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Kimura Y, Jo T, Hashimoto Y, Kumazawa R, Ishimaru M, Matsui H, Yokoyama A, Tanaka G, Yasunaga H. Epidemiology of patients with lymphangioleiomyomatosis: A descriptive study using the national database of health insurance claims and specific health checkups of Japan. Respir Investig 2024; 62:494-502. [PMID: 38583226 DOI: 10.1016/j.resinv.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/10/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Using patient registries or limited regional hospitalization data may result in underestimation of the incidence and prevalence of rare diseases. Therefore, we used the national administrative database to estimate the incidence and prevalence of lymphangioleiomyomatosis over six years (2014-2019) and describe changes in clinical practice and mortality. METHODS We extracted data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between January 2013 and December 2020. This database covers ≥99% of the population. We used the diagnostic code for lymphangioleiomyomatosis to estimate the incidence and prevalence from 2014 to 2019. Additionally, we examined the demographic characteristics, treatments, comorbidities, and mortality of the patients. RESULTS In women, the incidence and prevalence of lymphangioleiomyomatosis in 2019 were approximately 3 per 1,000,000 person-years and 28.7 per 1,000,000 persons, respectively. While, in men, the incidence and prevalence of lymphangioleiomyomatosis were <0.2 per 1,000,000 person-years and 0.8 per 1,000,000 persons, respectively. From 2014 to 2019, the proportion of prescriptions of sirolimus and everolimus increased, while the use of home oxygen therapy, chest drainage, comorbid pneumothorax, and bloody phlegm decreased. The mortality rate remained stable at approximately 1%. CONCLUSIONS The incidence and prevalence of lymphangioleiomyomatosis were higher in women than those reported previously. Although the incidence did not change during the 6-year period, the prevalence gradually increased. Moreover, lymphangioleiomyomatosis was observed to be rare in men. The practice of treating patients with lymphangioleiomyomatosis changed across the six years while mortality remained low, at approximately 1%.
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Affiliation(s)
- Yuya Kimura
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Clinical Research Center, National Hospital Organization Tokyo Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yohei Hashimoto
- Save Sight Institute, The University of Sydney, South Block, Sydney Eye Hospital 8 Macquarie Street, Sydney, NSW, 2000, Australia
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Institute of Education, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akira Yokoyama
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Jo T, Shigemi D, Konishi T, Yamana H, Michihata N, Kumazawa R, Yokoyama A, Urushiyama H, Matsui H, Fushimi K, Nagase T, Yasunaga H. Antiemetic Effect of Rikkunshito, a Japanese Kampo Herbal Medicine, on Cisplatin-induced Nausea and Vomiting: A Nationwide Database Study in Japan. Intern Med 2024; 63:919-927. [PMID: 37495535 PMCID: PMC11045374 DOI: 10.2169/internalmedicine.1946-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 07/28/2023] Open
Abstract
Objective The effect of Rikkunshito, a Japanese herbal Kampo medicine, on chemotherapy-induced nausea and vomiting (CINV) has been evaluated in several small prospective studies, with mixed results. We retrospectively evaluated the antiemetic effects of Rikkunshito in patients undergoing cisplatin-based chemotherapy using a large-scale database in Japan. Methods The Diagnosis Procedure Combination inpatient database from July 2010 to March 2019 was used to compare adult patients with malignant tumors who had received Rikkunshito on or before the day of cisplatin administration (Rikkunshito group) and those who had not (control group). Antiemetics on days 2 and 3 and days 4 and beyond following cisplatin administration were used as surrogate outcomes for CINV. Patient backgrounds were adjusted using the stabilized inverse probability of treatment weighting, and outcomes were compared using univariable regression models. Results We identified 669 and 123,378 patients in the Rikkunshito and control groups, respectively. There were significantly fewer patients using intravenous 5-HT3-receptor antagonists in the Rikkunshito group (odds ratio, 0.38; 95% confidence interval, 0.16-0.87; p=0.023) on days 2 and 3 of cisplatin-based chemotherapy. Conclusion The reduced use of antiemetics on day 2 and beyond of cisplatin administration suggested a beneficial effect of Rikkunshito in palliating the symptoms of CINV.
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Affiliation(s)
- Taisuke Jo
- Department of Health Services Research, the University of Tokyo, Japan
- Department of Respiratory Medicine, the University of Tokyo, Japan
| | - Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Japan
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, the University of Tokyo, Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Japan
- Data Science Center, Jichi Medical University, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, the University of Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Japan
- Center for Clinical Sciences, National Center for Global Health and Medicine, Japan
| | - Akira Yokoyama
- Department of Respiratory Medicine, the University of Tokyo, Japan
| | | | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, the University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Japan
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Kimura Y, Suzukawa M, Jo T, Hashimoto Y, Kumazawa R, Ishimaru M, Matsui H, Yokoyama A, Tanaka G, Yasunaga H. Epidemiology of severe childhood asthma in Japan: A nationwide descriptive study. Allergy 2024. [PMID: 38186054 DOI: 10.1111/all.16008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Yuya Kimura
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Clinical Research Center, National Hospital Organization Tokyo Hospital, Tokyo, Japan
| | - Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo Hospital, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Institute of Education, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Akira Yokoyama
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Endo M, Jo T, Konishi T, Kumazawa R, Matsui H, Yasunaga H. Association between the Timing of Urinary Antigen Testing and Outcomes in Legionella Pneumonia Patients: A Nationwide Database Study. Intern Med 2024; 63:51-56. [PMID: 37225496 PMCID: PMC10824650 DOI: 10.2169/internalmedicine.1115-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/02/2023] [Indexed: 05/26/2023] Open
Abstract
Objective Recommendations on the timing of Legionella urinary antigen tests for community-acquired pneumonia patients differ among guidelines in Japan, the United States, and European nations. We therefore evaluated the association between the timing of urinary antigen tests and in-hospital mortality in patients with Legionella pneumonia. Methods We conducted a retrospective cohort study using the Diagnosis Procedure Combination database, a nationwide database of acute care inpatients in Japan. Patients who underwent Legionella urinary antigen tests on the day of admission formed the tested group. Patients who were tested on day 2 of admission or later or were unexamined formed the control group. We performed a propensity score matching analysis to compare in-hospital mortality, length of hospital stay and duration of antibiotics use between the two groups. Results Of the 9,254 eligible patients, 6,933 were included in the tested group. One-to-one propensity score matching generated 1,945 pairs. The tested group had a significantly lower 30-day in-hospital mortality than the control group (5.7 vs. 7.7%; odds ratio, 0.72; 95% confidence intervals, 0.55-0.95; p=0.020). The tested group also showed a significantly shorter length of stay and duration of antibiotics use than the control group. Conclusion Urine antigen testing upon admission was associated with better outcomes in patients with Legionella pneumonia. Urine antigen tests upon admission may be recommended for all patients with severe community-acquired pneumonia.
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Affiliation(s)
- Masayuki Endo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Respiratory Medicine, The University of Tokyo Hospital, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Ryosuke Kumazawa
- Center for Clinical Sciences, National Center for Global Health and Medicine, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
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Okubo Y, Uda K, Miyairi I, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yasunaga H. Nationwide epidemiology and clinical practice patterns of pediatric urinary tract infections: application of multivariate time-series clustering. Pediatr Nephrol 2023; 38:4033-4041. [PMID: 37382710 DOI: 10.1007/s00467-023-06053-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The nationwide epidemiology and clinical practice patterns for younger children hospitalized with urinary tract infections (UTIs) were unclear. METHODS We conducted a retrospective observational study consisting of 32,653 children aged < 36 months who were hospitalized with UTIs from 856 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. We investigated the epidemiology of UTIs and changes in clinical practice patterns (e.g., antibiotic use) over 8 years. A machine learning algorithm of multivariate time-series clustering with dynamic time warping was used to classify the hospitals based on antibiotic use for UTIs. RESULTS We observed marked male predominance among children aged < 6 months, slight female predominance among children aged > 12 months, and summer seasonality among children hospitalized with UTIs. Most physicians selected intravenous second- or third-generation cephalosporins as the empiric therapy for treating UTIs, which was switched to oral antibiotics during hospitalizations for 80% of inpatients. Whereas total antibiotic use was constant over the 8 years, broad-spectrum antibiotic use decreased gradually from 5.4 in 2011 to 2.5 days of therapy per 100 patient-days in 2018. The time-series clustering distinctively classified 5 clusters of hospitals based on antibiotic use patterns and identified hospital clusters that preferred to use broad-spectrum antibiotics (e.g., antipseudomonal penicillin and carbapenem). CONCLUSIONS Our study provided novel insight into the epidemiology and practice patterns for pediatric UTIs. Time-series clustering can be useful to identify the hospitals with aberrant practice patterns to further promote antimicrobial stewardship. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yusuke Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Kazuhiro Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Endoscopic surgery versus craniotomy for spontaneous intracerebral hemorrhage in the late elderly patients. J Stroke Cerebrovasc Dis 2023; 32:107327. [PMID: 37677895 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/22/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES To compare the prognosis of late elderly patients with spontaneous intracerebral hemorrhage (ICH) treated by endoscopic evacuation and craniotomy MATERIALS AND METHODS: Using the Diagnosis Procedure Combination database, we identified patients aged ≥ 75 years who underwent surgery for spontaneous ICH within 48 hours after admission between April 2014 and March 2018. Eligible patients were classified into two groups according to the type of surgery (endoscopic surgery and craniotomy). Propensity-score matching weight analysis was conducted to compare the good neurological outcome modified Rankin Scale (mRS) score (0-4) at discharge as the primary endpoint between the two groups. Secondary endpoints were postoperative meningitis, tracheostomy, reoperation within 3 days and total hospitalization costs. RESULTS Among the 5,396 eligible patients, endoscopic surgery and craniotomy were performed in 895 and 4,501 patients, respectively. In the propensity-score matching weight analysis, all covariates were well balanced. The proportions of patients with a good prognosis (mRS score at discharge: 0-4) did not significantly differ between the surgical procedures (42.1% vs. 42.8%, p = 0.828). The proportions of meningitis, tracheostomy and reoperation were not significantly different between the two groups. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (25,536 vs. 29,603 US dollars, p = 0.012). CONCLUSIONS Inhospital outcomes did not differ between endoscopic and open surgeries for spontaneous ICH in the late-stage elderly patients aged ≥75 years. Hospitalization costs were significantly higher in the craniotomy group, suggesting that endoscopic surgery may be more acceptable.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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Yokoyama A, Jo T, Sakamoto Y, Urushiyama H, Tamiya H, Tanaka G, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Nagase T. Effectiveness and safety of the co-administration of Yokukan-San (Japanese herbal medicine) with antipsychotics in hospitalized older patients with pneumonia. Geriatr Gerontol Int 2023; 23:849-854. [PMID: 37804182 DOI: 10.1111/ggi.14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023]
Abstract
AIM Behavioral and psychological symptoms and delirium frequently occur in hospitalized older patients with pneumonia and are associated with longer hospital stays. Yokukan-San (YKS, traditional Japanese [Kampo] medicine) and antipsychotics are often used to treat delirium and behavioral and psychological symptoms in Japan. Hence, this study aimed to assess the effectiveness and safety of the co-administration of YKS with atypical antipsychotics in older patients with pneumonia. METHODS We used the Japanese Diagnosis Procedure Combination inpatient database to retrospectively identify older patients (≥65 years) hospitalized for pneumonia who received antipsychotics within 3 days of hospitalization. The patients were divided into two groups: those who received atypical antipsychotics alone (control group) and those who received both atypical antipsychotics and YKS (YKS group). We compared length of hospital stay, in-hospital mortality, bone fractures, and administration of potassium products between the two groups using propensity score overlap weighting. RESULT We identified 4789 patients in the YKS group and 61 641 in the control group. After propensity score overlap weighting, length of hospital stay was statistically significantly shorter in the YKS group (percentage difference -3.0%; 95% confidence interval -5.8% to -0.3%). The proportion of patients who received potassium products was higher in the YKS group (odds ratio 1.34; 95% confidence interval 1.15-1.55). In-hospital death and bone fractures were not significantly different. CONCLUSION Co-administration of YKS with atypical antipsychotics could be a reasonable treatment option for hospitalized older patients with pneumonia and aggressive psychiatric symptoms. Geriatr Gerontol Int 2023; 23: 849-854.
