Outcome research on esophagectomy analyzed using nationwide databases in Japan: evidences generated from real-world data.

Esophagectomy for esophageal cancer is a highly invasive gastrointestinal surgical procedure. The National Clinical Database (NCD) of Japan, initiated in 2011, has compiled real-world data on esophagectomy, one of nine major gastroenterological surgeries. This review examines outcomes after esophagectomy analyzed using the Japanese big databases. Certification systems by the Japanese Society of Gastroenterological Surgery (JSGS) and the Japan Esophageal Society (JES) have shown that institutional certification has a greater impact on short-term surgical outcomes than surgeon certification. Minimally invasive esophagectomy has emerged as a viable alternative to open esophagectomy, although careful patient selection is crucial, especially for elderly patients with advanced tumors. The NCD has significantly contributed to the assessment and enhancement of surgical quality and short-term outcomes, while studies based on Comprehensive Registry of Esophageal Cancer in Japan (CRECJ) have provided data on patient characteristics, treatments, and long-term outcomes. The JES has conducted various questionnaire-based retrospective clinical reviews in collaboration with authorized institutions certified by JES. The Diagnosis Procedure Combination (DPC) database provides administrative claims data including itemized prices for surgical, pharmaceutical, laboratory, and other inpatient services. Analyzing these nationwide databases can offer precise insights into surgical quality for esophageal cancer, potentially leading to improved treatment outcomes.

Orthorhombic Polar Phase in Sodium Niobate Nanoribbons.

Ferroelectric materials exhibit switchable spontaneous polarization below Curie's temperature, driven by octahedral distortions and rotations, as well as ionic displacements. The ability to manipulate polarization coupled with persistent remanence, drives diverse applications, including piezoelectric devices. In the last two decades, nanoscale exploration has unveiled unique material properties influenced by morphology, including the capability to manipulate polarization, patterns, and domains. This paper focuses on the characterization of nanometric sodium niobate (SN) synthesized from metallic niobium through alkali hydrothermal treatment, utilizing electron microscopy techniques, including high-resolution differential phase contrast (DPC) in scanning transmission electron microscopy (STEM). The material exhibits a nanoribbon structure forming a tree root-like network. The study identifies crystallographic phase, atomic columns displacement directions, and surface features, such as exposed planes and the absence of particular atomic columns. The high sensitivity of integrated DPC images proves crucial in overcoming observational challenges in other STEM modes. These observations are essential for potential applications in electronic, photocatalytic, and chemical reaction contexts.

Impact of the coronavirus disease 2019 pandemic on the number of colorectal cancer surgeries performed: analysis of a nationwide inpatient database in Japan.

PURPOSE: This study examined the impact of the COVID-19 pandemic on the number of colorectal cancer surgeries performed in Japan. METHODS: We selected patients who underwent colorectal cancer surgeries between January, 2017 and December, 2020 from the Diagnosis Procedure Combination database. The COVID-19 pandemic was divided into three waves. We evaluated the changes in the number of surgeries performed for colorectal cancer during each wave, stratified by cancer stage using Poisson regression. RESULTS: During the first wave, the rate ratio (RR) for stage III colon cancer decreased significantly (RR, 0.94), whereas those for stages 0 to II (RR, 1.01) and stage IV (RR, 1.04) were not different. During the second and third waves, the RR for stage 0 to II colon cancer decreased significantly (RR, 0.96), that for stage IV increased (RR, 1.09), and that for stage III was not different (RR, 0.97). During the first wave, the RR for stage 0 to II rectal cancer increased significantly (RR, 1.09), that for stage IV decreased (RR, 0.84), and that for stage III was not different (RR, 0.97). CONCLUSIONS: The number of colorectal cancer surgeries changed during the pandemic and varied according to the stage of disease.

Stroke Research Using Administrative Claims Database in Japan: A Narrative Review.

