler cohort). Psychosocial status, including depressed mood assessed by the Edinburgh Postnatal Depression Scale (EPDS), bonding assessed by the Postpartum Bonding Questionnaire (PBQ), and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) between the classified groups, was compared. Results: A total of 1559 participants completed the survey. They were split into 3 cohorts, comprising populations of various characteristics, including parenting difficulties and psychosocial measures. The classifier, which stratified participants into 5 groups, was generated from the self-reported scores of resilience and adaptation in the newborn cohort (n=310). The classifier identified that the group with the greatest difficulties in resilience and adaptation to a child’s temperament and perceived support had higher incidences of problems with depressed mood (relative prevalence [RP] 5.87, 95% CI 2.77-12.45), bonding (RP 5.38, 95% CI 2.53-11.45), and sleep quality (RP 1.70, 95% CI 1.20-2.40) compared to the group with no difficulties in perceived support. In the infant cohort (n=619) and toddler cohort (n=461), the stratified group with the greatest difficulties had higher incidences of problems with depressed mood (RP 9.05, 95% CI 4.36-18.80 and RP 4.63, 95% CI 2.38-9.02, respectively), bonding (RP 1.63, 95% CI 1.29-2.06 and RP 3.19, 95% CI 2.03-5.01, respectively), and sleep quality (RP 8.09, 95% CI 4.62-16.37 and RP 1.72, 95% CI 1.23-2.42, respectively) compared to the group with no difficulties. Conclusions: The classifier, based on a combination of resilience and adaptation to the child’s temperament and perceived support, was able identify psychosocial vulnerable groups in the newborn cohort, the start-up stage of childcare. Psychosocially vulnerable groups were also identified in qualitatively different infant and toddler cohorts, depending on their classifier. The vulnerable group identified in the infant cohort showed particularly high RP for depressed mood and poor sleep quality.

Background: The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40–74 years with treated and untreated type 2 diabetes. Methods and results: This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40–74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR >85 mL/min/1.73 m² or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40–59 and 60–74 years) and baseline eGFR levels (60–85, 30–59, and 30 subgroups (60–85 or 30–59 mL/min/1.73 m²), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60–74 age group and non-refreshing sleep in the 40–59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60–74 age group regardless of baseline eGFR levels. In the baseline eGFR 2 subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR. Conclusions: We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease.

Objectives: Prolonged air leak (PAL) is a common complication of lung resection. Research on predictors of PAL using a digital drainage system (DDS) remains insufficient. In this study, we investigated the predictive factors of PAL to establish a novel early postoperative prediction model for PAL.Methods: A retrospective cohort study and validation study were conducted. We examined patients who underwent lung resection with DDS at our institute. The relationship between the clinical factors and measurements of the DDS, including the difference between the set and measured intrapleural pressure (named: additional negative pressure [ANP]) at postoperative hour (POH) 3, with PAL was analyzed.Results: A total of 494 patients were enrolled, 29 of whom had PAL. Percent forced expiratory volume in 1 s n = 133) revealed that this scoring system showed a sufficient ability to predict PAL.Conclusions: ANP at POH 3 is an independent predictor of PAL. Thus, the risk‐scoring system proposed in this study is useful for predicting PAL in the early postoperative period.