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Affiliation(s)
- Akira Yokoyama
- Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yukiyo Sakamoto
- Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hirokazu Urushiyama
- Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Tamiya
- Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Division for Health Service Promotion, University of Tokyo, Tokyo, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Sato S, Yamana H, Kumazawa R, Watanabe H, Fujita A, Matsui H, Fushimi K, Yasunaga H. Cilostazol versus Aspirin or Clopidogrel for Reducing Post-Stroke Aspiration Pneumonia: A Nationwide Retrospective Cohort Study. Cerebrovasc Dis 2023; 53:152-159. [PMID: 37586338 PMCID: PMC10997247 DOI: 10.1159/000531716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/19/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION The association between the use of cilostazol as a post-stroke antiplatelet medication and a reduction in post-stroke pneumonia has been suggested. However, whether cilostazol has a greater preventive effect against post-stroke aspiration pneumonia (AP) than other antiplatelet medications remains unclear. Thus, this study aimed to evaluate whether cilostazol has a greater preventive effect against post-stroke AP than aspirin or clopidogrel. METHODS Through the Japanese Diagnosis Procedure Combination database, we identified patients who were hospitalized for ischemic stroke between April 2012 and September 2019. We performed 1:1 propensity score matching between patients who received cilostazol alone at discharge and those who received aspirin or clopidogrel alone at discharge. The primary outcome was the 90-day readmission for post-stroke AP. The occurrence of recurrent ischemic stroke within 90 days was also evaluated. RESULTS Among the 305,543 eligible patients with ischemic stroke, 65,141 (21%), 104,157 (34%), and 136,245 (45%) received cilostazol, aspirin, and clopidogrel, respectively. Propensity score matching generated 65,125 pairs. The cilostazol group had a higher proportion of 90-day post-stroke readmissions with AP than the aspirin or clopidogrel groups (1.5% vs. 1.2%, p < 0.001). The proportion of patients with recurrent ischemic stroke within 90 days was also higher in the cilostazol group (2.4% vs. 2.2%, p = 0.017). CONCLUSION The present study suggests that cilostazol may not have a greater effect on preventing post-stroke AP within 90 days than other antiplatelet medications. Nevertheless, further randomized controlled trials with longer follow-up periods are warranted.
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Affiliation(s)
- So Sato
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Data Science Center, Jichi Medical University, Tochigi, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideaki Watanabe
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asahi Fujita
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Okada A, Yamana H, Pan R, Yamaguchi S, Kumazawa R, Matsui H, Fushimi K, Honda Y, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T, Kim Y. Effect modification of the association between temperature variability and hospitalization for cardiovascular disease by comorbid diabetes mellitus: A nationwide time-stratified case-crossover analysis. Diabetes Res Clin Pract 2023; 202:110771. [PMID: 37276982 DOI: 10.1016/j.diabres.2023.110771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023]
Abstract
AIMS We aimed to explore the association between short-term exposure to temperature variability (TV), and cardiovascular hospitalization stratified by the presence of comorbid diabetes. METHODS We collected data on nationwide hospitalization for cardiovascular diseases and daily weather conditions during 2011-2018 in Japan. TV was calculated as the standard deviation of daily minimum and maximum temperatures within 0-7 lag days. We applied a two-stage time-stratified case-crossover design to estimate the association between TV and cardiovascular hospitalization with and without comorbid diabetes, adjusting for temperature and relative humidity. Furthermore, specific cardiovascular disease causes, demographic characteristics, and seasons were used for stratification. RESULTS In 3,844,910 hospitalizations for cardiovascular disease, each 1 °C increase in TV was associated with a 0.44% (95% CI: 0.22%, 0.65%) increase in the risk of cardiovascular admission. We observed a 2.07% (95% CI: 1.16%, 2.99%) and 0.61% (95% CI: -0.02%, 1.23%) increase per 1 °C in risk of heart failure admission in individuals with and those without diabetes, respectively. The higher risk among individuals with diabetes was mostly consistent in the analyses stratified by age, sex, body mass index, smoking status, and season. CONCLUSION Comorbid diabetes may increase susceptibility to TV in relation to acute cardiovascular disease hospitalization.
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Data Science Center, Jichi Medical University, Shimotsuke, Japan
| | - Rui Pan
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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10
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Endo M, Jo T, Konishi T, Kumazawa R, Matsui H, Yasunaga H. Association between Legionella urinary antigen tests on admission and inhospital mortality in patients with atypical pneumonia: A nationwide database study. Int J Mycobacteriol 2023; 12:350-356. [PMID: 37721243 DOI: 10.4103/ijmy.ijmy_135_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The guidelines for the requirement of Legionella urinary antigen tests on admission for patients hospitalized with community-acquired pneumonia differ in Japan, the United States, and Europe. We aimed to evaluate the association between the timing of Legionella urinary antigen testing and inhospital mortality in patients with atypical pneumonia. Methods We identified 654,708 patients with atypical pneumonia from July 2010 to March 2021 using the Japanese national inpatient database. The patients were divided into groups that underwent Legionella urinary antigen tests on the day of admission (test group, n = 229,649) and those that underwent testing after the day of admission or were untested (control group, n = 425,059). A propensity score-stabilized inverse probability of treatment weighting analysis was performed to compare inhospital mortality, length of hospital stay, and total hospitalization costs between the two groups. Odds ratios (ORs) or differences and their 95% confidence intervals (CIs) were calculated using generalized linear models. Results The tested group had a significantly lower 30-day inhospital mortality than that of the control group (7.7% vs. 9.0%; OR: 0.83 [95% CIs, 0.81-0.86]). The tested group also had a significantly shorter length of stay (difference, -2.3 [-2.6 to - 2.0] days and total hospitalization costs (-396 [-508 to - 285] US dollars) than that of the control group. Conclusions Legionella urinary antigen testing upon admission is associated with better outcomes in patients with atypical pneumonia. Legionella urinary antigen testing performed on the day of admission is recommended for hospitalized patients with atypical pneumonia.
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Affiliation(s)
- Masayuki Endo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Respiratory Medicine, The University of Tokyo Hospital; Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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11
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Outcomes After Endoscopic Evacuation Versus Evacuation Using Craniotomy or Stereotactic Aspiration for Spontaneous Intracerebral Hemorrhage: Analysis Using a Japanese Nationwide Database. Neurocrit Care 2023; 38:667-675. [PMID: 36348138 DOI: 10.1007/s12028-022-01634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Various surgical methods are available for managing large intracerebral hemorrhage. This study compared the prognosis of patients with spontaneous intracerebral hemorrhage who underwent endoscopic evacuation, stereotactic aspiration, and craniotomy by using a nationwide inpatient database in Japan. METHODS Using the Diagnosis Procedure Combination database, we identified patients who underwent surgery for spontaneous intracerebral hemorrhage within 48 h after admission between April 2014 and March 2018. Eligible patients were classified into three groups according to the type of surgery (endoscopic surgery, stereotactic surgery, and craniotomy). Propensity score matching weight analysis was conducted to compare poor modified Rankin Scale score at discharge (severe disability or death) and hospitalization cost among the groups. RESULTS Among 17,860 eligible patients, craniotomy, stereotactic surgery, and endoscopic surgery were performed in 14,354, 474, and 3,032 patients, respectively. In the matching weight analysis, all covariates were well balanced. Compared with the endoscopic surgery group, the proportion of poor prognosis (modified Rankin Scale score at discharge of 5 or 6) was significantly higher in craniotomy groups (odds ratio 2.51, 95% confidence interval 1.11-5.68; p = 0.028). Subgroup analysis based on hemorrhage location and consciousness level at the time of admission showed no significant difference between the surgical procedures. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (difference US $9,724, 95% confidence interval 2,169-17,259; p = 0.011). CONCLUSIONS Endoscopic surgery for spontaneous intracerebral hemorrhage was associated with improved prognosis compared with craniotomy at the hospital discharge. Future large-scale clinical trials are needed to evaluate the optimal surgical techniques for intracerebral hemorrhage.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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12
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Pan R, Okada A, Yamana H, Yasunaga H, Kumazawa R, Matsui H, Fushimi K, Honda Y, Kim Y. Association between ambient temperature and cause-specific cardiovascular disease admissions in Japan: A nationwide study. Environ Res 2023; 225:115610. [PMID: 36871945 DOI: 10.1016/j.envres.2023.115610] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/06/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Substantial evidence suggests that non-optimal temperatures can increase the risk of cardiovascular disease (CVD) mortality and morbidity; however, limited studies have reported inconsistent results for hospital admissions depending on study locations, which also lack national-level investigations on cause-specific CVDs. METHODS We performed a two-stage meta-regression analysis to examine the short-term associations between temperature and acute CVD hospital admissions by specific categories [i.e., ischemic heart disease (IHD), heart failure (HF), and stroke] in 47 prefectures of Japan from 2011 to 2018. First, we estimated the prefecture-specific associations using a time-stratified case-crossover design with a distributed lag nonlinear model. We then used a multivariate meta-regression model to obtain national average associations. RESULTS During the study period, a total of 4,611,984 CVD admissions were reported. We found cold temperatures significantly increased the risk of total CVD admissions and cause-specific categories. Compared with the minimum hospitalization temperature (MHT) at the 98th percentile of temperature (29.9 °C), the cumulative relative risks (RRs) for cold (5th percentile, 1.7 °C) and heat (99th percentile, 30.5 °C) on total CVD were 1.226 [95% confidence interval (CI): 1.195, 1.258] and 1.000 (95% CI: 0.998, 1.002), respectively. The RR for cold on HF [RR = 1.571 (95% CI: 1.487, 1.660)] was higher than those of IHD [RR = 1.119 (95% CI: 1.040, 1.204)] and stroke [RR = 1.107 (95% CI: 1.062, 1.155)], comparing to their cause-specific MHTs. We also observed that extreme heat increased the risk of HF with RR of 1.030 (95% CI: 1.007, 1.054). Subgroup analysis showed that the age group ≥85 years was more vulnerable to these non-optimal temperature risks. CONCLUSIONS This study indicated that cold and heat exposure could increase the risk of hospital admissions for CVD, varying depending on the cause-specific categories, which may provide new evidence to reduce the burden of CVD.
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Affiliation(s)
- Rui Pan
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Data Science Center, Jichi Medical University, Shimotsuke, Japan; Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Japan; Center for Climate Change Adaptation, National Institute for Environmental Studies, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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13
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Miyamoto Y, Ohbe H, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Ohta B. Evaluation of Plasmapheresis vs Immunoglobulin as First Treatment After Ineffective Systemic Corticosteroid Therapy for Patients With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. JAMA Dermatol 2023; 159:481-487. [PMID: 36884227 PMCID: PMC9996457 DOI: 10.1001/jamadermatol.2023.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/02/2023] [Indexed: 03/09/2023]
Abstract
Importance Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are severe cutaneous adverse reactions, and patients with SJS/TEN frequently require intensive care. However, there is limited evidence on the clinical outcomes of immunomodulating therapy, including plasmapheresis and intravenous immunoglobulin (IVIG) in patients with SJS/TEN. Objective To compare clinical outcomes of patients with SJS/TEN who were treated with plasmapheresis first vs IVIG first after ineffective systemic corticosteroid therapy. Design, Setting, and Participants This retrospective cohort study used data from a national administrative claims database in Japan that included more than 1200 hospitals and was conducted from July 2010 to March 2019. Inpatients with SJS/TEN who received plasmapheresis and/or IVIG therapy after initiation of at least 1000 mg/d of methylprednisolone equivalent systemic corticosteroid therapy within 3 days of hospitalization were included. Data were analyzed from October 2020 to May 2021. Exposures Patients who received IVIG or plasmapheresis therapy within 5 days after initiation of systemic corticosteroid therapy were included in the IVIG- and plasmapheresis-first groups, respectively. Main Outcomes and Measures In-hospital mortality, length of hospital stay, and medical costs. Results Of 1215 patients with SJS/TEN who had received at least 1000 mg/d of methylprednisolone equivalent within 3 days of hospitalization, 53 and 213 patients (mean [SD] age, 56.7 [20.2] years; 152 [57.1%] women) were included in the plasmapheresis- and IVIG-first groups, respectively. Propensity-score overlap weighting showed no significant difference in inpatient mortality rates between the plasmapheresis- and IVIG-first groups (18.3% vs 19.5%; odds ratio, 0.93; 95% CI, 0.38-2.23; P = .86). Compared with the IVIG-first group, the plasmapheresis-first group had a longer hospital stay (45.3 vs 32.8 days; difference, 12.5 days; 95% CI, 0.4-24.5 d; P = .04) and higher medical costs (US $34 262 vs $23 054; difference, US $11 207; 95% CI, $2789-$19 626; P = .009). Conclusions and Relevance This nationwide retrospective cohort study found no significant benefit to administering plasmapheresis therapy first instead of IVIG first after ineffective systemic corticosteroid treatment in patients with SJS/TEN. However, medical costs and length of hospital stay were greater for the plasmapheresis-first group.
