BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and...BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and Western guidelines recom-mend antibiotic prophylaxis following hemostasis.However,given the impro-vements in prognosis for variceal bleeding due to advancements in the management of bleeding and treatments of liver cirrhosis and the global concerns regarding the emergence of multidrug-resistant bacteria,there is a need to reassess the use of routine antibiotic prophylaxis after hemostasis.AIM To evaluate the effectiveness of antibiotic prophylaxis in patients treated for EVL.METHODS We conducted a 13-year observational study using the Tokushukai medical database across 46 hospitals.Patients were divided into the prophylaxis group(received antibiotics on admission or the next day)and the non-prophylaxis group(did not receive antibiotics within one day of admission).The primary outcome was composed of 6-wk mortality,4-wk rebleeding,and 4-wk spontaneous bacterial peritonitis(SBP).The secondary outcomes were each individual result and in-hospital mortality.A logistic regression with inverse probability of treatment weighting was used.A subgroup analysis was conducted based on the Child-Pugh classification to determine its influence on the primary outcome measures,while sensitivity analyses for antibiotic type and duration were also performed.RESULTS Among 980 patients,790 were included(prophylaxis:232,non-prophylaxis:558).Most patients were males under the age of 65 years with a median Child-Pugh score of 8.The composite primary outcomes occurred in 11.2%of patients in the prophylaxis group and 9.5%in the non-prophylaxis group.No significant differences in outcomes were observed between the groups(adjusted odds ratio,1.11;95%confidence interval,0.61-1.99;P=0.74).Individual outcomes such as 6-wk mortality,4-wk rebleeding,4-wk onset of SBP,and in-hospital mortality were not significantly different between the groups.The primary outcome did not differ between the Child-Pugh subgroups.Similar results were observed in the sensitivity analyses.CONCLUSION No significant benefit to antibiotic prophylaxis for esophageal variceal bleeding treated with EVL was detected in this study.Global reassessment of routine antibiotic prophylaxis is imperative.展开更多
BACKGROUND Acute esophageal mucosal lesions(AEMLs)are an underrecognized and largely unexplored disease.Endoscopic findings are similar,and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los A...BACKGROUND Acute esophageal mucosal lesions(AEMLs)are an underrecognized and largely unexplored disease.Endoscopic findings are similar,and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los Angeles classification grade D(RE-D).These diseases could have different pathologies and require different treatments.AIM To compare AEML and RE-D to confirm that the two diseases are different from each other and to clarify the clinical features of AEML.METHODS We selected emergency endoscopic cases of upper gastrointestinal bleeding with circumferential esophageal mucosal injury and classified them into AEML and RE-D groups according to the mucosal injury’s shape on the oral side.We examined patient background,blood sampling data,comorbidities at onset,endoscopic characteristics,and outcomes in each group.RESULTS Among the emergency cases,the AEML and RE-D groups had 105(3.1%)and 48(1.4%)cases,respectively.Multiple variables exhibited significantly different results,indicating that these two diseases are distinct.The clinical features of AEML consisted of more comorbidities[risk ratio(RR):3.10;95%confidence interval(CI):1.68–5.71;P<0.001]and less endoscopic hemostasis compared with RE-D(RR:0.25;95%CI:0.10–0.63;P<0.001).Mortality during hospitalization was higher in the AEML group(RR:3.43;95%CI:0.82–14.40;P=0.094),and stenosis developed only in the AEML group.CONCLUSION AEML and RE-D were clearly distinct diseases with different clinical features.AEML may be more common than assumed,and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding with comorbidities.展开更多
BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To...BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.METHODS We conducted a single-center retrospective cohort study.Patients who underwent colonoscopy within 24 h of presentation(early group)were compared with those who underwent colonoscopy beyond 24 h of presentation(elective group).The primary outcome was the length of hospital stay,and secondary outcomes were the identification of stigmata of recent hemorrhage(SRH),rebleeding,red blood cell transfusion more than 4 units,and interventional radiology and abdominal surgery after colonoscopy.RESULTS We identified 574 CDH cases.Patients were divided into the early(n=328)and elective(n=226)groups.After propensity score matching,191 pairs were generated.The length of hospital stay did not significantly differ between the two groups(early group vs elective group;median,7 vs 8 d;P=0.10).The early group had a significantly high identification of SRH(risk difference,11.6%;95%CI:2.7 to 20.3;P=0.02).No significant differences were found in the rebleeding(risk difference,4.7%;95%CI:-4.1 to 13.5;P=0.35),red blood cell transfusion more than 4 units(risk difference,1.6%;95%CI:-7.5 to 10.6;P=0.82),and interventional radiology and abdominal surgery rate after colonoscopy(risk difference,0.5%;95%CI:-2.2 to 3.2;P=1.00).CONCLUSION Early colonoscopy within 24 h,on arrival for CDH,could not improve the length of hospital stay.展开更多
Finding the optimal dose combination in two-agent dose-finding trials is challenging due to limited sample sizes and the extensive range of potential doses.Unlike traditional chemotherapy or radiotherapy,which primari...Finding the optimal dose combination in two-agent dose-finding trials is challenging due to limited sample sizes and the extensive range of potential doses.Unlike traditional chemotherapy or radiotherapy,which primarily focuses on identifying the maximum tolerated dose(MTD),therapies involving targeted and immune agents facilitate the identifica-tion of an optimal biological dose combination(OBDC)by simultaneously evaluating both toxicity and efficacy.Cur-rently,most approaches to determining the OBDC in the literature are model-based and require complex model fittings,making them cumbersome and challenging to implement.To address these challenges,we developed a novel model-as-sisted approach called uTPI-Comb.This approach refines the established utility-based toxicity probability interval design by integrating a strategically devised zone-based local and global candidate set searching strategy,which can effectively optimize the decision-making process for two-agent dose escalation or de-escalation in drug combination trials.Extensive simulation studies demonstrate that the uTPI-Comb design speeds up the dose-searching process and provides substantial improvements over existing model-based methods in determining the optimal biological dose combinations.展开更多
The three common genetic models(or modes of inheritance)in association analysis are the dominant,additive,and recessive models.It is known that the Cochran-Armitage trend test(CATT)which correctly incorporates informa...The three common genetic models(or modes of inheritance)in association analysis are the dominant,additive,and recessive models.It is known that the Cochran-Armitage trend test(CATT)which correctly incorporates information from genetic models,is more powerful than the commonly used Pearson’s chi-square test.However,the true genetic model is usually unknown in practice,and the power of the CAT test could be substantially reduced with a wrongly specified genetic model.To achieve a power that is close to that of a correctly specified CAT test,it is natural to apply trend tests under different possible genetic models and to report the most significant test result.This results in a MAX-type testing procedure,and it was found that this test is usually more powerful than the Pearson’s chi-square test.Although the signi-ficance(i.e.,p value)of the MAX-type test can be accessed by either large sample approximation or permutation methods,requirements for sample size or simulation replicates are demanding with respect to accuracy and efficiency.This paper proposes an approach to calculate the exact p values of MAX-type tests based on the combinatorial counting method.The simulation results show that the exact method is more accurate than the large sample approximation methods and more computationally efficient than the permutation method,and our method can be readily applied to genome-wide association studies(GWASs).The proposed methodis built in an R package,MaXact,which is available at the https://github.com/Myuan 2019/MaXact/.展开更多
The level of surveillance and preparedness against epidemics varies across countries,resulting in different responses to outbreaks.When conducting an in-depth analysis of microinfection dynamics,one must account for t...The level of surveillance and preparedness against epidemics varies across countries,resulting in different responses to outbreaks.When conducting an in-depth analysis of microinfection dynamics,one must account for the substantial heterogeneity across countries.However,many commonly used statistical model specifications lack the flexibility needed for sound and accurate analysis and prediction in such contexts.Nonlinear mixed effects models(NLMMs)constitute a specific statistical tool that can