Kayoko Mizuno

Background: Kidney Replacement Therapy (KRT) timing in septic shock remains debated. We assessed temporal trends in KRT initiation and outcomes in Japan. Methods: Using a nationwide EMR database (2016–2023), we included adults (≥ 20 years) with septic shock admitted to the intensive care unit (ICU) or high‐dependency care unit (HDU) on day 0 who received KRT. Outcomes were KRT timing by hospital day, in‐hospital mortality, and KRT dependency at discharge; sensitivity analyses used consistently reporting hospitals. Results: Among 688 hospitalizations (median age 74 years), KRT initiation shifted later, with day ≥ 2 initiation reaching 38.5% in 2023. In 2022, mortality was 54.3% ( n = 25), and KRT dependency was 43.5% ( n = 20). Patterns were similar across modalities/settings. Conclusions: KRT initiation shifted toward later timing after 2022. Studies with granular severity and indication data are needed to clarify drivers of variation and outcomes.

Background Hepatitis B virus (HBV) reactivation is a critical complication in patients receiving systemic chemotherapy. While current guidelines recommend screening, whether appropriate preventive measures are implemented based on screening results remains unclear. This study aimed to evaluate the implementation of HBV screening and subsequent preventive measures according to hepatitis B surface antigen (HBsAg) status in patients undergoing chemotherapy in Japan. Methods This retrospective cohort study utilized Japan’s largest electronic medical record database to evaluate HBV management in adults (≥ 20 years) who initiated anticancer therapy between 2006 and 2020. Patients with prior HBV treatment were excluded. We assessed the implementation proportions of key steps in HBV management, including initial HBsAg screening, subsequent antibody and DNA testing based on results, and prophylactic antiviral therapy initiation. Results Of 162,040 eligible patients, 93,801 (57.9%) underwent HBV screening. Among HBsAg-negative patients, only 29.4% received subsequent hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs) testing. HBV DNA testing was performed in 56.0% of patients positive for anti-HBc or anti-HBs. Only 18.3% of HBsAg-positive patients eligible for prophylaxis received nucleoside analogs. Screening and prophylaxis proportions improved over time, with the proportion receiving prophylactic administration reaching 27.1% in 2020. Screening was most frequent in patients with hematologic malignancies (58.3%) and in those receiving anti-CD20 antibodies (65.6%). Conclusion Despite suboptimal initial HBV screening proportions in Japan, a substantial gap remains in implementing subsequent preventive measures, particularly prophylactic therapy for HBsAg-positive patients. This highlights the critical need to improve adherence to guidelines to prevent HBV reactivation.

Background: Although physical activity (PA) is recommended for patients with cancer, changes in PA across cancer diagnosis and treatment have not been objectively evaluated. Objective: This study aimed to assess the impact of cancer diagnosis and treatment on PA levels. Methods: This was a retrospective cohort study using a Japanese claims database provided by DeSC Healthcare Inc, in which daily step count data, derived from smartphone pedometers, are linked to the claims data. In this study, we included patients newly diagnosed with cancer, along with those newly diagnosed with diabetes mellitus for reference. We collected data between April 2014 and September 2021 and analyzed them. The observation period spanned from 6 months before diagnosis to 12 months after diagnosis. We applied a generalized additive mixed model with a cubic spline to describe changes in step counts before and after diagnosis. Results: We analyzed the step count data of 326 patients with malignant solid tumors and 1388 patients with diabetes. Patients with cancer exhibited a 9.6% (95% CI 7.1%-12.1%; P<.001) reduction in step counts from baseline at the start of the diagnosis month, which further deepened to 12.4% (95% CI 9.5%-15.2%; P<.001) at 3 months and persisted at 7.1% (95% CI 4.2%-10.0%; P<.001) at 12 months, all relative to baseline. Conversely, in patients with diabetes, step counts remained relatively stable after diagnosis, with a slight upward trend, resulting in a change of +0.6% (95% CI –0.6% to 1.9%; P=.31) from baseline at 3 months after diagnosis. At 12 months after diagnosis, step counts remained decreased in the nonendoscopic subdiaphragmatic surgery group, with an 18.0% (95% CI 9.1%-26.2%; P<.001) reduction, whereas step counts returned to baseline in the laparoscopic surgery group (+0.3%, 95% CI –6.3% to 7.5%; P=.93). Conclusions: The analysis of objective pre- and postdiagnostic step count data provided fundamental information crucial for understanding changes in PA among patients with cancer. While cancer diagnosis and treatment reduced PA, the decline may have already started before diagnosis. The study findings may help tailor exercise recommendations based on lifelog data for patients with cancer in the future.

