Artificial Intelligence Imaging Diagnosis Using Super-Resolution and Three-Dimensional Shape for Lymph Node Metastasis of Low Rectal Cancer: A Pilot Study From a Single Center.

BACKGROUND: Although accurate preoperative diagnosis of lymph node metastasis is essential for optimizing treatment strategies for low rectal cancer, the accuracy of present diagnostic modalities has room for improvement. OBJECTIVE: The study aimed to establish a high-precision diagnostic method for lymph node metastasis of low rectal cancer using artificial intelligence. DESIGN: A retrospective observational study. SETTINGS: A single cancer center and a college of engineering in Japan. PATIENTS: Patients with low rectal adenocarcinoma who underwent proctectomy, bilateral lateral pelvic lymph node dissection, and contrast-enhanced multidetector row CT (slice ≤1 mm) between July 2015 and August 2021 were included in the present study. All pelvic lymph nodes from the aortic bifurcation to the upper edge of the anal canal were extracted, regardless of whether within or beyond the total mesenteric excision area, and pathological diagnoses were annotated for training and validation. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: A total of 596 pathologically negative nodes and 43 positive nodes from 52 patients were extracted and annotated. Four diagnostic methods, with and without using super-resolution images and with and without using 3-dimensional shape data, were performed and compared. The super-resolution + 3-dimensional shape data method had the best diagnostic ability for the combination of sensitivity, negative predictive value, and accuracy (0.964, 0.966, and 0.968, respectively), whereas the super-resolution only method had the best diagnostic ability for the combination of specificity and positive predictive value (0.994 and 0.993, respectively). LIMITATIONS: Small number of patients at a single center and the lack of external validation. CONCLUSIONS: Our results enlightened the potential of artificial intelligence for the method to become another game changer in the diagnosis and treatment of low rectal cancer. See Video Abstract . DIAGNSTICO POR IMGENES CON INTELIGENCIA ARTIFICIAL MEDIANTE SUPERRESOLUCIN Y FORMA D PARA LA METSTASIS EN LOS GANGLIOS LINFTICOS DEL CNCER DE RECTO BAJO UN ESTUDIO PILOTO DE UN SOLO CENTRO: ANTECEDENTES:Aunque el diagnóstico preoperatorio preciso de metástasis en los ganglios linfáticos es esencial para optimizar las estrategias de tratamiento para el cáncer de recto bajo, la precisión de las modalidades de diagnóstico actuales tiene margen de mejora.OBJETIVO:Establecer un método de diagnóstico de alta precisión para las metástasis en los ganglios linfáticos del cáncer de recto bajo utilizando inteligencia artificial.DISEÑO:Un estudio observacional retrospectivo.AJUSTE:Un único centro oncológico y una facultad de ingeniería en Japón.PACIENTES:En el presente estudio se incluyeron pacientes con adenocarcinoma rectal bajo sometidos a proctectomía, disección bilateral de ganglios linfáticos pélvicos laterales y tomografía computarizada con múltiples detectores con contraste (corte ≤1 mm) entre julio de 2015 y agosto de 2021. Se resecaron todos los ganglios linfáticos pélvicos desde la bifurcación aórtica hasta el borde superior del canal anal, independientemente de si estaban dentro o más allá del área de escisión mesentérica total, y se registraron los diagnósticos patológicos para entrenamiento y validación.PRINCIPALES MEDIDAS DE RESULTADO:Sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión.RESULTADOS:Se extrajeron y registraron un total de 596 ganglios patológicamente negativos y 43 positivos de 52 pacientes. Se realizaron y compararon cuatro métodos de diagnóstico, con y sin imágenes de súper resolución y sin datos de imagen en 3D. El método de superresolución + datos de imagen en 3D tuvo la mejor capacidad de diagnóstico para la combinación de sensibilidad, valor predictivo negativo y precisión (0,964, 0,966 y 0,968, respectivamente), mientras que el método de súper resolución solo tuvo la mejor capacidad de diagnóstico para la combinación de especificidad y valor predictivo positivo (0,994 y 0,993, respectivamente).LIMITACIONES:Pequeño número de pacientes en un solo centro y falta de validación externa.CONCLUSIONES:Nuestros resultados iluminan el potencial de la inteligencia artificial para que el método se convierta en otro elemento de cambio en el diagnóstico y tratamiento del cáncer de recto bajo. (Traducción ---Dr. Fidel Ruiz Healy ).