AIMS: Although administrative claims databases have recently been used for clinical research in Japan, no detailed description of their utilization in stroke research is available. We reviewed stroke studies using the Diagnosis Procedure Combination (DPC), the National Database of Health Insurance Claims and Specific Health Checkups (NDB), and several commercial databases sourced from social health insurance associations, focusing on their applications and limitations. METHODS: Original articles on stroke published by April 2024 using the DPC, NDB, and commercial databases were identified in Ovid MEDLINE. The characteristics of each database were compared in terms of comprehensiveness, traceability, baseline information, and outcome assessment in stroke research. RESULTS: A total of 114 studies were included (83 for DPC, 6 for NDB, and 25 for commercial databases). The number of stroke studies using administrative databases in Japan is still approximately 10 per year, although there is a slowly increasing trend. The DPC database was utilized for short-term outcome studies because of its detailed baseline and outcome information, although the inability to track patients once they changed facilities limits their use in long-term studies. The NDB database is potentially useful for long-term studies because of its comprehensiveness and traceability, but difficulties in data access restrict its usage. The most commonly used commercial database utilizes baseline information on lifestyle and blood test data, although the lack of coverage for those over 75 years old may limit its generalizability. CONCLUSIONS: Administrative claims databases are beginning to be used in stroke research in Japan but are not yet fully utilized. Researchers need to understand their applications and limitations.

Low-voltage single-atom electron microscopy with carbon-based nanomaterials.

The properties of materials are strongly correlated with their atomic scale structures. Achieving a comprehensive understanding of the atomic-scale structure-property relationship requires advancements of imaging and spectroscopy techniques. Aberration-corrected scanning transmission electron microscopy (STEM) has seen rapid development over the past decades and is now routinely employed for atomic-scale characterization. However, quantitative STEM imaging and spectroscopy analysis at the single-atom level is challenging due to the extremely weak signals generated from individual atom, thus imposing stringent requirements for analysis sensitivity. This review discusses the development and application of low-voltage STEM techniques with single-atom sensitivity, primarily based on recent research presented on an invited talk at the 5th 2D23 SALVE Symposium, including annular dark-field (ADF) imaging, functional imaging and electron energy-loss spectroscopy (EELS) analysis. Carbon-based nanomaterials were chosen as model systems for demonstrating the capabilities of single-atom STEM imaging and EELS analysis, due to their structural stability under low accelerating voltages and their rich physical and chemical properties. Moreover, this review summarizes recent advancements and applications of low-voltage single-atom STEM imaging and spectroscopy in the study of functional materials and discusses prospects for future developments.

Differential phase contrast STEM image calculation software - Magnifier.

An innovative software with a user-friendly interface for calculation of differential phase contrast (DPC) scanning transmission electron microscopy images (integrated iDPC- and differentiated dDPC-STEM) is presented. The underlying algorithm is described and the program functionalities are demonstrated on the examples of Li5OsO6, α-Ga2O3, and LiCoO2. The software supports interpretation of DPC-STEM images, which is crucial for qualitative and quantitative analysis of crystal structures and defects.

Exploration of the thickness-depended dynamic properties of differential phase contrast (DPC) and integrated differential phase contrast (iDPC).

A study on DPC and iDPC images of crystals is achieved with simulation. It highlights the use of electron wave intensity distribution to visualize the dynamic effect on DPC and iDPC contrasts. Electron waves near heavy atoms exhibit significant oscillations and rapid intensity decay. This oscillation causes DPC and iDPC signal inversion. Bloch wave theory is used to derive DPC and iDPC intensity distributions, elucidating the impact of dynamic effect on the contrast.

Exosomes derived from mouse vibrissa dermal papilla cells promote hair follicle regeneration during wound healing by activating Wnt/ß-catenin signaling pathway.