overcome these significant challenges.While compartmental models are well-established in infectious disease modeling and have seen significant advancements,Nonlinear Mixed Models(NLMMs)offer a flexible approach for handling heterogeneous and unbalanced repeated measures data,often with less computational effort than some individual-level compartmental modeling techniques.This study provides an overview of their current use and offers a solid foundation for developing guidelines that may help improve their implementation in real-world situations.Relevant scientific databases in the Research4life Access initiative programs were used to search for papers dealing with key aspects of NLMMs in infectious disease modeling(IDM).From an initial list of 3641 papers,124 were finally included and used for this systematic and critical review spanning the last two decades,following the PRISMA guidelines.NLMMs have evolved rapidly in the last decade,especially in IDM,with most publications dating from 2017 to 2021(83.33%).The routine use of normality assumption appeared inappropriate for IDM,leading to a wealth of literature on NLMMs with non-normal errors and random effects under various estimation methods.We noticed that NLMMs have attracted much attention for the latest known epidemics worldwide(COVID-19,Ebola,Dengue and Lassa)with the robustness and reliability of relaxed propositions of the normality assumption.A case study of the application of COVID-19 data helped to highlight NLMMs’performance in modeling infectious diseases.Out of this study,estimation methods,assumptions,and random terms specification in NLMMs are key aspects requiring particular attention for their application in IDM.展开更多
The uncontrolled spread of the coronavirus disease 2019(COVID-19)pandemic has led to the emergence of different severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variants across the globe.The ongoing global v...The uncontrolled spread of the coronavirus disease 2019(COVID-19)pandemic has led to the emergence of different severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variants across the globe.The ongoing global vaccination strategy to curtail the COVID-19 juggernaut is threatened by the rapidly spreading variants of concern(VOC)and other regional mutants,which are less responsive to neutralization by infection-or vaccine-derived antibodies(Gomez et al.,2021;Wang et al.,2021).展开更多
Objectives SARS-CoV-2 infection(COVID-19)has affected tertiary medical institutions and primary care.Admission for ambulatory care sensitive conditions(ACSCs)is an important indicator of primary care quality.However,n...Objectives SARS-CoV-2 infection(COVID-19)has affected tertiary medical institutions and primary care.Admission for ambulatory care sensitive conditions(ACSCs)is an important indicator of primary care quality.However,no nationwide study,especially in Asia,has examined the association between admissions for ACSCs and local surges in COVID-19.This study aimed to examine how the number of admissions for ACSCs has changed in Japan between the areas with higher and lower rates of COVID-19 infection.Design This was a retrospective two-stage cross-sectional study.We employed a difference-in difference design to compare the number of hospital admissions for ACSCs between the areas with higher and lower rates of COVID-19 infection in Japan.Setting The study used a nationwide database in Japan.Participants All patients were aged 20 years and above and were admitted due to ACSCs during the study period between March and September 2019(before the pandemic)and between March and September 2020(during the pandemic).Results The total number of ACSC admissions was 464560(276530 in 2019 and 188030 in 2020).The change in the number of admissions for ACSCs per 100000 was not statistically significant between the areas with higher and lower rates of COVID-19 infection:7.50(95%CI−87.02 to 102.01).In addition,in acute,chronic and preventable ACSCs,the number of admissions per 100000 individuals did not change significantly.Conclusion Although admissions for ACSCs decreased during the COVID-19 pandemic,there was no significant change between the areas with higher and lower rates of COVID-19 infection.This implies that the COVID-19 pandemic affected the areas with higher infection rates and the areas with lower rates.展开更多
BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying ...BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying the stigmata of a recent hemorrhage(SRH)during colonoscopy enables targeted hemostasis and reduces rebleeding.However,no benchmark exists for an appropriate observation duration,resulting in operator-dependent variation.Short observation periods may lead to missed SRH,whereas unnecessarily prolonged procedures,particularly in older patients,can increase patient burden and limit endoscopy unit availability.METHODS We retrospectively analyzed patients with acute hematochezia who underwent an initial colonoscopy between January 2017 and December 2024 at a Japanese tertiary hospital.The Observation time was measured from scope insertion to SRH detection(excluding therapeutic time)or withdrawal.The primary outcome,the“5%plateau time”,was defined as the point when the proportion of patients newly identified with SRH in each 5-minute interval consistently dropped below 5%.Computed tomography(CT)-based stratified analyses were performed by endoscopists who conducted≥10%of procedures.RESULTS Of the 1039 patients who underwent colonoscopy,845(mean age 77±11 years;64.5%male)were included.Nine board-certified endoscopists performed the procedures.SRH was detected in 286 patients(33.8%),with a median detection time of 19 minutes(interquartile range,12-28 minutes).The overall 5%plateau time was 40 minutes and varied according to the CT findings:40,35,and 30 minutes for no extravasation,right-sided extravasation,and left-sided extravasation,respectively.This time point corresponded to when 80%-90%of SRH cases were detected.De-spite variations in SRH detection rates and observation durations among endoscopists,the 5%plateau time was consistently approximately 40 minutes.CONCLUSION Although it varied according to the CT findings,the overall 5%plateau time was 40 minutes.This offers a practical benchmark for the minimum observation time without SRH detection.展开更多
This is a short communication to reflect on experiences at North American Primary Care Research Group(NAPCRG)conference from the perspective of Asian family physicians.They feel that NAPCRG can play an important role ...This is a short communication to reflect on experiences at North American Primary Care Research Group(NAPCRG)conference from the perspective of Asian family physicians.They feel that NAPCRG can play an important role to level up the skills and talents in countries with less-established primary care research capacity and capability.NAPCRG should not be restricted to networking functions for only North America,Europe and Oceania but should include Asia,South America and Africa.These international academic networks will strengthen primary care research in the world.展开更多
基金approved by the Institutional Review Board of the Future Medical Research Centre Ethical Committee(Approval No.TGE02100-02).
文摘BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and Western guidelines recom-mend antibiotic prophylaxis following hemostasis.However,given the impro-vements in prognosis for variceal bleeding due to advancements in the management of bleeding and treatments of liver cirrhosis and the global concerns regarding the emergence of multidrug-resistant bacteria,there is a need to reassess the use of routine antibiotic prophylaxis after hemostasis.AIM To evaluate the effectiveness of antibiotic prophylaxis in patients treated for EVL.METHODS We conducted a 13-year observational study using the Tokushukai medical database across 46 hospitals.Patients were divided into the prophylaxis group(received antibiotics on admission or the next day)and the non-prophylaxis group(did not receive antibiotics within one day of admission).The primary outcome was composed of 6-wk mortality,4-wk rebleeding,and 4-wk spontaneous bacterial peritonitis(SBP).The secondary outcomes were each individual result and in-hospital mortality.A logistic regression with inverse probability of treatment weighting was used.A subgroup analysis was conducted based on the Child-Pugh classification to determine its influence on the primary outcome measures,while sensitivity analyses for antibiotic type and duration were also performed.RESULTS Among 980 patients,790 were included(prophylaxis:232,non-prophylaxis:558).Most patients were males under the age of 65 years with a median Child-Pugh score of 8.The composite primary outcomes occurred in 11.2%of patients in the prophylaxis group and 9.5%in the non-prophylaxis group.No significant differences in outcomes were observed between the groups(adjusted odds ratio,1.11;95%confidence interval,0.61-1.99;P=0.74).Individual outcomes such as 6-wk mortality,4-wk rebleeding,4-wk onset of SBP,and in-hospital mortality were not significantly different between the groups.The primary outcome did not differ between the Child-Pugh subgroups.Similar results were observed in the sensitivity analyses.CONCLUSION No significant benefit to antibiotic prophylaxis for esophageal variceal bleeding treated with EVL was detected in this study.Global reassessment of routine antibiotic prophylaxis is imperative.
