Tracing all patients who received insured dialysis treatment in Japan and the present situation of their number of deaths

Background The survival rate of chronic dialysis patients in Japan remains the highest worldwide, so there is value in presenting Japan’s situation internationally. We examined whether aggregate figures on dialysis patients in the National Database of Health Insurance Claims and Special Health Checkups of Japan (NDB), which contains data on insured procedures of approximately 100 million Japanese residents, complement corresponding figures in the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). Methods Subjects were patients with medical fee points for dialysis recorded in the NDB during 2014–2018. We analyzed annual numbers of dialysis cases, newly initiated dialysis cases– and deaths. Results Compared with the JRDR, the NDB had about 6–7% fewer dialysis cases but a similar number of newly initiated dialysis cases. In the NDB, the number of deaths was about 6–10% lower, and the number of hemodialysis cases was lower, while that of peritoneal dialysis cases was higher. The cumulative survival rate at dialysis initiation was approximately 6 percentage points lower in the NDB than in the JRDR, indicating that some patients die at dialysis initiation. Cumulative survival rate by age group was roughly the same between the NDB and JRDR in both sexes. Conclusion The use of the NDB enabled us to aggregate data of dialysis patients. With the definition of dialysis patients used in this study, analyses of concomitant medications, comorbidities, surgeries, and therapies will become possible, which will be useful in many future studies.

Efficacy of two-stage Meek micrografting in patients with severe burns

Background Burns are common injuries associated with high disability and mortality. In recent years, Meek micrografting technique has been gradually applied for the wound treatment of severe burns. However, the efficacy of two-stage Meek micrografting in patients with severe burns keeps unclear. Methods The data of eligible patients with severe burns who were admitted to Southwest Hospital of the Third Military Medical University from January 2013 to December 2019 were retrospectively analysed. The patients were divided into two groups according to the Meek micrografting method: one-stage skin grafting (group A) and two-stage skin grafting (group B). The baseline data, survival rate of skin graft, length of hospital stay, treatment costs, laboratory data and cumulative survival were statistically analysed. Results 127 patients (91 in group A and 36 in group B) were included in the study. There were no significant difference in the baseline data, the length of hospital stay and treatment costs between the two groups. The survival rate of skin graft was higher in group B. Total protein and albumin level, platelet count in group B were superior to those in group A, while there were no difference in other laboratory data (prealbumin, serum creatinine, urea nitrogen, cystatin C, blood cultures, wound exudate cultures) and cumulative survival between the two groups. Conclusion Our results demonstrated that staged Meek micrografting could improve the survival rate of skin graft, by reducing the risks of hypoproteinaemia, hypoalbuminemia and low platelet counts after adequate resuscitation.

Effect of Combination of Traditional Chinese Medicine with Western Medicine on Endometrial Carcinoma and Its Influence on Ultrasound, MRI, Tumor Markers HE4 and CA125

Objective. To study the clinical efficacy of integrated traditional Chinese medicine (TCM) and Western medicine (WM) in treating endometrial cancer and the influence on ultrasound, magnetic resonance imaging (MRI), tumor markers, human epididymis protein 4 (HE4) and carbohydrate antigen 125 (CA125). Method. A total of 152 cases of patients with endometrial carcinoma were randomly divided into two groups: the TCM + WM group and the WM group. The WM group was treated with megestrol acetate tablets, and the TCM + WM group was treated with Radix Astragali injection on the basis of the control group. The levels of inflammatory factors, HE4 and CA125 in serum, were detected using enzyme-linked immunosorbent assay (ELISA) or radioimmunoassay. The characteristics of ultrasound images and MRI images were observed and recorded. Toxicity, side effects, and the 3-year cumulative survival rate after treatment were assessed. Results. After treatment, the levels of interleukin-4 (IL-4), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) in both groups decreased, and the decrease in the TCM + WM group was more obvious than that in the WM group. There were statistically significant differences between the two groups in lesion shape, boundary, blood flow signal, lesion diameter, resistance index (RI), echo, intima thickness, and muscle layer infiltration from transvaginal ultrasound images after treatment. The diameter, echo, boundary, shape, composition, and enhancement degree of lesions between the two groups have a significant difference. Moreover, the levels of serum HE4 and CA125 in both groups decreased after treatment, and the decrease in the TCM + WM group was more obvious than that in the WM group. There were statistically significant differences between the two groups in the occurrence of myelosuppression, abnormal liver function, decreased platelet number, gastrointestinal reactions, leukopenia, and cardiotoxicity. After three years of follow-up, the cumulative survival rate of the TCM + WM group was 76.32%, and the cumulative survival rate of the WM group was 57.89%. Conclusion. Radix Astragali injection combined with megestrol acetate tablets has obvious therapeutic effects against endometrial cancer. Through vaginal ultrasonography and MRI, it can significantly improve the size, shape, and blood flow signals of patients’ lesions, reduce the level of serum inflammatory factors and tumor markers HE4 and CA125, reduce the incidence of toxic and side reactions, improve the patient’s immunity, improve the patient’s condition significantly, and prolong the survival time of patients.