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Affiliation(s)
- Yuki Miyamoto
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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14
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Konishi T, Sakata A, Inokuchi H, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Treatments and outcomes of adult parapharyngeal and retropharyngeal abscess: 1882 cases from a Japanese nationwide database. Am J Otolaryngol 2023; 44:103770. [PMID: 36577172 DOI: 10.1016/j.amjoto.2022.103770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Although parapharyngeal and retropharyngeal abscesses are potentially fatal deep neck abscesses, there is limited evidence for the treatment courses for adult patients with these abscesses. We aimed to describe the practice patterns and clinical outcomes of adult patients undergoing an emergency surgery for parapharyngeal or retropharyngeal abscesses using a nationwide database. MATERIALS AND METHODS We identified patients aged ≥18 years who underwent emergency surgery for parapharyngeal (para group, n = 1148) or retropharyngeal (retro group, n = 734) abscesses from July 2010 to March 2020, using a nationwide inpatient database. We performed between-group comparisons of the baseline characteristics, treatment course, and outcomes. RESULTS Compared with the retro group, the para group was more likely to be older (median, 66 vs. 60 years; P < 0.001) and have several comorbidities, such as diabetes (21 % vs 16 %; P = 0.010) and epiglottitis (33 % vs. 26 %; P = 0.002), except for peritonsillar abscess (14 % vs. 22 %; P < 0.001) and tonsillitis (2.1 % vs. 13 %; P < 0.001). Regarding intravenous drugs administered within 2 days of admission, approximately half of the patients received steroids, non-antipseudomonal penicillins, and lincomycins. The para group received more comprehensive treatments, such as tracheostomy, intensive care unit admissions, and swallowing rehabilitation, within total hospitalization than the retro group. Moreover, it demonstrated higher in-hospital mortality (2.7 % vs. 1.1 %; P = 0.017) and morbidity (16 % vs. 9.7 %; P < 0.001), and longer length of hospitalization than the retro group. CONCLUSION The current nationwide study provided an overview of the characteristics, treatments, and outcomes for patients who underwent an emergency surgery for parapharyngeal or retropharyngeal abscess.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Aki Sakata
- Department of Otorhinolaryngology, Kanto Central Hospital, 6-25-1 Kamiyoga, Setagaya-ku, Tokyo 158-8531, Japan
| | - Haruhi Inokuchi
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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15
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Kimura Y, Jo T, Inoue N, Suzukawa M, Tanaka G, Kage H, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Matsui H. Association Between Systemic Corticosteroid Use and Mortality in Patients with Epiglottitis. Laryngoscope 2023; 133:344-349. [PMID: 35305022 DOI: 10.1002/lary.30110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/10/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To clarify whether treatment with systemic corticosteroids at a certain dose was associated with better outcomes in patients with epiglottitis requiring airway management (tracheotomy or airway intubation). METHODS This was a retrospective cohort study on patients hospitalized for epiglottitis requiring airway management from a nationwide inpatient database (between July 2010 and March 2019). Patients treated with systemic corticosteroids equivalent to methylprednisolone ≥40 mg/d within 2 days of admission and patients who were not treated with corticosteroids within 2 days of admission were compared after inverse probability of treatment weighting using covariate balancing propensity score. The primary outcome was all-cause 30-day in-hospital mortality, and secondary outcomes included all-cause 7-day in-hospital mortality, length of hospital stay, and total medical cost. RESULTS There were 1986 and 1771 patients in the corticosteroid and control groups, respectively. A total of 72 of 3757 (1.9%) patients died within 30 days of admission, including 17 of 1986 (0.9%) patients in the corticosteroid group and 55 of 1771 (3.1%) in the control group (weighted odds ratio, 0.28 [95% confidence interval, 0.11-0.70]; weighted risk difference, -2.2% [-3.2% to -1.3%]). Treatment with corticosteroids was associated with lower total medical costs (weighted median, $6,187 vs. $6,587; weighted difference, $-1,123 [-2,238 to -8]) but not all-cause 7-day in-hospital mortality (weighted odds ratio, 0.63 [0.22-1.82]; weighted risk difference, -0.3% [-0.9 to 0.2]) and length of hospital stay (weighted median, 13 vs. 13 days; weighted difference, -0.2 days [-2.1 to 1.8]). CONCLUSIONS Systemic corticosteroids may be beneficial to patients with epiglottitis requiring airway management. LEVEL OF EVIDENCE 3 Laryngoscope, 133:344-349, 2023.
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Affiliation(s)
- Yuya Kimura
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norihiko Inoue
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.,Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | - Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Tokyo, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Kage
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.,Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotoshi Matsui
- Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
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16
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Miyakawa T, Michihata N, Kumazawa R, Matsui H, Honda M, Yasunaga H. Short-term surgical outcomes of laparoscopic and open surgery for rectal cancer: A nationwide retrospective analysis. Asian J Endosc Surg 2023. [PMID: 36693819 DOI: 10.1111/ases.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/26/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Laparoscopy for treatment of rectal cancer is widely used in clinical practice. However, the safety and advantages of laparoscopy over open surgery at the national level remain unclear. We compared the short-term outcomes of laparoscopy and open surgery for rectal cancer. METHODS Using a Japanese nationwide inpatient database, this study analyzed data on patients who underwent rectal resection between July 2010 and March 2018. We performed propensity score matching analyses to compare in-hospital mortality, morbidities, blood transfusion, diverting stomas, anastomotic leakages, duration of anesthesia, postoperative length of stay, and readmission within 30 days between the laparoscopy and open surgery groups. RESULTS Among 99 137 eligible patients, propensity score matching generated 29 717 pairs. Laparoscopy was associated with lower in-hospital mortality (0.4% vs 0.6%, P = .006), overall morbidities (28.7% vs 33.2%, P < .001), and blood transfusion rate (11.5% vs 22.9%, P < .001); shorter postoperative duration of stay (16 days vs 18 days, P < .001); and longer duration of anesthesia (390 vs 310 minutes, P < .001). Grade C anastomotic leakage was not different between the groups. CONCLUSION With respect to in-hospital mortality, morbidities, blood transfusion, postoperative length of hospitalization, and readmission within 30 days, laparoscopy is advantageous over open surgery in the treatment of rectal cancer.
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Affiliation(s)
- Teppei Miyakawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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17
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Okada A, Ikeda Kurakawa K, Harita Y, Shimizu A, Yamaguchi S, Aso S, Ono S, Hashimoto Y, Kumazawa R, Michihata N, Jo T, Matsui H, Fushimi K, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T. Comparison of bleeding complications after pediatric kidney biopsy between intravenous sedation and general anesthesia: a nationwide cohort study. BMC Pediatr 2023; 23:33. [PMID: 36670403 PMCID: PMC9854031 DOI: 10.1186/s12887-022-03828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND An increasing number of studies are evaluating the safety of intravenous sedation compared with that of general anesthesia; however, data on bleeding complications after pediatric percutaneous renal biopsy performed under intravenous sedation or general anesthesia are lacking. We aimed to examine differences in bleeding complications between intravenous sedation and general anesthesia in pediatric patients. METHODS Data of pediatric patients aged ≤ 15 years undergoing percutaneous kidney biopsy for kidney disease between July 2007 and March 2019 were retrieved from a national inpatient database in Japan. We examined differences in bleeding complications after renal biopsy performed under intravenous sedation, defined by the absence of the record of general anesthesia with intubation but by the presence of intravenous sedation during biopsy, and general anesthesia, defined by the presence of the record of general anesthesia with intubation during biopsy, among pediatric patients admitted for percutaneous renal biopsy. We performed binomial regression using overlap weights based on propensity scores for patients receiving intravenous sedation. Analyses stratified by age or sex, a sensitivity analysis using generalized estimating equations considering cluster effects by hospital among a propensity score-matched cohort, and another sensitivity analysis using the instrumental variable method were performed to confirm the robustness of the results. RESULTS We identified 6,560 biopsies performed in 5,999 children aged 1-15 years from 328 hospitals and 178 events. Only three severe complications and no death were observed. No significant difference in the proportion of bleeding complications was observed between procedures performed under intravenous sedation and those performed under general anesthesia (unadjusted proportions, 2.8% and 2.3%; adjusted proportions, 2.5% and 2.2%), with an unadjusted relative risk of 1.21 (95% confidence interval, 0.80-1.81) and adjusted relative risk of 1.13 (95% confidence interval, 0.74-1.73). Both age- and sex-stratified analyses yielded similar results. The analysis using generalized estimating equation and the instrumental variable method showed relative risks of 0.95 (95% confidence interval, 0.48-1.88) and 1.18 (95% confidence interval, 0.74-1.89), respectively. CONCLUSION This retrospective cohort study using a national database revealed that the risk of biopsy-related bleeding was comparable between intravenous sedation and general anesthesia during pediatric percutaneous kidney biopsy, suggesting that intravenous sedation alone and general anesthesia may have a similar bleeding risk in pediatric percutaneous kidney biopsies.
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Affiliation(s)
- Akira Okada
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kayo Ikeda Kurakawa
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan ,grid.419714.e0000 0004 0596 0617Department of Pediatrics, National Rehabilitation Center for Persons with Disabilities, Namiki, Saitama Japan
| | - Yutaka Harita
- grid.26999.3d0000 0001 2151 536XDepartment of Pediatrics, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akira Shimizu
- grid.410821.e0000 0001 2173 8328Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoko Yamaguchi
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shotaro Aso
- grid.26999.3d0000 0001 2151 536XDepartment of Biostatistics and Bioinformatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- grid.26999.3d0000 0001 2151 536XDepartment of Eat-Loss Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Epidemiology and Health Economics, the University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Epidemiology and Health Economics, the University of Tokyo, Tokyo, Japan ,grid.45203.300000 0004 0489 0290Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Michihata
- grid.26999.3d0000 0001 2151 536XDepartment of Health Services Research, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- grid.26999.3d0000 0001 2151 536XDepartment of Health Services Research, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Epidemiology and Health Economics, the University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- grid.265073.50000 0001 1014 9130Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaomi Nangaku
- grid.26999.3d0000 0001 2151 536XDivision of Nephrology and Endocrinology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- grid.26999.3d0000 0001 2151 536XDepartment of Diabetes and Metabolism, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Epidemiology and Health Economics, the University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Diabetes and Metabolism, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan ,grid.410813.f0000 0004 1764 6940Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, 105-8470 Tokyo, Japan
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Okubo Y, Nishi A, Uda K, Miyairi I, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yasunaga H. Financial incentives for infection prevention and antimicrobial stewardship to reduce antibiotic use: Japan's nationwide observational study. J Hosp Infect 2023; 131:89-98. [PMID: 36424696 DOI: 10.1016/j.jhin.2022.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Japanese government introduced financial incentives to reduce nationwide antibiotic use in hospital settings. AIM This study aimed to determine whether the nationwide financial incentives for creating infection prevention and control (IPC) teams introduced in 2012 and antimicrobial stewardship (ASP) teams introduced in 2018 were associated with changes in antibiotic use and health resource utilization at a national level. METHODS We conducted time-series analyses and a difference-in-differences study consisting of 3,057,517 inpatients with infectious diseases from 472 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. The primary outcome was the days of therapy (DOT) of antibiotic use per 100 patient-days (PDs). The secondary outcomes consisted of types of antibiotic used, health resource utilization, and mortality. RESULTS A total of 5,201,304 financial incentives were observed during 2012-2018, which resulted in a total of 12.1 billion JPY (≈110 million USD). Time-series analyses found decreasing trends in total antibiotic use (79.3-72.5 DOTs/100 PDs (8.6% reduction)) and carbapenem use (9.0-7.0 DOTs/100 PDs (7.8% reduction)) from 2011 to 2018 without adversely affecting other healthcare outcomes (e.g., mortality). In the difference-in-differences analyses, we did not observe meaningful changes in total antibiotic use between the incentivized and unincentivized hospitals for ASP teams, except for the northern part of Japan. No dose-response relationships were observed between the amount of financial incentives and reductions in antibiotic use during 2011-2019. CONCLUSIONS Further research and efforts are needed to accelerate antimicrobial stewardship in hospital settings in Japan.