Objectives: The diagnosis of early‐onset Alzheimer's disease (EOAD) can cause emotional stress not only to the patients themselves but also to their spouses. This study aimed to evaluate the risk of psychiatric disorders in spouses of EOAD patients, using psychotropic drug initiation as a surrogate indicator.Methods: A cohort study was conducted using a Japanese claims database, with spouses of EOAD patients (exposed spouses) matched with spouses of non‐EOAD individuals (reference spouses) up to a 1:10 ratio. Primary outcome was the initiation of mood disorder drugs, and secondary outcomes were the initiation of drugs for anxiety disorders, sleep disorders, and schizophrenia spectrum disorders. Four study cohorts were created according to each outcome analysis. Multivariable Cox regression models were used to estimate adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs) for study outcomes.Results: The analysis of mood disorder drugs included 395 exposed spouses and 3711 reference spouses. The proportion of patients excluded from the analysis due to prescription of mood disorder drugs during the baseline period was 4.3% higher among exposed spouses than reference spouses. There was no major difference between groups with respect to mood disorder drug initiation after 1 year (aHR, 2.08 [95% CI, 0.61 to 7.13]). In subgroup analysis of females and dependents, exposed spouses showed a higher rate of initiation (females: aHR, 6.39 [95% CI, 1.24 to 32.80]; dependents: aHR, 6.47 [95% CI, 1.25 to 33.55]). No substantial differences in secondary outcomes were observed in any comparison.Conclusions: This study does not conclusively demonstrate an increase in mood disorder drug initiation among spouses of EOAD patients overall; however, initiation rates may be higher among female or dependent spouses. Our findings also suggest that exposed spouses experience significant psychological stress prior to their partners' EOAD diagnoses.

Purpose: Specialized pressure transducers for arterial pulse waveform analysis (S-APWA) devices are dedicated kits connected to an arterial pressure catheter that monitors hemodynamic parameters, such as cardiac output, pulse pressure variation, and stroke volume variation, less invasively. While the association between the use of S-APWA devices and clinical outcomes in perioperative patients has been previously evaluated, its assessment in patients with septic shock remains inadequate. Materials and Methods: This retrospective cohort study utilized a nationwide Diagnosis Procedure Combination database in Japan. Adult patients with septic shock admitted to the intensive care unit (ICU) with arterial pressure catheter placement on the admission day from August 2012 to February 2021 were included. Hospitalizations meeting the eligibility criteria were categorized into groups based on S-APWA device usage. The primary outcome, evaluated using Cox regression analysis, was 30-day all-cause mortality in the propensity score overlap-weighted population. Secondary outcomes included in-hospital mortality, ICU duration, and overall hospital stay. Results: Among 5130 eligible hospitalizations, 643 were in the S-APWA group and 4487 were in the conventional pressure transducer group. Cox regression analysis within the propensity score overlap-weighted population showed no significant difference in 30-day mortality (adjusted hazard ratio: 0.94; 95% confidence interval: 0.9-1.38; P = .58). Logistic regression analysis indicated no significant differences in the in-hospital mortality. While the S-APWA group had prolonged ICU stays, no significant difference in the overall hospital stay was observed according to linear regression analyses. Conclusions: Our study found no significant association between S-APWA use and 30-day mortality in patients with septic shock. These findings offer insights into optimizing monitoring systems in ICUs.