Evaluation of the clinical success of four different types of lithium disilicate ceramic restorations: a retrospective study

Background/purpose How long do lithium disilicate restorations last before they fail? The aim of this study was to assess the success rate of four different types of restorations made from lithium disilicate. Materials and methods A total of 87,203 ceramic restorations, classified into four different types (inlay or onlay, veneers (Vs), single crowns (SCs), and fixed partial dentures (FPDs)), were used. All were made of lithium disilicate (IPS e.Max CAD) with Cerec Inlab CAD/CAM system (Sirona Dental Systems, Bensheim, Germany). They were reported by dentists and entered in the database of the private B&R Dental Center between March 2015 and June 2020 and assessed retrospectively up to a period of 5 years based on the following parameters: failure rate and cause of failures (ceramic fracture, debonding, marginal adaptation, color match, endodontic intervention, periodontal disease, and secondary caries). Failure distribution according to gender, arch, and teeth type was also evaluated. The time-dependent time-to-failure/complication and their differences were calculated in months according to the Kaplan Meier and log-rank tests. The Chi-squared test (p 0.05) was used to assess the variations in causes of failure rates between different restorations. Results Kaplan Meier test showed overall cumulative survival probability of lithium disilicate restorations for up to years was 85.08%. Inlay/onlay and Vs ceramic restorations showed highest cumulative survival probability (99.4%, 98.6, respectively). FPDs had the least cumulative survival probability (52.9%) which was significantly (P < 0.00001) higher than for other ceramic restorations using the log-rank test. Moreover, overall time-dependent time-to-failure/complication occurred after 52.373 months according to Kaplan–Meier (CI: lower bound: 51.875 months; upper bound: 52.871 months). Ceramic fracture in both FPDs and SCs (27.6% and 26.6%, respectively) and debonding in Vs (12.7%) were significant as the main reasons for failure (P = 0.000). The failure rate was significantly higher for the maxillary arch than the mandibular arch (P = 0.021). Fracture and marginal discrepancy were more frequent in the molar region (77.5% and 14.75%, respectively) and significantly higher here than in the anterior and premolar regions (P = 0.000). Conclusion The medium-term performance of lithium disilicate is ideal. Ceramic fracture was the most common cause of failure in SCs and FPDs. FPDs presented with the highest failure rate based on evaluation for up to 5 years.

Association of Computer Tomography Features Of COVID-19 with Outcomes, Clinical and Laboratory Parameters

Aim: to assess the results of chest computer tomography (CT) of patients with novel coronavirus infection in correspondence with their outcomes, clinical and laboratory data. Methods: retrospective analysis of 962 chest CT scans, outcomes, clinical and laboratory data of all 354 COVID-19 patients hospitalized from April to June 2020. Results: Sensitivity and specificity of CT with polimerase chain reaction (PCR) as a reference were: 98.0 % and 5.7 % respectively; for PCR with CT as a reference: 54.6 % and 70.7 % respectively. Patients with positive and negative PCR tests had no significant differences in mean CT score and CO-RADS score. Cumulative survival was better in patients with lower CT score (significant only for maximal, not baseline scores). CT score changed during hospitalization in survived patients clinically insignificant (from 2 (1-2) to 2 (1-2), p=0.001), and increased in dead (from 2 (1,5-3) to 4 (4-4), p <0.001). Lower CT score and better survival was in females, patient younger than 59 years, with NEWS score <3, without atrial fibrillation. Diabetes mellitus and obesity was associated with higher CT score, but not with survival. Chronic obstructive pulmonary disease, coronary heart disease and chronic heart failure was associated with lower survival, but not CT score. Conclusion: chest CT significantly increases diagnostic accuracy and assessment of the prognosis in COVID-19 patients.