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Affiliation(s)
- Y Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - A Nishi
- Department of Epidemiology, UCLA Fielding School of Public Health, CA, USA
| | - K Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - I Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, TN, USA; Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - N Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - R Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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19
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Iwai C, Jo T, Konishi T, Kumazawa R, Matsui H, Fushimi K, Yasunaga H. Comparative Safety and Effectiveness of Direct Oral Anticoagulants and Warfarin during Chemotherapy in Cancer Patients with Venous Thromboembolism Aged 75 Years or Older: A Nationwide Inpatient Database Study. Gerontology 2022; 69:561-570. [PMID: 36502790 PMCID: PMC10332483 DOI: 10.1159/000528606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/02/2022] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a life-threatening complication occurring in cancer patients. Direct oral anticoagulants (DOACs) or warfarin are widely prescribed for treating cancer-associated VTE. However, data are sparse as to the effectiveness and bleeding complications associated with these medications in elderly patients. The purpose of this study was to compare effectiveness and safety profiles between DOACs and warfarin in elderly cancer patients undergoing chemotherapy. METHODS Using the Diagnosis Procedure Combination inpatient database, we retrospectively identified cancer patients aged ≥75 years who developed VTE during chemotherapy (n = 4,278, January 2016 to March 2020). Eligible patients were divided into those receiving warfarin (n = 557) and DOACs (n = 3,721). We conducted a 1:4 propensity score matching analysis to adjust for measured confounders. The primary outcome was VTE recurrence requiring hospitalization. Secondary outcomes were major bleeding requiring hospitalization and inhospital death from all causes within 6 months. RESULTS The propensity-matched cohort included 557 patients in the warfarin group and 2,278 patients in the DOACs group. The proportion of VTE recurrence requiring hospitalization was lower in the DOACs group (5.3% vs. 7.5%; odds ratio [OR], 0.69; 95% confidence interval [CI], 0.48-0.98). The proportion of recurrent deep vein thrombosis was 6.3% and 4.4%, while that of recurrent pulmonary emboli was 1.3% and 1.3% in the warfarin and DOACs groups, respectively. No statistically significant differences were found in the proportion of major bleeding events requiring hospitalization (1.6% vs. 1.1%; OR, 1.47; 95% CI, 0.62-3.50) or all-cause inhospital mortality (11.1% vs. 9.9%; OR, 1.14; 95% CI, 0.84-1.56) between the DOACs and warfarin groups. CONCLUSION Our findings suggest that DOACs may be more effective than warfarin in terms of VTE recurrence requiring hospitalization and that these medications may be equivalent in terms of safety.
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Affiliation(s)
- Chikako Iwai
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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20
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Ohbe H, Sasabuchi Y, Kumazawa R, Matsui H, Yasunaga H. Intensive Care Unit Occupancy in Japan, 2015-2018: A Nationwide Inpatient Database Study. J Epidemiol 2022; 32:535-542. [PMID: 33840654 PMCID: PMC9643790 DOI: 10.2188/jea.je20210016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning. METHODS We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies. RESULTS Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively. CONCLUSION Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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21
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Urushiyama H, Jo T, Hasegawa W, Yokoyama A, Ando T, Sakamoto Y, Kumazawa R, Uda K, Michihata N, Awano N, Hiroki M, Fushimi K, Yasunaga H, Nagase T. Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: A national database study in Japan. ERJ Open Res 2022; 8:00209-2022. [DOI: 10.1183/23120541.00209-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
IntroductionAcute exacerbation (AE) is a life-threatening event in patients with fibrosing interstitial lung diseases (ILDs). Although nintedanib reduces AE incidence, its effectiveness during AE is unclear.MethodsUsing data from the Diagnosis Procedure Combination database (September 2015–March 2020), we identified patients with fibrosing ILDs who received intravenous injection of a high-dose corticosteroid within 3 days post-admission and analysed their first hospitalisation. We performed overlap propensity score weighting to compare in-hospital outcomes between patients who received nintedanib within 14 days post-admission and those who did not. The primary and secondary outcomes were in-hospital mortality and length of hospitalisation in the patients discharged alive, respectively.ResultsAmong the 6235 identified patients, 353 patients received nintedanib within 14 days post-admission. In-hospital mortality occurred in 13.7% and 6.0% patients in the control (n=5882) and nintedanib-treated (n=353) patients, respectively. The mean length of hospitalisation was 39.9 and 30.4 days in the control and nintedanib-treated patients, respectively. After overlap propensity score weighting, nintedanib treatment was significantly associated with lower in-hospital mortality in the adjusted cohort (odds ratio, 0.43; 95% confidence interval, 0.27–0.70; p=0.001). The mean length of hospitalisation in nintedanib-treated patients (30.7 days) was significantly shorter than that in the control group (37.5 days, p<0.001).ConclusionsNintedanib initiation during AE was significantly associated with a lower risk of in-hospital death and shorter length of hospitalisation in patients with fibrosing ILDs. Our results elucidate the potential role of nintedanib in the treatment of AE in patients with fibrosing ILDs. Further prospective studies are warranted.
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22
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Kurakawa KI, Okada A, Bessho K, Jo T, Ono S, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yamaguchi S, Yamauchi T, Nangaku M, Kadowaki T, Yasunaga H. Major complications after percutaneous biopsy of native or transplanted liver in pediatric patients: a nationwide inpatient database study in Japan. BMC Gastroenterol 2022; 22:395. [PMID: 36002811 PMCID: PMC9404589 DOI: 10.1186/s12876-022-02476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/03/2022] [Indexed: 11/12/2022] Open
Abstract
Aim Although major complication rates following percutaneous liver biopsy (PLB) have been reported to be higher in children than in adults, scarce data are available regarding pediatric patients stratified by native and transplanted liver. We aimed to assess the factors associated with major complications after percutaneous biopsy of native or transplanted liver using a nationwide inpatient database.
Methods Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified pediatric patients who underwent PLB between 2010 and 2018. We described major complication rates and analyzed factors associated with major complications following PLB, stratified by native and transplanted liver. Results We identified 3584 pediatric PLBs among 1732 patients from 239 hospitals throughout Japan during the study period, including 1310 in the native liver and 2274 in the transplanted liver. Major complications following PLB were observed in 0.5% (n = 18) of the total cases; PLB in the transplanted liver had major complications less frequently than those in the native liver (0.2% vs. 1.0%, p = 0.002). The occurrence of major complications was associated with younger age, liver cancers, unscheduled admission, anemia or coagulation disorders in cases with native liver, while it was associated with younger age alone in cases with transplanted liver. Conclusions The present study, using a nationwide database, found that major complications occurred more frequently in pediatric cases with native liver and identified several factors associated with its major complications.
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Affiliation(s)
- Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Pediatrics, National Rehabilitation Center for Persons With Disabilities, Saitama, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Ohbe H, Matsui H, Kumazawa R, Yasunaga H. Intensive care unit versus high dependency care unit admission after emergency surgery: a nationwide in-patient registry study. Br J Anaesth 2022; 129:527-535. [PMID: 35961814 DOI: 10.1016/j.bja.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/04/2022] [Accepted: 06/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The appropriate level of postoperative critical care for patients undergoing emergency surgery is unknown. We aimed to assess the outcomes of postoperative patients treated in the intensive care unit (ICU) and high dependency care unit (HDU) after emergency surgery. METHODS Analysis of national in-patient registry data in Japan from July 2010 to March 2018, including patients undergoing one of 10 emergency surgeries on the day of hospital admission. The exposures were ICU or HDU admission on the day of surgery. The primary outcome was in-hospital mortality. We performed multivariable logistic regression analysis adjusted for patient and hospital characteristics. Results are presented as n (%) and odds ratios (ORs) with 95% confidence intervals. RESULTS We included 158 149 patients from 646 hospitals. Crude in-hospital mortality for each procedure ranged from 168/8583 (2.0%) for cholecystectomy to 2842/12 958 (21.9%) for patients undergoing surgery for traumatic brain injury. Compared with HDU admission, ICU admission was associated with lower in-hospital mortality among the cohorts for medium-mortality risk procedures (procedure-specific mortality 5-15%) (ICU: 8834/73 616 [12.0%] vs HDU: 2586/25 262 [10.2%]; OR=0.90 [0.85-0.96]; P=0.001), and high-mortality risk procedures (procedures-specific mortality >15%) (ICU: 3445/16 334 [21.1%] vs HDU: 996/4613 [21.6%]; OR=0.86 [0.78-0.96]; P=0.005). There were no differences in mortality for low-mortality risk procedures with procedure-specific mortality <5%. CONCLUSIONS In this national registry study, postoperative critical care in ICU was associated with lower in-hospital mortality than in HDU for patients undergoing medium-risk and high-risk emergency surgery. Further research is needed to understand the role of critical care for surgical patients.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Trends in surgical procedures for spontaneous intracerebral hemorrhage in Japan. J Stroke Cerebrovasc Dis 2022; 31:106664. [PMID: 35908346 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/01/2022] [Accepted: 07/17/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Minimally invasive surgery for spontaneous intracerebral hemorrhage (ICH) has become increasingly popular in recent years. However, there are no reports on the recent trends in surgical procedures for spontaneous ICH. To investigate current trends in surgical methods for spontaneous ICH using a nationwide inpatient database from Japan. MATERIALS AND METHODS Patients who underwent surgery for spontaneous ICH between April 2014 and March 2018 were identified in a nationwide inpatient database from Japan. We examined patient characteristics, diagnoses, types of surgery, complications, and discharge status. RESULTS We identified 21,129 inpatients who underwent surgery for spontaneous ICH. The procedures were as follows: 16,256 (76.9%) transcranial hemorrhage evacuations, 3722 (17.6%) endoscopic hemorrhage evacuations, and 1151 (5.4%) stereotactic aspirations of hemorrhage. Patients tended to receive transcranial hemorrhage evacuations in hospitals with fewer surgical cases. The proportions of endoscopic hemorrhage evacuations increased annually, whereas those of stereotactic surgery decreased. The proportions of transcranial surgery remained almost unchanged. Tracheostomy and hospitalization costs were lower in the stereotactic aspirations of hemorrhage group, and the proportions of reoperation were higher in the endoscopic hemorrhage evacuations group. CONCLUSIONS The use of endoscopic surgery for spontaneous ICH has increased in Japan. This study can form the basis of future clinical investigations into spontaneous ICH surgery.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
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25
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Konishi T, Fujiogi M, Sato A, Michihata N, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Short-Term Outcomes Following Breast Cancer Surgery With and Without Neoadjuvant Chemotherapy: A Nationwide Administrative Database Study in Japan. Ann Surg Oncol 2022; 29:3000-3010. [PMID: 34994909 DOI: 10.1245/s10434-021-11212-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Although neoadjuvant chemotherapy (NAC) has become common for breast cancer, its impact on short-term surgical outcomes and the feasible chemotherapy-surgery interval remain unclear. Using a Japanese nationwide database, this study investigated the impact of NAC on short-term outcomes following breast cancer surgery. METHODS In this study of 11,722 patients with NAC and 120,538 patients without NAC who underwent surgery for stage 0-III breast cancer July 2010-March 2017, to cancel out site-specific effects, we generated a 1:4 matched-pair cohort matched for age, institution, and fiscal year of admission. We then conducted multivariable analyses adjusting for potential confounders to compare postoperative complications, duration of anesthesia, and total hospitalization costs. Additionally, we conducted three sensitivity analyses for patients with a short interval from NAC to surgery, patients receiving a particular NAC regimen, and patients undergoing a particular surgical procedure. RESULTS In total, the occurrence of postoperative complications was 6.0%, and the median interval from NAC to surgery was 31 (interquartile range, 24-39) days. The two groups did not differ significantly in terms of complications (odds ratio, 0.95; 95% confidence interval, 0.88-1.04), including local and general complications. NAC was significantly associated with shorter duration of anesthesia and lower total hospitalization costs. The sensitivity analyses showed similar results. CONCLUSIONS Our matched-pair cohort analyses revealed no significant differences in postoperative complications between patients with and without NAC for breast cancer, regardless of the interval, regimen, and surgical procedure. Patients can safely receive surgery and NAC without a lengthened interval.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ayaka Sato
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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26
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Ohbe H, Matsui H, Kumazawa R, Yasunaga H. Postoperative ICU admission following major elective surgery: A nationwide inpatient database study. Eur J Anaesthesiol 2022; 39:436-444. [PMID: 34636358 DOI: 10.1097/eja.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether the routine use of the ICU after major elective surgery improves postoperative outcomes is not well established. OBJECTIVES To describe the association between use of postoperative ICU admission and clinical outcomes for patients undergoing major elective surgery. DESIGN Observational study. SETTING Nationwide inpatient database in Japan, July 2010 to March 2018. PATIENTS Patients undergoing one of 15 major elective orthopaedic, gastrointestinal, neurological, thoracic or cardiovascular surgical procedures. INTERVENTION ICU admission on the day of surgery. ICU was defined as a separate unit providing critical care services with around-the-clock physician staffing and nursing, the equipment necessary for critical care and a nurse-to-patient ratio at least one to two. MAIN OUTCOME In-hospital mortality. Patient-level and hospital-level analyses were performed. RESULTS Overall, 2 011 265 patients from 1524 hospitals were assessed. The cohort size ranged from 38 547 patients in 467 hospitals for surgical clipping for cerebral aneurysms to 308 952 patients in 599 hospitals for spinal fixation, laminectomy or laminoplasty. In the patient-level analyses, there were no significant mortality differences among patients undergoing the 12 major noncardiovascular surgical procedures, whereas postoperative ICU admission was associated with trends towards lower in-hospital mortality among patients undergoing coronary artery bypass grafting, risk difference -1.0% (95% CI -1.8 to -0.1) open aortic aneurysm repair, risk difference -0.6% (95% CI -1.3 to 0.1), and heart valve replacement, risk difference -0.7% (95% CI - 1.6 to 0.1). In the hospital-level analyses, similar to the results of the patient-level analyses, a higher proportion of postoperative ICU admission at hospital level was associated with trends toward lower in-hospital mortality for patients undergoing the three cardiovascular surgical procedures. CONCLUSION This nationwide observational study showed that postoperative ICU admission was associated with improved survival outcomes among patients undergoing three types of cardiac surgery but not among patients undergoing low-risk elective surgery.