Hair follicle (HF) regeneration during wound healing continues to present a significant clinical challenge. Dermal papilla cell-derived exosomes (DPC-Exos) hold immense potential for inducing HF neogenesis. However, the accurate role and underlying mechanisms of DPC-Exos in HF regeneration in wound healing remain to be fully explained. This study, represents the first analysis into the effects of DPC-Exos on fibroblasts during wound healing. Our findings demonstrated that DPC-Exos could stimulate the proliferation and migration of fibroblasts, more importantly, enhance the hair-inducing capacity of fibroblasts. Fibroblasts treated with DPC-Exos were capable of inducing HF neogenesis in nude mice when combined with neonatal mice epidermal cells. In addition, DPC-Exos accelerated wound re-epithelialization and promoted HF regeneration during the healing process. Treatment with DPC-Exos led to increased expression levels of the Wnt pathway transcription factors ß-catenin and Lef1 in both fibroblasts and the dermis of skin wounds. Specifically, the application of a Wnt pathway inhibitor reduced the effects of DPC-Exos on fibroblasts and wound healing. Accordingly, these results offer evidence that DPC-Exos promote HF regeneration during wound healing by enhancing the hair-inducing capacity of fibroblasts and activating the Wnt/ß-catenin signaling pathway. This suggests that DPC-Exos may represent a promising therapeutic strategy for achieving regenerative wound healing.

A DPC Database Study on the Safety of Atezolizumab/Carboplatin/Etoposide in Extensive-Disease Small Cell Lung Cancer in Japanese Patients.

INTRODUCTION: Atezolizumab, carboplatin, and etoposide (ACE) therapy is a standard of care for extensive-disease small cell lung cancer (SCLC); however, its safety data are scarce, limiting generalization to the Japanese population. METHODS: This study aimed to compare the safety of ACE versus carboplatin and etoposide (CE) therapies in Japanese patients using the Diagnosis Procedure Combination (DPC) database by comparing the incidence of adverse events (AEs). Retrospective data on clinical background and AEs were extracted from the DPC database. Incidence rates and restricted mean survival times (RMSTs) up to 6 months were analyzed for 19 clinically important AEs. Covariates were adjusted using the inverse probability weighting method. RESULTS: A total of 330,774 patients were identified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes, of whom 277 were included in the ACE cohort and 478 in the CE cohort. Among the 19 AEs, the incidence of skin disorder and thyroid dysfunction was significantly higher in the ACE cohort compared with the CE cohort. The adjusted incidence rate ratios were 2.38 (95% confidence interval [CI] 1.04-5.43) for skin disorder and 6.92 (95% CI 2.00-23.89) for thyroid dysfunction. The adjusted RMST differences were - 8.2 days (95% CI - 16.0 to - 0.4 days) for skin disorder and - 8.8 days (95% CI - 15.7 to - 1.9 days) for thyroid dysfunction. CONCLUSIONS: This study provides evidence regarding the safety of ACE combination therapy in Japanese clinical practice using the DPC database, with results comparable to those reported in pivotal clinical trials. TRIAL REGISTRATION: UMIN Clinical Trials Registry ID UMIN000041508.

Potential of Reusing 3D Printed Concrete (3DPC) Fine Recycled Aggregates as a Strategy towards Decreasing Cement Content in 3DPC.

This paper explores the new potential strategy of using fine recycled aggregates (fRA) derived from waste 3D printed concrete (3DPC) as a substitute for cement in additive manufacturing. This study hypothesizes that fRA can optimize mixture design, reduce cement content, and contribute to sustainable construction practices. Experimental programs were conducted to evaluate the fresh and hardened properties, printability window, and buildability of 3DPC mixes containing fRA. Mixes with replacement rates of cement with fRA by 10 vol%, 20 vol%, 30 vol%, 40 vol%, and 50 vol% were produced. A comprehensive experimental protocol consisting of rheological studies (static and dynamic yield stress), dynamic elastic modulus determination (first 24 h of hydration), flexural and compressive strengths (2 d and 28 d), and an open porosity test was performed. The obtained results were verified by printing tests. In addition, an economic and environmental life cycle assessment (LCA) of the mixes was performed. The results indicate that up to 50 vol% cement replacement with fRA is feasible, albeit with some technical drawbacks. While fRA incorporation enhances sustainability by reducing CO2 emissions and material costs, it adversely affects the printability window, green strength, setting time, and mechanical properties, particularly in the initial curing stages. Therefore, with higher replacement rates (above 20 vol%), potential optimization efforts are needed to mitigate drawbacks such as reduced green strength and buildability. Notably, replacement rates of up to 20 vol% can be successfully used without compromising the overall material properties or altering the mixture design. The LCA analysis shows that reducing the cement content and increasing the fRA addition results in a significant reduction in mix cost (up to 24%) and a substantial decrease in equivalent CO2 emissions (up to 48%). In conclusion, this study underscores the potential of fRA as a sustainable alternative to cement in 3D printed concrete.