Effects of simultaneous short-term neuromuscular electrical stimulation and static stretching on calf muscles.

[Purpose] The simultaneous application of static stretching and neuromuscular electrical stimulation (NMES) to calf muscles may enhance physiological parameters in young and healthy individuals; however, the efficacy of this intervention and potential sex variation remain to be elucidated. The present study aimed to investigate these aspects. [Participants and Methods] Thirty healthy university students (15 males and 15 females) participated in this study. All participants simultaneously underwent static stretching and NMES of the calf muscles for 4 min while lying on an upright and tilted table. The mean differences in the dorsiflexion angle (DFA), finger-floor distance (FFD), and straight leg raising (SLR) angle before and after the intervention were calculated. Sex variations were assessed using a two-way analysis of variance (ANOVA). [Results] The DFA, FFD, and SLR angle exhibited significant effects on time. No significant sex variations were observed between the groups. [Conclusion] Simultaneous static stretching and NMES of the calf muscles potentially enhanced the DFA, FFD, and SLR angle in healthy university students, irrespective of sex.

Artificial intelligence for surgical safety during laparoscopic gastrectomy for gastric cancer: Indication of anatomical landmarks related to postoperative pancreatic fistula using deep learning.

BACKGROUND: Postoperative pancreatic fistula (POPF) is a critical complication of laparoscopic gastrectomy (LG). However, there are no widely recognized anatomical landmarks to prevent POPF during LG. This study aimed to identify anatomical landmarks related to POPF occurrence during LG for gastric cancer and to develop an artificial intelligence (AI) navigation system for indicating these landmarks. METHODS: Dimpling lines (DLs)-depressions formed between the pancreas and surrounding organs-were defined as anatomical landmarks related to POPF. The DLs for the mesogastrium, intestine, and transverse mesocolon were named DMP, DIP, and DTP, respectively. We included 50 LG cases to develop the AI system (45/50 were used for training and 5/50 for adjusting the hyperparameters of the employed system). Regarding the validation of the AI system, DLs were assessed by an external evaluation committee using a Likert scale, and the pancreas was assessed using the Dice coefficient, with 10 prospectively registered cases. RESULTS: Six expert surgeons confirmed the efficacy of DLs as anatomical landmarks related to POPF in LG. An AI system was developed using a semantic segmentation model that indicated DLs in real-time when this system was synchronized during surgery. Additionally, the distribution of scores for DMP was significantly higher than that of the other DLs (p < 0.001), indicating the relatively high accuracy of this landmark. In addition, the Dice coefficient of the pancreas was 0.70. CONCLUSIONS: The DLs may be used as anatomical landmarks related to POPF occurrence. The developed AI navigation system can help visualize the DLs in real-time during LG.

Novel reconstruction method using long and narrow gastric tube in laparoscopic proximal gastrectomy for cancer: a retrospective case series study.

Background and objectives: To clarify the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with our novel reconstruction methods. Methods: Novel method is a reconstruction with a long and narrow gastric tube with widening of the proximal side created by linear stapler, and esophagogastrostomy is performed by linear stapler. In conventional method, esophagogastrostomy is performed by a circular stapler. Short- and long-term outcomes of a novel method were compared with those of conventional method. Results: A total of 44 patients whom LPG was performed were enrolled in this retrospective study. No cases of anastomotic leakage and stenosis were observed in both groups. The cases of postoperative reflux esophagitis (Grade B or higher) at 1 year after operation in the Novel group were less than those in the Conventional group (17% vs. 44%). Conclusion: LPG with novel reconstruction method can be easily performed, and may be feasible for the treatment of proximal gastric cancer.

Synthesis of a Gold-Silver Alloy Nanocluster within a Ring-Shaped Polyoxometalate and Its Photocatalytic Property.

Alloying is an effective method for modulating metal nanoclusters to enrich their structural diversity and physicochemical properties. Recent investigations have demonstrated that polyoxometalates (POMs) can act as effective multidentate ligands for silver (Ag) nanoclusters to endow them with synergistic properties, reactivity, catalytic properties, and stability. However, the application of POMs as ligands has been confined predominantly to monometallic nanoclusters. Herein, we report a synthetic method for fabricating surface-exposed gold (Au)-Ag alloy nanoclusters within a ring-shaped POM ([P8W48O184]40-). Reacting an Ag nanocluster stabilized by the ring-shaped POM with Au ions (Au+) was found to substitute several Ag atoms at the core of the nanocluster with Au atoms. The resultant {Au8Ag26} alloy nanocluster demonstrated superior photocatalytic activity and stability compared to the pristine Ag nanocluster in the aerobic oxidation of α-terpinene under visible-light irradiation. These findings provide fundamental insights into the formation and catalytic properties of POM-stabilized alloy nanoclusters and advance exploration into the synthesis and applications of diverse metal nanoclusters.