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Affiliation(s)
- Hiroyuki Ohbe
- From the Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (HO, HM, RK, HY)
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Kumazawa R, Jo T, Matsui H, Fushimi K, Yasunaga H. Direct oral anticoagulants versus warfarin for secondary prevention of cerebral infarction and bleeding in older adults with atrial fibrillation. J Am Geriatr Soc 2022; 70:2029-2039. [PMID: 35397114 DOI: 10.1111/jgs.17770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) have been used for both primary and secondary prevention of cerebral infarction in older patients with atrial fibrillation (AF). However, whether DOACs are more effective and safer than warfarin for secondary prevention of cerebral infarction in older patients with AF remains unclear. METHODS Using the Japanese Diagnosis Procedure Combination database, we identified patients with AF who were hospitalized for cerebral infarction from January 1, 2015 to March 31, 2019 and were aged ≥75 years at admission. We performed propensity score-stabilized inverse probability of treatment weighting analyses to balance measured confounders between patients with AF receiving DOACs and those receiving warfarin after discharge. The primary outcomes were 365-day readmission for (a) benefit: cerebral infarction or (b) harm: bleeding events after discharge. The secondary outcomes were 365-day readmission for intracranial bleeding or gastrointestinal bleeding after discharge as well as all-cause death during readmission. Using a Fine-Gray model, we compared the subdistribution hazard ratios (SHRs) of readmission between the DOAC group and warfarin group. RESULTS We identified 101,389 eligible patients, including 80,726 patients receiving DOACs and 20,663 patients receiving warfarin. After the propensity score-stabilized inverse probability of treatment weighting, the adjusted SHRs of readmission (95% confidence interval [CI]) for cerebral infarction, bleeding events, and intracranial bleeding in the DOAC group as compared with the warfarin group were 0.76 (0.71-0.81), 0.78 (0.68-0.90), and 0.69 (0.57-0.82), respectively. There was no significant difference in readmission for gastrointestinal bleeding (SHR, 1.01; 95% CI, 0.72-1.41) between the DOAC and warfarin groups. CONCLUSION In this retrospective nationwide study, DOACs were more effective and safer than warfarin for preventing reinfarction and bleeding events in patients with AF aged ≥75 years who have a history of cerebral infarction.
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Affiliation(s)
- Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Konishi T, Fujiogi M, Michihata N, Kumazawa R, Ohbe H, Matsui H, Fushimi K, Ogita M, Tanabe M, Seto Y, Yasunaga H. Interstitial lung disorders following postoperative radiotherapy with concurrent or sequential hormonal therapy for breast cancer: a nationwide database study in Japan. Breast Cancer 2022; 29:688-697. [PMID: 35217987 DOI: 10.1007/s12282-022-01346-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hormonal therapy and radiotherapy are conducted concurrently or sequentially after breast cancer surgery. It remains unclear whether concurrent or sequential treatment is safer in terms of lung complications. Using a Japanese nationwide database, this study aimed to compare the occurrence of severe lung complications between concurrent and sequential treatments. METHODS We identified patients who underwent partial mastectomy for stage 0-III breast cancer from July 2010 to March 2020 and received adjuvant hormonal therapy and radiotherapy concurrently (n = 1851) or sequentially (n = 18,429). Two propensity score analyses (1:4 matching and overlap weighting) were conducted to compare hospitalization for radiation pneumonitis and pneumonia within 1 year after surgery, and intensive care unit admission and mortality during the hospitalization. We conducted additional analyses stratified by hormonal drugs (aromatase inhibitors and tamoxifen). RESULTS The propensity score-matched analysis showed no significant differences in occurrence of hospitalization for radiation pneumonitis (0.27 vs. 0.58%, p = 0.10) and pneumonia (0.16 vs. 0.58%, p = 0.05) between the concurrent and sequential treatments. The overlap propensity score-weighted analysis also showed no significant differences (0.25 vs. 0.56%, p = 0.08 and 0.15 vs. 0.44%, p = 0.06, respectively). Intensive care unit admission and in-hospital mortality did not differ significantly between the two treatments. The stratified analysis showed similar results. CONCLUSION Our propensity score analyses revealed no significant differences in severe lung complications between concurrent and sequential hormonal therapy with radiotherapy following breast cancer surgery, regardless of the type of hormonal drugs. Clinicians can provide concurrent or sequential treatment with equivalent attention to early lung complications.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Mami Ogita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Kodama S, Jo T, Yasunaga H, Michihata N, Matsui H, Kumazawa R, Shirota Y, Fushimi K, Toda T, Hamada M. Outcomes of gastrointestinal cancer surgeries in Parkinson's disease patients: A nationwide study. Parkinsonism Relat Disord 2022; 96:45-49. [DOI: 10.1016/j.parkreldis.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
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Konishi T, Fujiogi M, Sato A, Michihata N, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. ASO Visual Abstract: Short-Term Outcomes Following Breast Cancer Surgery With and Without Neoadjuvant Chemotherapy: A Nationwide Administrative Database Study in Japan. Ann Surg Oncol 2022. [PMID: 35018591 DOI: 10.1245/s10434-021-11272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ayaka Sato
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Konishi T, Fujiogi M, Michihata N, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Outcomes of Nonoperative Treatment for Gastroduodenal Ulcer Perforation: a Nationwide Study of 14,918 Inpatients in Japan. J Gastrointest Surg 2021; 25:2770-2777. [PMID: 33825122 DOI: 10.1007/s11605-021-05003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastroduodenal ulcer perforation is a common abdominal emergency that may be curable without surgical repair in non-elderly patients with localized and stable symptoms. However, the outcomes of nonoperative approaches have rarely been described. METHODS Using a Japanese national inpatient database, we identified 14,918 patients with gastroduodenal ulcer perforation who were hospitalized and received nonoperative treatment from July 2010 to March 2017. We categorized these patients into three groups according to age: 18 to 64 years (young group, n=8407), 65 to 74 years (old group, n=2616), and ≥75 years (old-old group, n=3895). We investigated the characteristics, treatments, and outcomes in each group. RESULTS Most of the patients were men (71%), and the median patient age was 62 years (interquartile range, 47-75 years). The old and old-old groups had more comorbidities than the young group. Whereas most patients were administered proton pump inhibitors and various antibiotics (96% and 90%, respectively), only 58% of patients underwent gastric tube placement. Surgical repair >3 days after admission was performed in 7.1% of all patients (6.3% vs. 7.9% vs. 5.5%, P<0.001). The old and old-old groups showed higher mortality (1.4% vs. 8.3% vs. 18%, P<0.001) and morbidity (6.6% vs. 15% vs. 17%, P<0.001) than the young group. The median length of stay was almost 2 weeks (13 vs. 17 vs. 20 days, P<0.001). DISCUSSION Unlike previous studies, many patients aged >65 years received nonoperative treatment in this nationwide cohort. Our findings provide useful information for clinicians and patients hospitalized for gastric ulcer perforation.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Konishi T, Goto T, Fujiogi M, Michihata N, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. New machine learning scoring system for predicting postoperative mortality in gastroduodenal ulcer perforation: A study using a Japanese nationwide inpatient database. Surgery 2021; 171:1036-1042. [PMID: 34538648 DOI: 10.1016/j.surg.2021.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conventional prediction models for estimating risk of postoperative mortality in gastroduodenal ulcer perforation have suboptimal prediction ability. We aimed to develop and validate new machine learning models and an integer-based score for predicting the postoperative mortality. METHODS We retrospectively identified patients with gastroduodenal ulcer perforation who underwent surgical repair, using a nationwide Japanese inpatient database. In a derivation cohort from July 2010 to March 2016, we developed 2 machine learning-based models, Lasso and XGBoost, using 45 candidate predictors, and also developed an integer-based score for clinical use by including important variables in Lasso. In a validation cohort from April 2016 to March 2017, we measured the prediction performances of the models by computing area under the curve and comparing it to the conventional American Society of Anesthesiology risk score. RESULTS Of 25,886 patients, 1,176 (4.5%) died after surgical repair. For the validation cohort, Lasso and XGBoost had significantly higher prediction abilities than the American Society of Anesthesiology score (Lasso area under the curve = 0.84; 95% confidence interval 0.81-0.86; American Society of Anesthesiology score area under the curve = 0.70; 95% confidence interval 0.65-0.74, P < .001). The integer-based risk score, which had 13 factors, had a prediction ability similar to those of Lasso and XGBoost (area under the curve = 0.83; 95% confidence interval 0.81-0.86). According to the integer-based score, the mortalities were 0.1%, 2.3%, 9.3%, and 29.0% for the low (score, 0), moderate (1-2), high (3-4), and very high (≥5) score groups, respectively. CONCLUSION Machine learning models and the integer-based risk score performed well in predicting risk of postoperative mortality in gastroduodenal ulcer perforation. These models will help in decision making.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan.
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan; TXP Medical Co. Ltd, Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, University of Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Japan; Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
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Miyachi H, Konishi T, Kumazawa R, Matsui H, Shimizu S, Fushimi K, Matsue H, Yasunaga H. Treatments and outcomes of generalized pustular psoriasis: A cohort of 1516 patients in a nationwide inpatient database in Japan. J Am Acad Dermatol 2021; 86:1266-1274. [PMID: 34116101 DOI: 10.1016/j.jaad.2021.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Because generalized pustular psoriasis (GPP) is rare, there are few studies reporting treatments and outcomes for large numbers of patients. OBJECTIVE To report treatments and outcomes in a large cohort of patients hospitalized with GPP. METHODS Using a Japanese national inpatient database, we identified 1516 patients with GPP who required hospitalization between July 2010 and March 2019. We categorized patients into 3 medication groups: biologics (294 patients), oral agents without biologics (948 patients), and systemic corticosteroids only (274 patients). We investigated their characteristics, treatments, and outcomes. RESULTS Mean age was 66 years (interquartile range: 52-77 years). Fifty patients (3.3%) were admitted to the intensive care unit, 125 (8.2%) required blood pressure support, and 63 (4.2%) died. Patients who received biologics were younger and had fewer comorbidities. In-hospital mortality was lower in the biologics group (1.0% [biologics group] vs 3.7% [oral-agents group] vs 9.1% [corticosteroids-only group]; P < .001) as was morbidity (5.4% vs 8.2% vs 12%, respectively; P = .02). Among those who received biologics, IL-17 inhibitor use increased over time, with in-hospital mortality and morbidity comparable to those of tumor necrosis factor inhibitors. LIMITATIONS Retrospective study design. Some patients received multiple medications. CONCLUSION Biologic treatments showed favorable outcomes compared with other treatments.