文摘BACKGROUND Acute esophageal mucosal lesions(AEMLs)are an underrecognized and largely unexplored disease.Endoscopic findings are similar,and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los Angeles classification grade D(RE-D).These diseases could have different pathologies and require different treatments.AIM To compare AEML and RE-D to confirm that the two diseases are different from each other and to clarify the clinical features of AEML.METHODS We selected emergency endoscopic cases of upper gastrointestinal bleeding with circumferential esophageal mucosal injury and classified them into AEML and RE-D groups according to the mucosal injury’s shape on the oral side.We examined patient background,blood sampling data,comorbidities at onset,endoscopic characteristics,and outcomes in each group.RESULTS Among the emergency cases,the AEML and RE-D groups had 105(3.1%)and 48(1.4%)cases,respectively.Multiple variables exhibited significantly different results,indicating that these two diseases are distinct.The clinical features of AEML consisted of more comorbidities[risk ratio(RR):3.10;95%confidence interval(CI):1.68–5.71;P<0.001]and less endoscopic hemostasis compared with RE-D(RR:0.25;95%CI:0.10–0.63;P<0.001).Mortality during hospitalization was higher in the AEML group(RR:3.43;95%CI:0.82–14.40;P=0.094),and stenosis developed only in the AEML group.CONCLUSION AEML and RE-D were clearly distinct diseases with different clinical features.AEML may be more common than assumed,and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding with comorbidities.
文摘BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.METHODS We conducted a single-center retrospective cohort study.Patients who underwent colonoscopy within 24 h of presentation(early group)were compared with those who underwent colonoscopy beyond 24 h of presentation(elective group).The primary outcome was the length of hospital stay,and secondary outcomes were the identification of stigmata of recent hemorrhage(SRH),rebleeding,red blood cell transfusion more than 4 units,and interventional radiology and abdominal surgery after colonoscopy.RESULTS We identified 574 CDH cases.Patients were divided into the early(n=328)and elective(n=226)groups.After propensity score matching,191 pairs were generated.The length of hospital stay did not significantly differ between the two groups(early group vs elective group;median,7 vs 8 d;P=0.10).The early group had a significantly high identification of SRH(risk difference,11.6%;95%CI:2.7 to 20.3;P=0.02).No significant differences were found in the rebleeding(risk difference,4.7%;95%CI:-4.1 to 13.5;P=0.35),red blood cell transfusion more than 4 units(risk difference,1.6%;95%CI:-7.5 to 10.6;P=0.82),and interventional radiology and abdominal surgery rate after colonoscopy(risk difference,0.5%;95%CI:-2.2 to 3.2;P=1.00).CONCLUSION Early colonoscopy within 24 h,on arrival for CDH,could not improve the length of hospital stay.
基金This work was supported by the Natural Science Foundation of Anhui Province(2022AH050703)the National Natural Science Foundation of China(11671375).
文摘Finding the optimal dose combination in two-agent dose-finding trials is challenging due to limited sample sizes and the extensive range of potential doses.Unlike traditional chemotherapy or radiotherapy,which primarily focuses on identifying the maximum tolerated dose(MTD),therapies involving targeted and immune agents facilitate the identifica-tion of an optimal biological dose combination(OBDC)by simultaneously evaluating both toxicity and efficacy.Cur-rently,most approaches to determining the OBDC in the literature are model-based and require complex model fittings,making them cumbersome and challenging to implement.To address these challenges,we developed a novel model-as-sisted approach called uTPI-Comb.This approach refines the established utility-based toxicity probability interval design by integrating a strategically devised zone-based local and global candidate set searching strategy,which can effectively optimize the decision-making process for two-agent dose escalation or de-escalation in drug combination trials.Extensive simulation studies demonstrate that the uTPI-Comb design speeds up the dose-searching process and provides substantial improvements over existing model-based methods in determining the optimal biological dose combinations.