Synthesis of polyoxothiometalates through site-selective post-editing sulfurization of polyoxometalates.

Polyoxometalates (POMs) function as platforms for synthesizing structurally well-defined inorganic molecules with diverse structures, metals, compositions, and arrangements. Although post-editing of the oxygen sites of POMs has great potential for development of unprecedented structures, electronic states, properties, and applications, facile methods for site-selective substitution of the oxygen sites with other atoms remain limited. Herein, we report a direct site-selective oxygen-sulfur substitution method that enables transforming POMs [XW12O40]4- (X = Si, Ge) to Keggin-type polyoxothiometalates (POTMs) [XW12O28S12]4- using sulfurizing reagents in an organic solvent. The resulting POTMs retain the original Keggin-type structure, with all 12 surface W[double bond, length as m-dash]O groups selectively converted to W[double bond, length as m-dash]S without sulfurization of other oxygen sites. These POTMs show high stability against water and O2 in organic solvents and a drastic change in the electronic states and redox properties. The findings of this study represent a facile method for converting POMs to POTMs, leading to the development of their unique properties and applications in diverse fields, including (photo)catalysis, sensing, optics, electronics, energy conversion, and batteries.

Diffusely distributed centrilobular micronodules and branching opacities as the main chest computed tomography manifestations in a patient with humidifier lung.

We report a 60-year-old man with humidifier lung showing diffusely distributed centrilobular micronodules and branching opacities on chest computed tomography (CT). Fever and dyspnea occurred 2 months after using an ultrasonic humidifier. KL-6 and SP-D were within normal ranges. Bronchoalveolar lavage showed elevated lymphocytes (53 %) and histological findings of transbronchial lung biopsy demonstrated organizing pneumonia. His condition improved after cessation of the humidifier. A provocation test exhibited a positive response to the humidifier. Humidifier lung should be considered as a differential diagnosis in patients with these CT findings. Detailed clinical, pathological and microbiological examinations are needed to exclude other diseases.

Association between mental health social worker staffing in psychiatric emergency wards and readmission outcomes: A nationwide survey in Japan.

Aim: The mental healthcare system in Japan is transitioning from institution-based to community-based treatment. To prevent prolonged hospitalization and community integration of psychiatric patients, mental health social workers (MHSWs) are pivotal in coordinating post-discharge arrangements for psychiatric inpatients. This study aimed to propose a care model to improve clinical outcomes in psychiatric emergency wards in Japan. Methods: We conducted a mail-in questionnaire survey targeting medical facilities with psychiatric emergency wards. We collected data of the psychiatric care system, including facility profiles, staffing conditions and caseloads, and the provided psychiatric services and treatment options. Using multiple regression analyses, we explored associations between these data and clinical outcomes, focusing on the average number of days for hospitalization and the integration of patients into a community. Results: Data were collected from 82 facilities (response rate, 45.8%). The average number of days for hospitalization and community integration were 64.7 and 327.9 days, respectively. The caseloads for MHSWs were significantly associated with longer hospitalization (ß = 0.31, p = 0.009) and shorter duration of community living (ß = -0.28, p = 0.027). Conclusion: The clinical performance in psychiatric emergency wards surpassed the Japanese government's targets regarding these outcomes. We found that heavy caseloads on MHSWs were associated with worse clinical outcomes for patients in psychiatric emergency wards. These findings suggest that reducing MHSW caseloads (≤20 cases) may be a potential interventional strategy to prevent prolonged hospitalization and promote successful community integration of patients.

Self-assembled molecular hybrids comprising lacunary polyoxometalates and multidentate imidazole ligands.