DFT-Assisted Investigation of the Electric Field and Charge Density Distribution of Pristine and Defective 2D WSe2 by Differential Phase Contrast Imaging.

Most properties of solid materials are defined by their internal electric field and charge density distributions which so far are difficult to measure with high spatial resolution. Especially for 2D materials, the atomic electric fields influence the optoelectronic properties. In this study, the atomic-scale electric field and charge density distribution of WSe2 bi- and trilayers are revealed using an emerging microscopy technique, differential phase contrast (DPC) imaging in scanning transmission electron microscopy (STEM). For pristine material, a higher positive charge density located at the selenium atomic columns compared to the tungsten atomic columns is obtained and tentatively explained by a coherent scattering effect. Furthermore, the change in the electric field distribution induced by a missing selenium atomic column is investigated. A characteristic electric field distribution in the vicinity of the defect with locally reduced magnitudes compared to the pristine lattice is observed. This effect is accompanied by a considerable inward relaxation of the surrounding lattice, which according to first principles DFT calculation is fully compatible with a missing column of Se atoms. This shows that DPC imaging, as an electric field sensitive technique, provides additional and remarkable information to the otherwise only structural analysis obtained with conventional STEM imaging.

Patient characteristics, diagnostic testing, and initial treatment profiles of patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) using a Japanese claims database.

OBJECTIVES: To investigate the diagnostic and therapeutic landscape for patients with connective tissue disease (CTD) and CTD-associated pulmonary arterial hypertension (CTD-PAH) in acute-care general hospitals in Japan. METHODS: We conducted a retrospective cohort study by analysing the Medical Data Vision (MDV) database from April 2008 and September 2020. CTD patients who prescribed immunosuppressants were included in cohort 1, and CTD-PAH patients extracted from cohort 1 were included in cohort 2. Patient characteristics, diagnostic screening frequencies for PAH, and initial PAH-specific treatment patterns were assessed. RESULTS: Overall, 16648 patients with CTD and 81 patients with CTD-PAH were included in cohorts 1 and 2, respectively. The frequencies of screening tests for PAH, including brain natriuretic peptide (BNP), transthoracic echocardiogram (TTE), and diffusing capacity of the lungs for carbon monoxide (DLCO), among CTD patients were 0.7, 0.3, and 0.1 tests/person-year, respectively. The most common initial PAH-specific treatment therapy was monotherapy (87.7%), followed by dual therapy (7.4%), and triple therapy (2.5%). CONCLUSION: This is the first study to describe the patient flow from PAH diagnosis to initial PAH-specific treatment for real-world patients who were followed regularly due to CTD in Japanese clinical practice.

Diffraction contrast of ferroelectric domains in DPC STEM images.

Differential phase contrast scanning transmission electron microscopy (DPC STEM) is a powerful technique for directly visualizing electromagnetic fields inside materials at high spatial resolution. Electric field observation within ferroelectric materials is potentially possible by DPC STEM, but concomitant diffraction contrast hinders the quantitative electric field evaluation. Diffraction contrast is basically caused by the diffraction-condition variation inside a field-of-view, but in the case of ferroelectric materials, the diffraction conditions can also change with respect to the polarization orientations. To quantitatively observe electric field distribution inside ferroelectric domains, the formation mechanism of diffraction contrast should be clarified in detail. In this study, we systematically simulated diffraction contrast of ferroelectric domains in DPC STEM images based on the dynamical diffraction theory, and clarify the issues for quantitatively observing electric fields inside ferroelectric domains. Furthermore, we conducted experimental DPC STEM observations for a ferroelectric material to confirm the influence of diffraction contrast predicted by the simulations.