Clinical Effects of Jiawei Danggui Beimu Kushen Pills in the Treatment of Prostate Cancer and Their Influence on the Expression of Serum Prostate Specific Antigen

Objective. To observe the clinical effects of Jiawei Danggui Beimu Kushen pills in treating prostate cancer and their influence on the expression of serum prostate specific antigen. Methods. A total of 234 prostate cancer patients were selected and randomly divided into observation group and control group, with 117 cases in each group. The control group was given oral bicalutamide tablets, while the observation group was treated with Jiawei Danggui Beimu Kushen pills on the basis of the control group. The treatment efficacy, IPSS score, TCM syndrome score, VAS score, quality-of-life score, and immune function of the two groups were compared before and after treatment. The serum PSA and f-PSA levels of patients before treatment and after 30 days, 90 days, and 180 days of treatment in the two groups were compared. The five-year cumulative survival rate and the incidence of adverse reactions were compared between the two groups. Results. After treatment, the total effective rate of the observation group was 88.03% (103/117), which was higher than that of the control group 69.23% (81/117); the difference was statistically significant ( P < 0.05 ). After treatment, the IPSS score, TCM syndrome score, and VAS score of the two groups were reduced, and those in the observation group were lower than those in the control group; the difference was statistically significant ( P < 0.05 ). After treatment, the quality-of-life scores of the two groups increased, and the observation group was higher than the control group; the difference was statistically significant ( P < 0.05 ). Before treatment, there was no significant difference in serum PSA levels and f-PSA levels when comparing between the two groups of patients ( P > 0.05 ). With the increase of treatment time, the two index levels of the two groups were gradually decreased. After 180 days of treatment, the two index levels of the two groups of patients were significantly lower than those before treatment, and the two index levels of the observation group were significantly lower than those of the control group; the difference was statistically significant ( P < 0.05 ). After treatment, the levels of IgM and IgA in the two groups were decreased, and the level of IgG was increased. The difference between the two groups in the levels of each index before and after treatment was statistically significant ( P < 0.05 ), and the difference between the two groups in the levels of each index after treatment was also statistically significant ( P < 0.05 ). The five-year cumulative survival rate of the observation group was 69.23%, and the five-year cumulative survival rate of the control group was 46.15% ( P < 0.05 ). There was no statistically significant difference between the two groups in the incidence of dizziness, fatigue, and gastrointestinal reactions ( P > 0.05 ), but the difference in the incidence of dysuria as well as dysuria and hematuria was statistically significant ( P < 0.05 ). Conclusion. Jiawei Danggui Beimu Kushen pills are effective in treating prostate cancer, which can effectively reduce the patients’ IPSS score and TCM syndrome scores, relieve the pain, and improve the quality of life of patients. They also have a potential role in regulating serum PSA levels, clearing tumor lesions, reducing postoperative complications, and improving related symptoms.

Predictors of Loss to Follow-Up among HIV-Infected Adults after Initiation of the First-Line Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia: A 5-Year Retrospective Cohort Study

Background. Loss to follow-up (LTFU) from antiretroviral therapy (ART) reduces treatment benefits and leads to treatment failure. Hence, this study was aimed at determining the incidence of loss to follow-up and predictors among HIV-infected adults who began first-line antiretroviral therapy at Arba Minch General Hospital. Methods. We carried out an institutional-based retrospective cohort study, and data were collected from the charts of 508 patients who were selected using a simple random sampling technique. All the data management and statistical analyses were conducted using STATA version 14. Cumulative survival probability was estimated and presented in the life table, and the Kaplan-Meir survival curves were compared using the log-rank test. The Cox proportional hazard model was used to identify the independent predictors. Results. We followed 508 patients for 871.9 person-years. A total of 46 (9.1%) experienced loss to follow-up, yielding an overall incidence rate of 5.3 (95% CI: 3.9-7.1) per 100 person-years. The cumulative survival probability was 90%, 88%, 86%, and 86% at the end of one, two, three, and four years, respectively. The predictors identified were age less than 35 years (adjusted hazard ratio ( aHR = 1.96 ; 95% CI: 1.92-4.00)), rural residence ( aHR = 1.98 ; 95% CI: 1.02-3.83), baseline body weight greater than 60 kilograms ( aHR = 2.19 ; 95% CI: 1.11-4.37), a fair level of adherence ( aHR = 11.5 ; 95% CI: 2.10-61.10), and a poor level of adherence ( aHR = 12.03 ; 95% CI: 5.4-26.7). Conclusions. In this study, the incidence rate of loss to follow-up was low. Younger adults below the age of 35 years, living in rural areas, with a baseline weight greater than 60 kilograms, which had a fair and poor adherence level were more likely to be lost from treatment. Therefore, health professionals working in ART clinics and potential stakeholders in HIV/AIDS care and treatment should consider adult patients with these characteristics to prevent LTFU.