Self-assembly via coordination bonding facilitates the creation of diverse inorganic-organic molecular hybrids with distinct structures and properties. Recent advances in this field have been driven by the versatility of organic ligands and inorganic units. Lacunary polyoxometalates are a class of well-defined metal-oxide clusters with a customizable number of reactive sites and bond directions, which make them promising inorganic units for self-assembled molecular hybrids. Herein, we report a novel synthesis method for self-assembled molecular hybrids utilizing the reversible coordination of multidentate imidazole ligands to the vacant sites of lacunary polyoxometalates. We synthesized self-assembled molecular hybrids including monomer, dimers, and tetramer, demonstrating the potential of our method for constructing intricate hybrids with tailored properties and functionalities.

Multidentate polyoxometalate modification of metal nanoparticles with tunable electronic states.

To respond to the increasing demands for practical applications, stabilization and property modulation of metal nanoparticles have emerged as a key research subject. Herein, we present a viable protocol for preparing small metal nanoparticles (<5 nm; Ag, Pd, Pt, and Ru) via multidentate polyoxometalate (POM, [SiW9O34]10-) modification. In addition to enhancing stability, the POMs can modulate the electronic states of metal nanoparticles. Moreover, immobilization of the POM-modified metal nanoparticles on solid supports enables further tuning of the electronic states via a cooperative effect between the POMs and the supports without altering the particle size. Notably, POM-modified Pd nanoparticles on carbon support exhibited superior catalytic activity and selectivity in hydrogenation reactions in comparison with the catalyst without the POM modification.

Bottom-up butterfly model with thorax-pitch control and wing-pitch flexibility.

The diversity in butterfly morphology has attracted many people around the world since ancient times. Despite morphological diversity, the wing and body kinematics of butterflies have several common features. In the present study, we constructed a bottom-up butterfly model, whose morphology and kinematics are simplified while preserving the important features of butterflies. The present bottom-up butterfly model is composed of two trapezoidal wings and a rod-shaped body with a thorax and abdomen. Its wings are flapped downward in the downstroke and backward in the upstroke by changing the geometric angle of attack (AOA). The geometric AOA is determined by the thorax-pitch and wing-pitch angles. The thorax-pitch angle is actively controlled by abdominal undulation, and the wing-pitch angle is passively determined because of a rotary spring representing the basalar and subalar muscles connecting the wings and thorax. We investigated the effectiveness of abdominal undulation for thorax-pitch control and how wing-pitch flexibility affects aerodynamic-force generation and thorax-pitch control, through numerical simulations using the immersed boundary-lattice Boltzmann method. As a result, the thorax-pitch angle perfectly follows the desired angle through abdominal undulation. In addition, there is an optimal wing-pitch flexibility that maximizes the flying speed in both the forward and upward directions, but the effect of wing-pitch flexibility on thorax-pitch control is not significant. Finally, we compared the flight behavior of the present bottom-up butterfly model with that of an actual butterfly. It was found that the present model does not reproduce reasonable body kinematics but can provide reasonable aerodynamics in butterfly flights.

Artificial Intelligence Imaging Diagnosis Using Super-Resolution and 3D Shape for Lymph Node Metastasis of Low Rectal Cancer: A Pilot Study From a Single Center.

BACKGROUND: Although accurate preoperative diagnosis of lymph node metastasis is essential for optimizing treatment strategies for low rectal cancer, the accuracy of present diagnostic modalities has room for improvement. OBJECTIVE: To establish a high-precision diagnostic method for lymph node metastasis of low rectal cancer using artificial intelligence. DESIGN: A retrospective observational study. SETTINGS: A single cancer center and a college of engineering in Japan. PATIENTS: Patients with low rectal adenocarcinoma who underwent proctectomy, bilateral lateral pelvic lymph node dissection, and contrast-enhanced multi-detector row computed tomography (slice ≤1 mm) between July 2015 and August 2021 were included in the present study. All pelvic lymph nodes from the aortic bifurcation to the upper edge of the anal canal were extracted, regardless of whether within or beyond the total mesenteric excision area, and pathological diagnoses were annotated for training and validation. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: A total of 596 pathologically negative and 43 positive nodes from 52 patients were extracted and annotated. Four diagnostic methods, with and without using super-resolution images and without using 3D shape data, were performed and compared. The super-resolution + 3D shape data method had the best diagnostic ability for the combination of sensitivity, negative predictive value, and accuracy (0.964, 0.966, and 0.968, respectively), while the super-resolution only method had the best diagnostic ability for the combination of specificity and positive predictive value (0.994 and 0.993, respectively). LIMITATIONS: Small number of patients at a single center and the lack of external validation. CONCLUSIONS: Our results enlightened the potential of artificial intelligence for the method to become another game changer in the diagnosis and treatment of low rectal cancer. See Video Abstract.