Analysis of in-hospital deaths in patients with critical limb ischemia necessitating invasive treatments: based on a Japanese nationwide database.

Critical limb ischemia (CLI) is associated with systemic cardiovascular and non-cardiovascular diseases. Treatments primarily targeting limb-related outcomes may not improve overall life prognosis. We aimed to describe in-hospital mortality and the underlying etiologies in Japanese patients with CLI. We analyzed the Diagnosis Procedure Combination (DPC) database from approximately 1200 Japanese acute-care hospitals between April 2018 and March 2020. The definition of patients with CLI was based on the diagnostic codes listed as the most resource-intensive diagnosis and information regarding invasive procedures (endovascular treatment, bypass, or amputation). The DPC database provides information on whether in-hospital death was caused by the most resource-intensive diagnosis. Among 15,228 distinct patients with CLI, we identified 18,970 records, including 5,378 amputations. In-hospital death occurred in 1238 (6.5%) patients. Among them, 811 (65.5%) were due to causes unrelated to CLI. In patients who underwent amputation (n = 5378), causes unrelated to CLI accounted for 70.0% of in-hospital deaths, whereas among patients who did not undergo amputation (n = 13,592), this proportion was 60.1%. When compared to patients who died due to causes related to CLI, the prevalence of male patients was higher (62.6% vs 52.7%, p = 0.001), and amputation was more frequently performed (58.0% vs 47.1%, p < 0.001) in those who died due to causes unrelated to CLI. The majority of in-hospital deaths among patients with CLI necessitating endovascular treatment, bypass, or amputation were attributable to factors unrelated to the primary condition of CLI. Managing systemic cardiovascular and non-cardiovascular diseases beyond the affected limb is crucial to improve the prognosis of these patients.

A Reduction in the Number of Hospitalized Cases of Acute Meningitis during the COVID-19 Pandemic in Japan.

Objective The changes in the prevalence of acute meningitis during the coronavirus disease 2019 (COVID-19) pandemic remain unclear. This study aimed to compare the prevalence of acute meningitis before and during the COVID-19 pandemic in Japan. Methods We retrospectively reviewed the Japanese nationwide administrative medical payment system database, Diagnosis Procedure Combination (DPC), from 2016 to 2022. A total of 547 hospitals consistently and seamlessly offered DPC data during this period. The study period was divided into the following three periods: April 2016 to March 2018 (fiscal years 2016-2017), April 2018-March 2020 (2018-2019), and April 2020-March 2022 (2020-2021). Results Among the 28,161,806 patients hospitalized during the study period, 28,399 were hospitalized for acute meningitis: 16,678 for viral/aseptic type, 6,189 for bacterial type, 655 for fungal type, 429 for tuberculous, 2,310 for carcinomatous type, and 2,138 for other or unknown types of meningitis. A significant decrease during the pandemic was confirmed in viral (n=7,032, n=5,775, and n=3,871 in each period; p<0.0001) and bacterial meningitis (n=2,291, n=2,239, and n=1,659; p<0.0001) cases. Meanwhile, no decrease was observed in fungal meningitis (n=212, n=246, and n=197; p=0.056) or carcinomatous meningitis (n=781, n=795, and n=734; p=0.27). The decrease in the number of tuberculous meningitis cases was equivocal (n=166, n=146, and n=117; p=0.014). The decrease during the pandemic was more remarkable in younger populations aged <50 years than in older populations, both for viral and bacterial meningitis. Conclusion The number of hospitalized cases of acute meningitis clearly decreased during the COVID-19 pandemic, especially for viral and bacterial meningitis in younger populations aged <50 years.

Dimerization of the ß-Hairpin Membrane-Active Cationic Antimicrobial Peptide Capitellacin from Marine Polychaeta: An NMR Structural and Thermodynamic Study.