基金This work was supported by the Natural Science Foundation of Anhui Province(2008085MA09)the National Natural Science Foundation of China(11671375).
文摘The three common genetic models(or modes of inheritance)in association analysis are the dominant,additive,and recessive models.It is known that the Cochran-Armitage trend test(CATT)which correctly incorporates information from genetic models,is more powerful than the commonly used Pearson’s chi-square test.However,the true genetic model is usually unknown in practice,and the power of the CAT test could be substantially reduced with a wrongly specified genetic model.To achieve a power that is close to that of a correctly specified CAT test,it is natural to apply trend tests under different possible genetic models and to report the most significant test result.This results in a MAX-type testing procedure,and it was found that this test is usually more powerful than the Pearson’s chi-square test.Although the signi-ficance(i.e.,p value)of the MAX-type test can be accessed by either large sample approximation or permutation methods,requirements for sample size or simulation replicates are demanding with respect to accuracy and efficiency.This paper proposes an approach to calculate the exact p values of MAX-type tests based on the combinatorial counting method.The simulation results show that the exact method is more accurate than the large sample approximation methods and more computationally efficient than the permutation method,and our method can be readily applied to genome-wide association studies(GWASs).The proposed methodis built in an R package,MaXact,which is available at the https://github.com/Myuan 2019/MaXact/.
基金support from Deutscher Akademischer Austauschdienst German Academic Exchange Service(DAAD)through the programme In-Country/In-Region ScholarshipRGK acknowledges the support from the German Federal Foreign Office(Grant number:Ref.3.4.-Ben-Hub).
文摘The level of surveillance and preparedness against epidemics varies across countries,resulting in different responses to outbreaks.When conducting an in-depth analysis of microinfection dynamics,one must account for the substantial heterogeneity across countries.However,many commonly used statistical model specifications lack the flexibility needed for sound and accurate analysis and prediction in such contexts.Nonlinear mixed effects models(NLMMs)constitute a specific statistical tool that can overcome these significant challenges.While compartmental models are well-established in infectious disease modeling and have seen significant advancements,Nonlinear Mixed Models(NLMMs)offer a flexible approach for handling heterogeneous and unbalanced repeated measures data,often with less computational effort than some individual-level compartmental modeling techniques.This study provides an overview of their current use and offers a solid foundation for developing guidelines that may help improve their implementation in real-world situations.Relevant scientific databases in the Research4life Access initiative programs were used to search for papers dealing with key aspects of NLMMs in infectious disease modeling(IDM).From an initial list of 3641 papers,124 were finally included and used for this systematic and critical review spanning the last two decades,following the PRISMA guidelines.NLMMs have evolved rapidly in the last decade,especially in IDM,with most publications dating from 2017 to 2021(83.33%).The routine use of normality assumption appeared inappropriate for IDM,leading to a wealth of literature on NLMMs with non-normal errors and random effects under various estimation methods.We noticed that NLMMs have attracted much attention for the latest known epidemics worldwide(COVID-19,Ebola,Dengue and Lassa)with the robustness and reliability of relaxed propositions of the normality assumption.A case study of the application of COVID-19 data helped to highlight NLMMs’performance in modeling infectious diseases.Out of this study,estimation methods,assumptions,and random terms specification in NLMMs are key aspects requiring particular attention for their application in IDM.
基金supported by a grant-in-aid fromthe Japan Agency for Medical Researchand Development (JP19fk0108110,JP20he0522001, and JP21fk0108104)。
文摘The uncontrolled spread of the coronavirus disease 2019(COVID-19)pandemic has led to the emergence of different severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variants across the globe.The ongoing global vaccination strategy to curtail the COVID-19 juggernaut is threatened by the rapidly spreading variants of concern(VOC)and other regional mutants,which are less responsive to neutralization by infection-or vaccine-derived antibodies(Gomez et al.,2021;Wang et al.,2021).