Photocatalytic aerobic α-oxygenation of amides to imides using a highly durable decatungstate tetraphenylphosphonium salt.

Decatungstate is a potent photocatalyst for hydrogen atom transfer (HAT) but faces degradation issues when using a typical tetra-n-butylammonium salt. Herein, we employed tetraphenylphosphonium as a countercation to yield a highly durable and efficient HAT photocatalyst, enabling α-oxygenation of amides to their corresponding imides using O2 as an oxidant.

Small Copper Nanoclusters Synthesized through Solid-State Reduction inside a Ring-Shaped Polyoxometalate Nanoreactor.

Cu nanoclusters exhibit distinctive physicochemical properties and hold significant potential for multifaceted applications. Although Cu nanoclusters are synthesized by reacting Cu ions and reducing agents by covering their surfaces using organic protecting ligands or supporting them inside porous materials, the synthesis of surface-exposed Cu nanoclusters with a controlled number of Cu atoms remains challenging. This study presents a solid-state reduction method for the synthesis of Cu nanoclusters employing a ring-shaped polyoxometalate (POM) as a structurally defined and rigid molecular nanoreactor. Through the reduction of Cu2+ incorporated within the cavity of a ring-shaped POM using H2 at 140 °C, spectroscopic studies and single-crystal X-ray diffraction analysis revealed the formation of surface-exposed Cu nanoclusters with a defined number of Cu atoms within the cavities of POMs. Furthermore, the Cu nanoclusters underwent a reversible redox transformation within the cavity upon alternating the gas atmosphere (i.e., H2 or O2). These Cu nanoclusters produced active hydrogen species that can efficiently hydrogenate various functional groups such as alkenes, alkynes, carbonyls, and nitro groups using H2 as a reductant. We expect that this synthesis approach will facilitate the development of a wide variety of metal nanoclusters with high reactivity and unexplored properties.

A density functional study of the photocatalytic degradation of polycaprolactone by the decatungstate anion in acetonitrile solution.

A recent experimental study has reported that decatungstate [W10O32]4- can degrade various polyesters in the presence of light and molecular oxygen [Li et al., Nanoscale, 2023, 15, 15038]. We apply density functional theory to the photocatalyst-polycaprolactone model complex in acetonitrile solution and elucidate the degradation mechanisms and catalytic cycle. We consider hydrogen atom transfer (HAT) and single electron transfer (SET) mechanisms. The potential energy profiles show that the former proceeds exergonically in a single step but that the latter involves a subsequent proton transfer and finally yields HAT products as well. Oxygenated polymer species can regain the transferred hydrogen and regenerate the reduced photocatalyst. We propose a photocatalytic cycle that realizes both the photocatalyst regeneration and the polymer degradation.

Comparison of postoperative clinical outcome in medial-pivotal and gradually reducing radius design cruciate-retaining total knee arthroplasty-A multicenter analysis of propensity-matched cohorts.

Purpose: To clarify differences in surgery duration, postoperative knee range of motion (ROM), anterior and posterior (AP) laxity, and Forgotten Joint Score (FJS) in patients undergoing medial-pivot (MP) and GRADIUS cruciate-retaining (CR) total knee arthroplasty (TKA) surgeries. Methods: We examined patients who underwent either MP or CR TKA at six different Japanese centres. Patients were propensity score matched for age, sex, and preoperative hip-knee angle (HKA). We compared the groups' average surgery duration, postoperative knee ROM, AP laxity, and FJS 1 year after surgery. Results: There were 86 study patients: 43 MP and 43 CR TKA matched for age, sex, and preoperative HKA. The MP group enjoyed a significantly shorter surgery duration (89.1 ± 10.9 mins vs. 95.7 ± 12.0 mins, p = 0.0091) and significantly better postoperative knee flexion than the CR group (123.7 ± 9.1° vs. 115.3 ± 12.4°, p < 0.001). The MP had significantly smaller postoperative AP laxity with 30° of knee flexion than the CR group (3.4 ± 1.3 vs. 5.6 ± 2.2 mm, p < 0.001). Conversely, postoperative AP laxity with 90° of knee flexion was significantly larger for the MP group (3.6 ± 1.3 vs. 2.7 ± 1.9 mm, p = 0.0098). There were no between-group differences in postoperative FJS. Conclusions: The MP group showed better postoperative knee flexion, midrange AP knee stability, and shorter surgery duration. Level of Evidence: Level III, retrospective comparative study.