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Affiliation(s)
- Hideaki Miyachi
- Department of Dermatology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sayuri Shimizu
- Departmant of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Matsue
- Department of Dermatology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Furuya H, Nakajima M, Ikeda K, Nakamura K, Ohbe H, Aso S, Kumazawa R, Iwamoto T, Iwata A, Furuta S, Matsui H, Fushimi K, Yasunaga H, Nakajima H. Prognosis and treatment of myositis-associated severe interstitial lung disease: A descriptive study using a nation-wide inpatient database in Japan. Arthritis Care Res (Hoboken) 2021; 74:478-483. [PMID: 33973401 DOI: 10.1002/acr.24646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prognosis, clinical course, and current management of severe interstitial lung disease (ILD) associated with myositis in Japan. METHODS We conducted a retrospective descriptive study using a nation-wide database for inpatient care of acute illness in Japan. Among a total of approximately 66 million inpatient admissions, we identified patients with severe ILD associated with polymyositis (PM) or dermatomyositis (DM) which required mechanical ventilation and methylprednisolone pulse therapy (≥1g/day usage of methylprednisolone) from July 2010 to March 2018. RESULTS We identified 155 patients with PM and 394 with DM who fulfilled the above criteria. The median age of patients was 65 years old; DM patients were significantly younger than PM patients (64 vs. 68 years old; p<0.001). The numbers of patients who were treated with calcineurin inhibitors, intravenous cyclophosphamide and Polymyxin B immobilized fiber column direct hemoperfusion (PMX-DHP) were 403 (73.4%), 318 (57.9%) and 78 (14.2%), respectively. All these treatments were given significantly more frequently to the patients with DM compared with those with PM. The uses of other treatment options were much less frequent. The median hospital days of initiating methylprednisolone pulse therapy, calcineurin inhibitors, mechanical ventilation, intravenous cyclophosphamide, PMX-DHP, and in-hospital death among patients with DM were 2, 4, 7, 8, 17, and 36, respectively. In-hospital mortality was significantly higher in patients with DM than in those with PM (76.6% vs. 56.8%, p<0.001). CONCLUSION The mortality of patients with myositis-associated severe ILD that requires mechanical ventilation is extremely high despite aggressive and prompt interventions.
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Affiliation(s)
- Hiroki Furuya
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Mikio Nakajima
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Kaito Nakamura
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shotaro Aso
- Department of Biostatistics & Bioinformatics, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taro Iwamoto
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Arifumi Iwata
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Biostatistics & Bioinformatics, The University of Tokyo, Tokyo, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
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Hamada S, Nakajima M, Kaszynski RH, Kumazawa R, Matui H, Fushimi K, Goto H, Yamaguchi Y, Yasunaga H. In-hospital mortality among patients with invasive non-group A β-hemolytic Streptococcus treated with clindamycin combination therapy: a nationwide cohort study. Acute Med Surg 2021; 8:e634. [PMID: 33659065 PMCID: PMC7893999 DOI: 10.1002/ams2.634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 11/08/2022] Open
Abstract
Aim Combination treatment with clindamycin is recommended in patients with invasive group A Streptococcus infection; however, whether the same treatment is effective in invasive group B Streptococcus and S. dysgalactiae subspecies equisimilis infections remains unknown. We aimed to investigate whether clindamycin added to standard of care therapy would be effective in patients with invasive non-group A β-hemolytic Streptococcus infections. Methods This was a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database focusing on the period between 2010 and 2018. We extracted data on patients diagnosed with sepsis due to non-group A β-hemolytic Streptococcus. One-to-four propensity score-matching was undertaken to compare patients who were treated with clindamycin within 2 days of admission (clindamycin group) and those who did not (control group). The primary outcome was in-hospital mortality. Results We identified 3754 eligible patients during the study period. The patients were divided into the clindamycin (n = 296) and control groups (n = 3458). After one-to-four propensity score matching, we compared 289 and 1156 patients with and without clindamycin, respectively. In-hospital mortality did not significantly differ between the two groups (9.7% versus 10.3%; risk difference 0.3%; 95% confidence interval, -3.5% to 4.2%). Conclusions This nationwide database study showed that combination therapy involving the use of clindamycin was not associated with lower in-hospital mortality in patients with invasive non-group A β-hemolytic Streptococcus.
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Affiliation(s)
- Shoichiro Hamada
- Emergency and Critical Care Center Tokyo Metropolitan Hiroo Hospital Tokyo Japan.,Department of Trauma and Critical Care medicine School of Medicine Kyorin University Tokyo Japan
| | - Mikio Nakajima
- Emergency and Critical Care Center Tokyo Metropolitan Hiroo Hospital Tokyo Japan.,Department of Trauma and Critical Care medicine School of Medicine Kyorin University Tokyo Japan.,Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
| | - Richard H Kaszynski
- Emergency and Critical Care Center Tokyo Metropolitan Hiroo Hospital Tokyo Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
| | - Hiroki Matui
- Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School of Medicine Tokyo Japan
| | - Hideaki Goto
- Emergency and Critical Care Center Tokyo Metropolitan Hiroo Hospital Tokyo Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care medicine School of Medicine Kyorin University Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan
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Katsuki R, Jo T, Yasunaga H, Kumazawa R, Uda K. Outcomes of laparoscopic versus open pancreatoduodenectomy: A nationwide retrospective cohort study. Surgery 2021; 169:1427-1433. [PMID: 33487433 DOI: 10.1016/j.surg.2020.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/27/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Whether laparoscopic pancreatoduodenectomy is a feasible treatment option equivalent to open pancreatoduodenectomy remains unclear. Using a nationwide inpatient database, we investigated the postoperative outcomes of laparoscopic pancreatoduodenectomy versus open pancreatoduodenectomy. METHODS We conducted a retrospective cohort study using a nationwide inpatient database in Japan. We included patients who underwent pancreatoduodenectomy from April 2016 to March 2018. One-to-four propensity score matching was used to compare in-hospital mortality, postoperative complications, perioperative findings, and total hospitalization costs between the 2 groups. We also compared outcomes between laparoscopic pancreatoduodenectomy and open pancreatoduodenectomy in low- and high-volume hospitals. RESULTS We identified 2,100 eligible patients. The laparoscopic pancreatoduodenectomy group contained higher proportions of younger patients and patients with fewer comorbidities compared with the open pancreatoduodenectomy group. Using propensity score matching, 95 patients in the laparoscopic pancreatoduodenectomy group were matched with 380 patients in the open pancreatoduodenectomy group. No significant differences in in-hospital mortality or postoperative complication rates were found between the groups. Compared with the open pancreatoduodenectomy group, the laparoscopic pancreatoduodenectomy group showed a longer duration of anesthesia (639 vs 497 minutes; P < .001), higher proportion of unplanned mechanical ventilation (10% vs 3%; P = .007), and higher total hospitalization costs (32,242 vs 24,657 US dollars; P < .001). The subgroup analyses showed that laparoscopic pancreatoduodenectomy was associated with a higher proportion of unplanned mechanical ventilation than open pancreatoduodenectomy but only in low-volume hospitals. CONCLUSION This study demonstrated almost no advantage of laparoscopic pancreatoduodenectomy over open pancreatoduodenectomy. Our results suggest that laparoscopic pancreatoduodenectomy can be an alternative option for open pancreatoduodenectomy only in high-volume hospitals.
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Affiliation(s)
- Ryusuke Katsuki
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
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Kamon T, Kaneko H, Kiriyama H, Itoh H, Fujiu K, Kumazawa R, Morita K, Michihata N, Jo T, Miura M, Kodera S, Uehara M, Ando J, Inoue T, Kinoshita O, Yamauchi H, Mori Y, Nakao T, Daimon M, Takeda N, Morita H, Ono M, Yasunaga H, Komuro I. Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement for Aortic Stenosis in Japan - Analysis of a Nationwide Inpatient Database. Circ Rep 2020; 2:753-758. [PMID: 33693206 PMCID: PMC7937519 DOI: 10.1253/circrep.cr-20-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Nationwide data on transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in Japan are scarce. Methods and Results: Using a nationwide inpatient database, we analyzed patients undergoing TAVI (n=8,338) or SAVR (n=16,298) due to aortic stenosis between 2014 and 2017. The annual number of TAVI increased rapidly from 2014 to 2017, particularly in older patients. In-hospital deaths were lower and the length of hospital stay was shorter for patients undergoing TAVI than SAVR. Conclusions: TAVI has been penetrating in Japan as an alternative therapeutic option for aortic stenosis and is associated with acceptable clinical outcomes.
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Affiliation(s)
- Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
- Department of Advanced Cardiology, The University of Tokyo Tokyo Japan
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
- Department of Advanced Cardiology, The University of Tokyo Tokyo Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo Tokyo Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo Tokyo Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba Tsukuba Japan
| | - Nobuaki Michihata
- Department of Health Services Research, The University of Tokyo Tokyo Japan
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo Tokyo Japan
| | - Mizuki Miura
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Masae Uehara
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Jiro Ando
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Takafumi Inoue
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Haruo Yamauchi
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Yoshiteru Mori
- Department of Anesthesiology, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Tomoko Nakao
- Department of Clinical Laboratory, The University of Tokyo Tokyo Japan
| | - Masao Daimon
- Department of Clinical Laboratory, The University of Tokyo Tokyo Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo Tokyo Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
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Iwagami M, Kumazawa R, Miyamoto Y, Ito Y, Ishimaru M, Morita K, Hamada S, Tamiya N, Yasunaga H. Risk of Cancer in Association with Ranitidine and Nizatidine vs Other H2 Blockers: Analysis of the Japan Medical Data Center Claims Database 2005-2018. Drug Saf 2020; 44:361-371. [PMID: 33247391 DOI: 10.1007/s40264-020-01024-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In September 2019, ranitidine and nizatidine were suggested to contain N-nitrosodimethylamine, a carcinogenic substance. People have since been concerned about the potential impact of ranitidine/nizatidine use on the risk of cancer. OBJECTIVE The objective of this study was to investigate the risk of cancer among people receiving ranitidine or nizatidine compared with other histamine 2 receptor antagonists (H2 blockers) [cimetidine, famotidine, roxatidine, and lafutidine]. METHODS In the Japan Medical Data Center claims database (comprising people aged < 75 years) from 2005 to 2018, we identified new adult users of H2 blockers and classified them into ranitidine/nizatidine users and other H2 blocker users. We estimated the incidence of cancer diagnosis in each group and conducted a multivariable Cox regression analysis. RESULTS We identified 113,745 new users of ranitidine/nizatidine (median age 41.2 years [interquartile range 31.7-51.1]; 49.1% men; median follow-up 2.4 years [1.1-4.5]) and 503,982 new users of other H2 blockers (median age 40.9 years [31.1-51.2]; 51.0% men; median follow-up 2.3 years [0.9-4.2]). The incidence rate of cancer diagnosis was 6.39 (95% confidence interval 6.13-6.66) cases per 1000 person-years (top three sites: breast 14.8%; colorectal 14.6%; and stomach 11.5%) in the ranitidine/nizatidine group and 6.17 (6.05-6.30) cases per 1000 person-years (colorectal 14.7%; breast 13.5%; and stomach 11.2%) in the other H2 blockers group. The adjusted hazard ratio (ranitidine/nizatidine users vs other H2 blocker users) was 1.02 (0.98-1.07). The results were similar by follow-up length, by cancer site, and when ranitidine and nizatidine users were separately compared with the other H2 blockers group. By cumulative dose, the adjusted hazard ratio (95% confidence interval) was 1.03 (0.98-1.08) from 1 to 180 defined daily doses (DDDs), 1.00 (0.73-1.39) from 181 to 365 DDDs, 0.95 (0.61-1.48) from 366 to 730 DDDs, and 0.83 (0.45-1.55) at > 730 DDDs. CONCLUSIONS We found no evidence that ranitidine/nizatidine is associated with an increased risk of cancer, although further studies with more accurate measurement of exposure, inclusion of older people, and longer follow-up may be needed.