Capitellacin is the ß-hairpin membrane-active cationic antimicrobial peptide from the marine polychaeta Capitella teleta. Capitellacin exhibits antibacterial activity, including against drug-resistant strains. To gain insight into the mechanism of capitellacin action, we investigated the structure of the peptide in the membrane-mimicking environment of dodecylphosphocholine (DPC) micelles using high-resolution NMR spectroscopy. In DPC solution, two structural forms of capitellacin were observed: a monomeric ß-hairpin was in equilibrium with a dimer formed by the antiparallel association of the N-terminal ß-strands and stabilized by intermonomer hydrogen bonds and Van der Waals interactions. The thermodynamics of the enthalpy-driven dimerization process was studied by varying the temperature and molar ratios of the peptide to detergent. Cooling the peptide/detergent system promoted capitellacin dimerization. Paramagnetic relaxation enhancement induced by lipid-soluble 12-doxylstearate showed that monomeric and dimeric capitellacin interacted with the surface of the micelle and did not penetrate into the micelle interior, which is consistent with the "carpet" mode of membrane activity. An analysis of the known structures of ß-hairpin AMP dimers showed that their dimerization in a membrane-like environment occurs through the association of polar or weakly hydrophobic surfaces. A comparative analysis of the physicochemical properties of ß-hairpin AMPs revealed that dimer stability and hemolytic activity are positively correlated with surface hydrophobicity. An additional positive correlation was observed between hemolytic activity and AMP charge. The data obtained allowed for the provision of a more accurate description of the mechanism of the oligomerization of ß-structural peptides in biological membranes.

Improved Activities of Daily Living With Adjunctive Intravenous Steroids in Bacterial Meningitis: A Nationwide, Population-Based Medical Database Study.

The benefit of using adjunctive intravenous steroids (IVS) to reduce the neurological sequelae in bacterial meningitis remains inconclusive. This study evaluated the effect of IVS on improving the subsequent Activities of Daily Living (ADL) in bacterial meningitis by analyzing data from a large nationwide administrative medical database in Japan. Data from 1,132 hospitals, covered by the administrative Diagnosis Procedure Combination (DPC) payment system from 2016 to 2022, were evaluated. The ADL levels at admission and discharge were measured using the Barthel Index (BI). Out of the cumulative 47,366,222 patients hospitalized, 8,736 were diagnosed with acute bacterial meningitis and had BI data available. The BI at discharge, adjusted for sex, age, and BI at admission, was significantly better among those treated with IVS (p<0.0001). Exploratory subgroup analyses suggested that this benefit is expected across a broad spectrum of bacterial species. In summary, the use of IVS for improving the subsequent ADL level in bacterial meningitis was suggested.

Isolation and Culture of Primary Human Dental Pulp Cells-A Description of Technical and Methodological Steps to Maximise Predictability and Yield.

The dental pulp has critical functions in tooth development as well as an ongoing role in promoting and maintaining the vitality of teeth. In particular, its regenerative ability allows dental tissues to be restored following damage caused by traumatic injury or caries. Regenerative endodontic procedures aim to utilise these processes to stimulate dental pulp repair in a minimally invasive manner and reduce the need for more invasive procedures such as root canal treatment. Dental pulp is a source of dental pulp cells (DPCs), which has a subpopulation of dental pulp stem cells (DPSCs), which are attractive for use in regenerative medicine due to their high proliferation rate, ability to differentiate into multiple cell types, and their preserved vitality following cryopreservation. The development of next-generation clinical therapeutics that maximise the potential of dental pulp relies on strong empirical evidence arising from in vitro experimentation. Here, we describe a modified method for the efficient isolation of primary human DPCs from sound third molar teeth for culture using an explant outgrowth method on basement membrane-coated flasks, as well as using high-resolution macro-photography to illustrate the methods. Critically, steps are taken to minimise potential physical and mechanical trauma to the cells and maximise yield. Human DPCs cultured using this method can be further expanded in cell culture flasks to facilitate their use in various in vitro experimental procedures.