Multi-stimuli-responsive polymer degradation by polyoxometalate photocatalysis and chloride ions.

Photocatalytic polymer degradation based on harnessing the abundant light energy present in the environment is one of the promising approaches to address the issue of plastic waste. In this study, we developed a multi-stimuli-responsive photocatalytic polymer degradation system facilitated by the photocatalysis of a polyoxometalate [γ-PV2W10O40]5- in conjunction with chloride ions (Cl-) as harmless and abundant stimuli. The degradation of various polymers was significantly accelerated in the presence of Cl-, which was attributed to the oxidation of Cl- by the polyoxometalate photocatalysis into a highly reactive chlorine radical that can efficiently generate a carbon-centered radical for subsequent polymer degradation. Although organic and organometallic photocatalysts decomposed under the conditions for photocatalytic polymer degradation in the presence of Cl-, [γ-PV2W10O40]5- retained its structure even under these highly oxidative conditions.

Ultra-stable and highly reactive colloidal gold nanoparticle catalysts protected using multi-dentate metal oxide nanoclusters.

Owing to their remarkable properties, gold nanoparticles are applied in diverse fields, including catalysis, electronics, energy conversion and sensors. However, for catalytic applications of colloidal gold nanoparticles, the trade-off between their reactivity and stability is a significant concern. Here we report a universal approach for preparing stable and reactive colloidal small (~3 nm) gold nanoparticles by using multi-dentate polyoxometalates as protecting agents in non-polar solvents. These nanoparticles exhibit exceptional stability even under conditions of high concentration, long-term storage, heating and addition of bases. Moreover, they display excellent catalytic performance in various oxidation reactions of organic substrates using molecular oxygen as the sole oxidant. Our findings highlight the ability of inorganic multi-dentate ligands with structural stability and robust steric and electronic effects to confer stability and reactivity upon gold nanoparticles. This approach can be extended to prepare metal nanoparticles other than gold, enabling the design of novel nanomaterials with promising applications.

Cognitive Impairment and Early-onset Cerebral Amyloid Angiopathy in a Middle-aged Man with a History of Childhood Traumatic Brain Injury.

We herein report the a 42-year-old man with early-onset cerebral amyloid angiopathy (CAA) and a history of traumatic brain injury and neurosurgery in childhood. Computed tomography revealed cognitive impairment and recurrent lobar intracerebral hemorrhaging. Magnetic resonance imaging indicated cerebral microbleeds, and Pittsburgh compound B positron emission tomography detected brain amyloid deposition, mainly in the region of trauma and occipital lobes. Interestingly, the patient had no genetic predispositions or relevant family history. This case suggests that a single traumatic brain injury or neurosurgery in childhood can cause early-onset CAA.

Self-controlled Case Series Study for Acute Kidney Injury after Starting Proton Pump Inhibitors or Potassium-Competitive Acid Blocker in Patients with Cancer Using a Large Claims Database.

To investigate the risk of acute kidney injury (AKI) in patients with cancer following the initiation of proton pump inhibitors (PPIs) and potassium-competitive acid blocker (PCAB), considering sex and anti-cancer drug use. We conducted a self-controlled case-series study using the Japan Medical Data Center claims data from 12422 patients with cancer who were prescribed PPIs or PCAB between January 2017 and December 2019. Considering the timing of PPI or PCAB, control period (days -120 to -1), risk period 1 (days 0 to +30), and risk period 2 (days +31 to +365) were defined. To assess the incidence rate ratio (IRR) and 95% confidence interval (CI) as the risk ratio, we adjusted for anti-cancer drugs to assess the risk of AKI. Additionally, we also examined sex differences to identify the risk of AKI. AKI was observed in risk period 1 [2.05 (1.12-3.72), p = 0.0192], but a slight reduction was noted in risk period 2 [0.60 (0.36-1.00), p = 0.0481]. A sex-specific increase in the risk of AKI was observed only in males during risk period 1 [2.18 (1.10-4.32), p = 0.0260], with a reduction in risk period 2 [0.48 (0.26-0.89), p = 0.0200]. We identified an increased risk of AKI in patients with cancer starting PPIs or PCAB particularly in males within 30 d after PPI or PCAB initiation, emphasizing the need for vigilant monitoring and management of AKI in this patient population.