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Affiliation(s)
- Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, Institutes of Medicine, University of Tsukuba, Building #861, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan. .,Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Yuri Ito
- Department of Medical Statistics, Research and Development Center, Osaka Medical College, Osaka, Japan
| | - Miho Ishimaru
- Department of Health Services Research, Faculty of Medicine, Institutes of Medicine, University of Tsukuba, Building #861, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan
| | - Kojiro Morita
- Department of Health Services Research, Faculty of Medicine, Institutes of Medicine, University of Tsukuba, Building #861, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, Institutes of Medicine, University of Tsukuba, Building #861, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan
| | - Hideo Yasunaga
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Sato D, Uda K, Kumazawa R, Matsui H, Yasunaga H. Mortality and morbidity following postoperative use of short-term, low-dose quetiapine vs risperidone in patients with diabetes: Analysis using a national inpatient database. Pharmacoepidemiol Drug Saf 2020; 29:1703-1709. [PMID: 33111396 DOI: 10.1002/pds.5164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/25/2020] [Accepted: 10/23/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE Short-term, low-dose quetiapine is used to treat postoperative delirium and insomnia. Quetiapine is contraindicated for patients with diabetes in Japan because there have been several case reports of diabetic ketoacidosis (DKA) in patients receiving long-term, high-dose quetiapine. However, because safety of short-term, low-dose quetiapine remains controversial, it is prescribed for patients with diabetes in real-world clinical practice. The present study aimed to compare in-hospital mortality and morbidity between short-term, low-dose quetiapine and risperidone in postoperative patients with diabetes. METHODS We used a national inpatient database in Japan to perform a retrospective cohort study. We identified hospitalized patients with diabetes who underwent scheduled elective surgery and received oral quetiapine 200 mg/d or less or oral risperidone 4 mg/d or less within 7 days of surgery between July 2010 and March 2018. We performed one-to-one propensity score-matched analyses to compare outcomes between patients with quetiapine and risperidone. The primary outcome was in-hospital mortality. The secondary outcome was infectious complications (pneumonia, urinary tract infection, surgical site infection, and sepsis). RESULTS Propensity score matching created 665 pairs of patients who received quetiapine or risperidone. The primary outcome was observed in 19 (2.9%) of the quetiapine group and 11 (1.7%) of the risperidone group (relative risk, 1.27; 95% confidence interval, 0.97-1.68; P = .14). The secondary outcome did not differ significantly between the groups. CONCLUSION In terms of mortality and infectious outcomes, safety of quetiapine and risperidone may be comparable.
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Affiliation(s)
- Daisuke Sato
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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40
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Imai H, Hirai T, Kumazawa R, Nakagawa S, Yonezawa A, Matsubara K, Nakao H. Prevalence of and risk factors for adverse events in Alzheimer's patients receiving anti-dementia drugs in at-home care. PLoS One 2020; 15:e0231226. [PMID: 32251456 PMCID: PMC7135264 DOI: 10.1371/journal.pone.0231226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/18/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The objective of this study was to clarify the types and prevalence of, and the risk factors for, the adverse events that occur in patients receiving anti-dementia drugs. METHODS A questionnaire survey was conducted. The respondents were pharmacists who were dispensing anti-dementia drugs. The pharmacists responded to questions about patients who were receiving anti-dementia drugs delivered to them at home by the pharmacists. The survey questions included questions about whether or not the patients experienced adverse reactions to the drugs, about the patients' background characteristics, about the numbers of drugs the patients were taking when the pharmacists first visited the patients at home, and about the pharmacists' assessments of the appropriateness of the use of the anti-dementia drugs. RESULTS Data were collected on 3712 patients from 1673 pharmacies in a nationwide survey. Anti-dementia drugs had been prescribed to 863 of these patients; and 801 (92.8%) of these 863 patients were 75 years of age or older, and. confirmed adverse events occurred in 170 (21%) of these 863 patients. The most common adverse event was excitation/anxiety, at 45.1%. A multivariate analysis found that polypharmacy (10 or more types of drugs per day) (P = 0.030), inappropriate use (P = 0.002), and irregular medication use (P = 0.034) were risk factors. INTERPRETATION In order to avoid adverse events when using anti-dementia drugs, doctors and pharmacists should carefully examine the prescribing of multiple medications, assess the applicability of the use of anti-dementia drugs, and investigate how to best manage patients' drug use.
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Affiliation(s)
- Hirohisa Imai
- Department of Medical and Pharmaceutical Community Healthcare, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Takuya Hirai
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Kazuo Matsubara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Hiroyuki Nakao
- Humanics in Nursing III, Basic Professional Educational Course, Faculty of Nursing, Miyazaki Prefectural Nursing University, Miyazaki, Japan
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Kumazawa R, Jo T, Matsui H, Fushimi K, Yasunaga H. Association between Angiotensin-Converting Enzyme Inhibitors and Post-Stroke Aspiration Pneumonia. J Stroke Cerebrovasc Dis 2019; 28:104444. [PMID: 31635965 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/22/2019] [Accepted: 09/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous small studies conducted around 2000 suggested an association between the use of angiotensin-converting enzyme inhibitors (ACEIs) and a reduction in post-stroke aspiration pneumonia (AP) in Japan. However, it is unclear whether receiving ACEIs can reduce post-stroke AP in the current clinical environment, where stroke management has been improved. This study aimed to re-evaluate the preventive effect of ACEIs on post-stroke AP, compared with that of angiotensin II receptor blockers (ARBs). METHODS Using the Japanese Diagnosis Procedure Combination database, we identified patients who were hospitalized for stroke and developed AP during hospitalization from July 2010 to December 2016. After applying the exclusion criteria, we performed 1:1 propensity score matching between patients receiving ACEIs and those receiving ARBs after discharge. The outcomes were 14-day, 30-day, and 90-day readmission for post-stroke AP among patients with stroke who had AP during their initial hospitalization. Cox regression was performed to analyze these readmissions. RESULTS In total, 35,586 eligible patients were identified. Of these patients, 5846 (16%) received ACEIs. Propensity score matching created 5789 pairs. No significant difference was seen in 14-day readmission (0.7% versus 0.8%), 30-day readmission (1.3% versus 1.3%), or 90-day readmission (2.4% versus 2.6%) between the ARB and ACEI groups. The hazard ratio of the ACEI group compared with the ARB group was not significant (1.21; 95% confidence interval: 0.98-1.48). CONCLUSIONS In this retrospective nationwide study, ACEIs could not be concluded to have a preventive effect on post-stroke AP in the current clinical environment.
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Affiliation(s)
- Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Komori A, Morisaki T, Mutoh T, Sakakibara S, Takeiri Y, Kumazawa R, Kubo S, Ida K, Morita S, Narihara K, Shimozuma T, Tanaka K, Watanabe KY, Yamada H, Yoshinuma M, Akiyama T, Ashikawa N, Emoto M, Funaba H, Goto M, Ido T, Ikeda K, Inagaki S, Isobe M, Igami H, Itoh K, Kaneko O, Kawahata K, Kobuchi T, Masuzaki S, Matsuoka K, Minami T, Miyazawa J, Muto S, Nagayama Y, Nakamura Y, Nakanishi H, Narushima Y, Nishimura K, Nishiura M, Nishizawa A, Noda N, Ohdachi S, Oka Y, Osakabe M, Ohyabu N, Ozaki T, Peterson BJ, Sagara A, Saito K, Sakamoto R, Sato K, Sato M, Seki T, Shoji M, Sudo S, Tamura N, Toi K, Tokuzawa T, Tsumori K, Uda T, Watari T, Yamada I, Yokoyama M, Yoshimura Y, Motojima O, Beidler CD, Fujita T, Isayama A, Sakamoto Y, Takenaga H, Goncharov P, Ishii K, Sakamoto M, Murakami S, Notake T, Takeuchi N, Okajima S, Sasao M. Overview of Progress in LHD Experiments. Fusion Science and Technology 2017. [DOI: 10.13182/fst06-a1229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Komori
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Morisaki
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Mutoh
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - S. Sakakibara
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Takeiri
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - R. Kumazawa
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - S. Kubo
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Ida
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - S. Morita
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Narihara
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Shimozuma
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Tanaka
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Y. Watanabe
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - H. Yamada
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Yoshinuma
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Akiyama
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - N. Ashikawa
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Emoto
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - H. Funaba
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Goto
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Ido
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Ikeda
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - S. Inagaki
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Isobe
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - H. Igami
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Itoh
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - O. Kaneko
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Kawahata
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Kobuchi
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - S. Masuzaki
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Matsuoka
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Minami
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - J. Miyazawa
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - S. Muto
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Nagayama
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Nakamura
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - H. Nakanishi
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Narushima
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Nishimura
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Nishiura
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - A. Nishizawa
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - N. Noda
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - S. Ohdachi
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Oka
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Osakabe
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - N. Ohyabu
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Ozaki
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - B. J. Peterson
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - A. Sagara
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Saito
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - R. Sakamoto
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Sato
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Sato
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Seki
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Shoji
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - S. Sudo
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - N. Tamura
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Toi
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Tokuzawa
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Tsumori
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Uda
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Watari
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - I. Yamada
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Yokoyama
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Yoshimura
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - O. Motojima
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - C. D. Beidler
- Max-Planck Institut fuer Plasmaphysik, Greifswald D-17491, Germany
| | - T. Fujita
- Japan Atomic Energy Research Institute, Naka 311-0193, Japan
| | - A. Isayama
- Japan Atomic Energy Research Institute, Naka 311-0193, Japan
| | - Y. Sakamoto
- Japan Atomic Energy Research Institute, Naka 311-0193, Japan
| | - H. Takenaga
- Japan Atomic Energy Research Institute, Naka 311-0193, Japan
| | - P. Goncharov
- Graduate University for Advanced Studies, School of Mathematical and Physical Science Department of Fusion Science, Hayama 240-0193, Japan
| | - K. Ishii
- Kyushu University, Research Institute for Applied Mechanics Kasuga 816-8580, Japan
| | - M. Sakamoto
- Kyushu University, Research Institute for Applied Mechanics Kasuga 816-8580, Japan
| | - S. Murakami
- Kyoto University, Department of Nuclear Engineering, Kyoto 606-8501, Japan
| | - T. Notake
- Nagoya University, Department of Energy Engineering and Science Nagoya 464-8603, Japan
| | - N. Takeuchi
- Nagoya University, Department of Energy Engineering and Science Nagoya 464-8603, Japan
| | - S. Okajima
- Chubu University, Kasugai, Aichi 487-8501, Japan
| | - M. Sasao
- Tohoku University, Graduate School of Engineering, Sendai 980-8579, Japan
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Kumazawa R, Mutoh T, Saito K, Seki T, Kasahara H, Tokitani M, Masuzaki S, Ashikawa N, Nakamura Y, Kubo S, Shimozuma T, Yoshimura Y, Igami H, Takahashi H, Takeiri Y, Tsumori K, Osakabe M, Ikeda K, Nagaoka K, Kaneko O, Goto M, Sato K, Chikaraishi H, Ida K, Nagayama Y, Zhao Y, Kwak JG, Yoon JS. Progress in Steady-State Plasma Operation Using ICRF Heating on LHD. Fusion Science and Technology 2017. [DOI: 10.13182/fst10-a10839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R. Kumazawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Mutoh
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Saito
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Seki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Kasahara
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Tokitani
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Masuzaki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - N. Ashikawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Nakamura
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Kubo
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Shimozuma
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Yoshimura
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Igami
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Takahashi
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Takeiri
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Tsumori
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Osakabe
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Ikeda
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Nagaoka
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - O. Kaneko
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Goto
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Sato
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Chikaraishi
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Ida
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Nagayama
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Zhao
- Institute of Plasma Physics, Chinese Academy of Science, Hefei 230031, China
| | - J. G. Kwak
- Korea Advanced Energy Research Institute, 150 Deogjin-dong, Yuseong-gu, Daejeon, Republic of Korea
| | - J. S. Yoon
- Korea Advanced Energy Research Institute, 150 Deogjin-dong, Yuseong-gu, Daejeon, Republic of Korea
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Saito K, Kumazawa R, Seki T, Kasahara H, Osakabe M, Isobe M, Shimpo F, Nomura G, Watari T, Murakami S, Sasao M, Mutoh T. ICRF Heating and Ion Tail Formation in LHD. Fusion Science and Technology 2017. [DOI: 10.13182/fst10-a10838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- K. Saito
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - R. Kumazawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Seki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Kasahara
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Osakabe
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Isobe
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - F. Shimpo
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - G. Nomura
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Watari
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Murakami
- Kyoto University, Department of Nuclear Engineering, Kyoto 606-8501, Japan
| | - M. Sasao
- Graduate School of Engineering, Tohoku University, Sendai 980-8579, Japan
| | - T. Mutoh
- National Institute for Fusion Science, Toki 509-5292, Japan
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45