Idarucizumab for Reversal of Dabigatran: Multicenter Real-World Experience

Introduction: Idarucizumab is a humanized monoclonal antibody fragment that binds to dabigatran and reverses its anticoagulant activity. It has been available in Spain since June 2016 and is indicated for imminent surgery or invasive procedures and life-threatening bleeding. The aim of the study was to describe the actual experience with idarucizumab in different centers in Madrid. Methods: Patients with electronic prescription of idarucizumab between June 2016 and July 2021 were included. Demographic information, comorbidities, laboratory parameters, dabigatran indication, anticoagulation resumption, adverse events related to idarucizumab and death within 30 days were collected from medical records. Qualitative data are presented as frequencies and percentages. Quantitative data are presented as mean ± standard deviation (SD) or median (interquartile range -IQR-). Cumulative survival was calculated by dividing the number of patients alive by the number of patients in each indication category for idarucizumab in a 30-day post-infusion period. Results: A total of 69 patients from 8 hospitals in Madrid were included. Ninety-six percent received dabigatran for prevention of stroke and embolism in nonvalvular atrial fibrillation and 4% received it for the treatment of thromboembolic disease. The mean age was 73.5 ± 13.9 years, and 55.6% were men. Median aPTT was 45.6 seconds and was prolonged in 72.1% (49). Patient characteristics, concomitant conditions and laboratory parameters are reviewed in Table 1. The main indication for idarucizumab was reversal of anticoagulation for persistent bleeding (46.4%), followed by surgery (44.9%). Fibrinolysis due to ischemic stroke was performed in 3 patients (4.3%), dabigatran intoxication occurred in 3 patients due to acute renal failure (4.3%). Gastrointestinal bleeding was the most common type of bleeding. Two of the patients intoxicated with dabigatran also had gastrointestinal bleeding. Cardiac surgery was the most common type of intervention, with heart transplant being a common indication (9/13). Minor surgical procedures included 2 lumbar punctures and 1 central venous catheterization. In one case, the type of surgery was not available. Figure 1 A and B summarize the bleeding location and type of surgery. The median time between infusion of idarucizumab and cessation of bleeding or onset of surgery was 3 hours, however this information was only available in 43 patients. No reports of excessive bleeding during surgery or after fibrinolysis were noted. One patient with dabigatran intoxication was reported to have an episode of persistent melena in which the trough plasma level was 1178.1 ng/mL. This patient died of an aggressive lymphoproliferative disorder that couldn´t be biopsied due to altered coagulation. A case of auricular thrombosis occurred in a patient with a heart transplant due to hyperthophic cardiomiopathy and end-stage heart failure requiring thrombectomy. The patient required a biventricular assistance and died of myocardial infarction. Full 30-day follow-up was available for 68 patients, during this period 11 died. Five patients in the bleeding group died, 3 from hypovolemic shock, 1 from intraparenchymal hemorrhage and data were missing for 1. Two patients who received a heart transplant died, one as described previously 10 days after the transplant and the other 2 days after the transplant from hemorrhagic shock. Three patients who underwent abdominal surgery died of septic shock. One patient with dabigatran intoxication died. Cumulative survival after a follow-up period of 30 days was 86% (Figure 2). Seventy-seven percent (53) resumed anticoagulation after a median of 3 days (0-180), and 62.3% (33) were bridged with low molecular weight heparin (LMWH) at prophylactic doses. Finally, 75% (40) maintained LMWH (7) or restarted dabigatran or another direct oral anticoagulant (33). A total of 13 patients didn´t resume any anticoagulation. Conclusions: Idarucizumab is an effective drug for reversal of dabigatran anticoagulation in bleeding or imminent surgery/invasive procedures. In this cohort it was used safely in patients awaiting a heart transplant. No cases of bleeding after infusion or during surgery were reported, except for a single case of auricular thrombosis. Most patients resumed anticoagulation at discharge. The experience described confirms the safety of idarucizumab in daily clinical practice. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Impact of severe mitral annular calcification on paravalvular leak after transcatheter aortic valve implantation