基金This study was supported by a grant from the 2020-2021 Research Development Fund of Yokohama City University.
文摘Objectives SARS-CoV-2 infection(COVID-19)has affected tertiary medical institutions and primary care.Admission for ambulatory care sensitive conditions(ACSCs)is an important indicator of primary care quality.However,no nationwide study,especially in Asia,has examined the association between admissions for ACSCs and local surges in COVID-19.This study aimed to examine how the number of admissions for ACSCs has changed in Japan between the areas with higher and lower rates of COVID-19 infection.Design This was a retrospective two-stage cross-sectional study.We employed a difference-in difference design to compare the number of hospital admissions for ACSCs between the areas with higher and lower rates of COVID-19 infection in Japan.Setting The study used a nationwide database in Japan.Participants All patients were aged 20 years and above and were admitted due to ACSCs during the study period between March and September 2019(before the pandemic)and between March and September 2020(during the pandemic).Results The total number of ACSC admissions was 464560(276530 in 2019 and 188030 in 2020).The change in the number of admissions for ACSCs per 100000 was not statistically significant between the areas with higher and lower rates of COVID-19 infection:7.50(95%CI−87.02 to 102.01).In addition,in acute,chronic and preventable ACSCs,the number of admissions per 100000 individuals did not change significantly.Conclusion Although admissions for ACSCs decreased during the COVID-19 pandemic,there was no significant change between the areas with higher and lower rates of COVID-19 infection.This implies that the COVID-19 pandemic affected the areas with higher infection rates and the areas with lower rates.
文摘BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying the stigmata of a recent hemorrhage(SRH)during colonoscopy enables targeted hemostasis and reduces rebleeding.However,no benchmark exists for an appropriate observation duration,resulting in operator-dependent variation.Short observation periods may lead to missed SRH,whereas unnecessarily prolonged procedures,particularly in older patients,can increase patient burden and limit endoscopy unit availability.METHODS We retrospectively analyzed patients with acute hematochezia who underwent an initial colonoscopy between January 2017 and December 2024 at a Japanese tertiary hospital.The Observation time was measured from scope insertion to SRH detection(excluding therapeutic time)or withdrawal.The primary outcome,the“5%plateau time”,was defined as the point when the proportion of patients newly identified with SRH in each 5-minute interval consistently dropped below 5%.Computed tomography(CT)-based stratified analyses were performed by endoscopists who conducted≥10%of procedures.RESULTS Of the 1039 patients who underwent colonoscopy,845(mean age 77±11 years;64.5%male)were included.Nine board-certified endoscopists performed the procedures.SRH was detected in 286 patients(33.8%),with a median detection time of 19 minutes(interquartile range,12-28 minutes).The overall 5%plateau time was 40 minutes and varied according to the CT findings:40,35,and 30 minutes for no extravasation,right-sided extravasation,and left-sided extravasation,respectively.This time point corresponded to when 80%-90%of SRH cases were detected.De-spite variations in SRH detection rates and observation durations among endoscopists,the 5%plateau time was consistently approximately 40 minutes.CONCLUSION Although it varied according to the CT findings,the overall 5%plateau time was 40 minutes.This offers a practical benchmark for the minimum observation time without SRH detection.
文摘This is a short communication to reflect on experiences at North American Primary Care Research Group(NAPCRG)conference from the perspective of Asian family physicians.They feel that NAPCRG can play an important role to level up the skills and talents in countries with less-established primary care research capacity and capability.NAPCRG should not be restricted to networking functions for only North America,Europe and Oceania but should include Asia,South America and Africa.These international academic networks will strengthen primary care research in the world.