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Affiliation(s)
- T. Mutoh
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - R. Kumazawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Seki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Saito
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Kasahara
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - F. Shimpo
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - G. Nomura
- National Institute for Fusion Science, Toki 509-5292, Japan
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46
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Osakabe M, Isobe M, Murakami S, Kobayashi S, Saito K, Kumazawa R, Mutoh T, Ozaki T, Nishiura M, Veshchev E, Seki T, Takeiri Y, Kaneko O, Nagaoka K, Tokuzawa T, Ogawa K, Toi K, Yamamoto S, Sasao M, Watanabe T. Fast-Ion Confinement Studies on LHD. Fusion Science and Technology 2017. [DOI: 10.13182/fst10-a10800] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Osakabe
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Isobe
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Murakami
- Kyoto University, Department of Nuclear Engineering, Kyoto 606-8501, Japan
| | - S. Kobayashi
- Institute of Advanced Energy, Kyoto University, Gokashou, Uji 611-0011, Japan
| | - K. Saito
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - R. Kumazawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Mutoh
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Ozaki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Nishiura
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - E. Veshchev
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Seki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Takeiri
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - O. Kaneko
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Nagaoka
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Tokuzawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Ogawa
- Nagoya University, Department of Energy Science and Engineering, Nagoya 464-8603, Japan
| | - K. Toi
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Yamamoto
- Institute of Advanced Energy, Kyoto University, Gokashou, Uji 611-0011, Japan
| | - M. Sasao
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Watanabe
- National Institute for Fusion Science, Toki 509-5292, Japan
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47
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Seki T, Mutoh T, Kumazawa R, Saito K, Nakamura Y, Sakamoto M, Watanabe T, Kubo S, Shimozuma T, Yoshimura Y, Igami H, Ohkubo K, Takeiri Y, Oka Y, Tsumori K, Osakabe M, Ikeda K, Nagaoka K, Kaneko O, Miyazawa J, Morita S, Narihara K, Shoji M, Masuzaki S, Goto M, Morisaki T, Peterson BJ, Sato K, Tokuzawa T, Ashikawa N, Nishimura K, Funaba H, Chikaraishi H, Takeuchi N, Notake T, Ogawa H, Torii Y, Shimpo F, Nomura G, Yokota M, Takahashi C, Kato A, Takase Y, Kasahara H, Ichimura M, Higaki H, Zhao YP, Kwak JG, Yamada H, Kawahata K, Ohyabu N, Ida K, Nagayama Y, Noda N, Watari T, Komori A, Sudo S, Motojima O. Study of Long-Pulse Plasma Experiment Using ICRF Heating in LHD. Fusion Science and Technology 2017. [DOI: 10.13182/fst06-a1234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- T. Seki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Mutoh
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - R. Kumazawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Saito
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Nakamura
- National Institute for Fusion Science, Toki 509-5292, Japan
| | | | - T. Watanabe
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Kubo
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Shimozuma
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Yoshimura
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Igami
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Ohkubo
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Takeiri
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Oka
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Tsumori
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Osakabe
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Ikeda
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Nagaoka
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - O. Kaneko
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - J. Miyazawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Morita
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Narihara
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Shoji
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Masuzaki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Goto
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Morisaki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - B. J. Peterson
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Sato
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Tokuzawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - N. Ashikawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Nishimura
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Funaba
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - H. Chikaraishi
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - N. Takeuchi
- Nagoya University, Faculty of Engineering, Nagoya 464-8601, Japan
| | - T. Notake
- Nagoya University, Faculty of Engineering, Nagoya 464-8601, Japan
| | - H. Ogawa
- Graduate University for Advanced Studies, Hayama 240-0162, Japan
| | - Y. Torii
- Kyoto University, Institute of Advanced Energy, Uji 611-0011, Japan
| | - F. Shimpo
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - G. Nomura
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Yokota
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - C. Takahashi
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - A. Kato
- National Institute for Fusion Science, Toki 509-5292, Japan
| | | | | | | | - H. Higaki
- University of Tsukuba, Tsukuba, Japan
| | - Y. P. Zhao
- Institute of Plasma Physics, Academia Sinica, Hefei 230031, P.R. China
| | - J. G. Kwak
- Korea Atomic Energy Research Institute, Daejeon 305-600, Korea Rep
| | - H. Yamada
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Kawahata
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - N. Ohyabu
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Ida
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Nagayama
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - N. Noda
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Watari
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - A. Komori
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Sudo
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - O. Motojima
- National Institute for Fusion Science, Toki 509-5292, Japan
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48
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Yamada H, Kawahata K, Mutoh T, Ohyabu N, Takeiri Y, Imagawa S, Ida K, Mito T, Nagayama Y, Shimozuma T, Watanabe KY, Kobayashi M, Kumazawa R, Masuzaki S, Morisaki T, Miyazawa J, Nagaoka K, Narushima Y, Sakakibara S, Sakamoto R, Toi K, Yokoyama M, Kaneko O, Komori A, Motojima O. Progress in the Integrated Development of the Helical System. Fusion Science and Technology 2017. [DOI: 10.13182/fst10-a10789] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- H. Yamada
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Kawahata
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Mutoh
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - N. Ohyabu
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Takeiri
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Imagawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Ida
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Mito
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Nagayama
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Shimozuma
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Y. Watanabe
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Kobayashi
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - R. Kumazawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Masuzaki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - T. Morisaki
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - J. Miyazawa
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Nagaoka
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - Y. Narushima
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - S. Sakakibara
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - R. Sakamoto
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - K. Toi
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - M. Yokoyama
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - O. Kaneko
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - A. Komori
- National Institute for Fusion Science, Toki 509-5292, Japan
| | - O. Motojima
- National Institute for Fusion Science, Toki 509-5292, Japan
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49
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Motojima O, Yamada H, Komori A, Watanabe KY, Mutoh T, Takeiri Y, Ida K, Akiyama T, Asakura N, Ashikawa N, Chikaraishi H, Cooper WA, Emoto M, Fujita T, Fujiwara M, Funaba H, Goncharov P, Goto M, Hamada Y, Higashijima S, Hino T, Hoshino M, Ichimura M, Idei H, Ido T, Ikeda K, Imagawa S, Inagaki S, Isayama A, Isobe M, Itoh T, Itoh K, Kado S, Kalinina D, Kaneba T, Kaneko O, Kato D, Kato T, Kawahata K, Kawashima H, Kawazome H, Kobuchi T, Kondo K, Kubo S, Kumazawa R, Lyon JF, Maekawa R, Mase A, Masuzaki S, Mito T, Matsuoka K, Miura Y, Miyazawa J, More R, Morisaki T, Morita S, Murakami I, Murakami S, Mutoh S, Nagaoka K, Nagasaki K, Nagayama Y, Nakamura Y, Nakanishi H, Narihara K, Narushima Y, Nishimura H, Nishimura K, Nishiura M, Nishizawa A, Noda N, Notake T, Nozato H, Ohdachi S, Ohkubo K, Ohyabu N, Oyama N, Oka Y, Okada H, Osakabe M, Ozaki T, Peterson BJ, Sagara A, Saida T, Saito K, Sakakibara S, Sakamoto M, Sakamoto R, Sasao M, Sato K, Seki T, Shimozuma T, Shoji M, Sudo S, Takagi S, Takahashi Y, Takase Y, Takenaga H, Takeuchi N, Tamura N, Tanaka K, Tanaka M, Toi K, Takahata K, Tokuzawa T, Torii Y, Tsumori K, Watanabe F, Watanabe M, Watanabe T, Watari T, Yamada I, Yamada S, Yamaguchi T, Yamamoto S, Yamazaki K, Yanagi N, Yokoyama M, Yoshida N, Yoshimura S, Yoshimura Y, Yoshinuma M. Review on the Progress of the LHD Experiment. Fusion Science and Technology 2017. [DOI: 10.13182/fst04-a535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- O. Motojima
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - H. Yamada
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - A. Komori
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Y. Watanabe
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Mutoh
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - Y. Takeiri
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Ida
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Akiyama
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - N. Asakura
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - N. Ashikawa
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - H. Chikaraishi
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - W. A. Cooper
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Emoto
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Fujita
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Fujiwara
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - H. Funaba
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - P. Goncharov
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Goto
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - Y. Hamada
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Higashijima
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Hino
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Hoshino
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - H. Idei
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Ido
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Ikeda
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Imagawa
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Inagaki
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - A. Isayama
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Isobe
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Itoh
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Itoh
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Kado
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - D. Kalinina
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - O. Kaneko
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - D. Kato
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Kato
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Kawahata
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - H. Kawashima
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - H. Kawazome
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Kubo
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - R. Kumazawa
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Murakami
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Mutoh
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - N. Oyama
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - H. Okada
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - B. J. Peterson
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Saida
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Saito
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Sakakibara
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Sakamoto
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - R. Sakamoto
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Sasao
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Sato
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Seki
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Shimozuma
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Shoji
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Sudo
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - Y. Takahashi
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - Y. Takase
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - H. Takenaga
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - N. Takeuchi
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - N. Tamura
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Tanaka
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Tanaka
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Toi
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Takahata
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Tokuzawa
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - Y. Torii
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Tsumori
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - F. Watanabe
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Watanabe
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Watanabe
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Watari
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - I. Yamada
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Yamada
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - T. Yamaguchi
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Yamamoto
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - K. Yamazaki
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - N. Yanagi
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Yokoyama
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - N. Yoshida
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - S. Yoshimura
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - Y. Yoshimura
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
| | - M. Yoshinuma
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki-shi, Gifu-ken 509-5292, Japan
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Murakami S, Yamada H, Sasao M, Isobe M, Ozaki T, Saida T, Goncharov P, Lyon JF, Osakabe M, Seki T, Takeiri Y, Oka Y, Tumori K, Ikeda K, Mutoh T, Kumazawa R, Saito K, Torii Y, Watari T, Wakasa A, Watanabe KY, Funaba H, Yokoyama M. Effect of Neoclassical Transport Optimization on Energetic Ion Confinement in LHD. Fusion Science and Technology 2017. [DOI: 10.13182/fst04-a561] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S. Murakami
- Kyoto University, Department of Nuclear Engineering, Kyoto 606-8501, Japan
| | - H. Yamada
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Sasao
- Tohoku University, Graduate School of Engineering, Sendai 980-8579, Japan
| | - M. Isobe
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Ozaki
- Tohoku University, Graduate School of Engineering, Sendai 980-8579, Japan
| | - T. Saida
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - P. Goncharov
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8072
| | - J. F. Lyon
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Osakabe
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Seki
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Takeiri
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Oka
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Tumori
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Ikeda
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - T. Mutoh
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - R. Kumazawa
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - K. Saito
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - Y. Torii
- Nagoya University, Department of Energy Engineering and Science, 464-8603, Japan
| | - T. Watari
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - A. Wakasa
- Hokkaido University, Graduate School of Engineering, Sapporo 060-8628, Japan
| | - K. Y. Watanabe
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - H. Funaba
- National Institute for Fusion Science, Toki, Gifu 509-5292, Japan
| | - M. Yokoyama
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, D-17491 Greifswald, Germany
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