Aims Paravalvular leak (PVL) remains a frequent complication after transcatheter aortic valve implantation (TAVI) and seems to affect short- and long-term survival. Purpose The aim of this study was: 1) to identify anatomical predictors of PVL after TAVI and 2) assess the impact of PVL on cumulative survival. Methods and results Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA) ≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to the presence of PVL after TAVI and were followed up postoperatively with clinical and echocardiographic assessment. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium 2. In total, 291 patients were included (male: 50.2%, mean age: 80±7.6 years) in our study. Of these, 165 (56,8%) presented at least mild PVL after TAVI (mild: 85,5%, moderate: 13.3% and severe: 1.2%). The median follow-up period was 27.3 [min. 0, max 113 months. Two patients with severe PVL were excluded from the analysis. In the follow up period, there was no significant difference regarding all-cause mortality between patients with and those without PVL after TAVI, independently from the degree of PVL (log rank: 0.991 - Figure 1). Severe aortic annulus calcification, the presence of a bicuspid aortic valve and aortic root angulation, as assessed by computed tomography (CT), were found to associate with PVL after TAVI in univariate analysis. In the multivariate analysis, severe aortic annulus calcification was found to be the only independent predictor of mild or moderate PVL after TAVI [Exp(B): 1.540, 95% Confidence Interval: 1.067–2.224, B=0.432, p=0.021]. Conclusion The presence of mild or moderate PVL after TAVI was not found to affect cumulative survival in the 27 months of follow up period. Severe annulus calcification assessed by CT-scan, was found to be the only independent predictor of PVL after TAVI. FUNDunding Acknowledgement Type of funding sources: None.

Thrombolysis Versus Redo-Surgery for Treatment of Mechanical Prosthetic Mitral Valve Thrombosis in Young Adult Patients

Objectives To evaluate and compare outcome of redo-surgery and thrombolysis for treatment of mitral PVT following mechanical valve replacement for rheumatic etiology in young adult patients (&lt;50 years old). Methods and Results This retrospective study included 42 young adult patients who had PVT after mechanical valve replacement for rheumatic mitral valve disease, between January 2014 and June 2019. Eighteen patients underwent redo-surgery and 24 patients underwent thrombolysis (Streptokinase 100,000 U/h for at least 24 hours). The approach of treatment was based on proposed criteria considering hemodynamic status, NYHA functional class, and thrombus size. Complete response to thrombolysis was defined by normal clinical and echocardiographic parameters. Primary outcome included response to thrombolysis, complications, mortality, and recurrence. The median follow-up period was 24 months. The thrombus size was significantly larger in redo-surgery group (9.88±2.44 mm2 vs 5.87±1.26 mm2, P &lt; 0.001). The response to thrombolysis was complete recovery (70.8%), partial recovery (16.7%), or failure (12.5%). There was no significant difference in the incidence of major complications. Mortality was significantly higher in redo-surgery group (27.8% vs 4.2%, P = 0.03), with cumulative survival of 72.2% for redo-surgery versus 95.8% for thrombolysis (Log-rank P-value = 0.04). The reduced cumulative survival with redo-surgery was more evident in patients with delayed presentation (&gt; 1 week). Recurrent thrombosis occurred only with thrombolysis (8.3% vs 0%, P = 0.20). Cumulative proportions for freedom from thrombosis were 100% for surgery versus 78.1% for thrombolysis (Log-rank P-value = 0.17). Conclusions Proper patient selection may improve outcome after treatment of mitral PVT using thrombolysis or redo-surgery in young adults. Redo-surgery has advantages over thrombolysis regarding mid-term recurrence of thrombosis; however, thrombolysis has significantly lower mortality than redo-surgery. Further evaluation of the proper treatment for delayed presentation of PVT is recommended.