Japanese Cases Research Articles

Exploration of novel biomarkers and novel therapies for immune checkpoint inhibitors (ICIs) in genetic variants of esophageal squamous cell carcinoma (ESCC): A study of 1,059 Japanese cases.

495 Background: In Japan, cancer genome profiling (CGP) tests will be covered by insurance in 2019, and more than 1,000 ESCC cases have been accumulated in the national database. ICIs are currently the key drugs for esophageal cancer, and MSI and TMB status can work as biomarkers for ICIs in solid tumors. Therefore, to improve the prognosis of esophageal squamous cell carcinoma (ESCC), we aim to search for gene variants that may predict the efficacy of ICIs and explore the possibility of new treatment from genetic data accumulated in the Japanese nation-wide C-CAT database. Methods: We retrospectively analyzed 1,059 ESCC cases from C-CAT data accumulated from June 2019 to February 2024. We used the registered clinical and genetic information to examine gene variants and carcinogenic pathways that could serve as biomarkers for ICIs. Results: Of the 1059, 152 (14.4%) had TMB-H and 3 (0.3%) had MSI-H, with a median TMB of 5.0 Muts/Mb (range: 0-268). XPO1 and TP53 were found to be positively and negatively correlated as genes affecting TTF in nivolumab monotherapy (FDR P value < 0.01). TMB has the potential to be a biomarker for ICI, but TMB was significantly higher in the group with variants in the ARID family ( ARID2 , ARID1A plus ARID5B ) (median TMB 5.0 vs 8.0 Muts/Mb, P<0.001). In addition, 709 patients (66.9%) had any variants in three pathways (TP53, RTK and cell cycle), which are thought to be involved in the carcinogenesis of ESCC. PIK/Akt/mTOR and epigenetic modulation pathways were also found to be abnormal in many cases, and abnormalities in the epigenetic modification pathway were found to contribute significantly to TMB-H (FDR P value<0.01, Logarithmic value=19.2). Conclusions: This is the first case-specific report on the relationship between mutations in the ARID family and TMB in ESCC and the signalling pathways leading to carcinogenesis. In the present study, the association between the ARID family and TMB, and between abnormalities in the epigenetic modification pathway and TMB, which has been previously reported in other cancer types but not in esophageal cancer, suggests that multiple pathological mutations including these may be new biomarkers for ICI in 1059 Japanese patients. Furthermore, multiple pathways are often involved in ESCC carcinogenesis at the same time, and a separate, combined approach that takes these into account may be necessary in the development of new drugs.

A Design School for Social Innovation: Reflections on a Pilot Case in Japan

AbstractThe paradigm of design must drastically change to promote sustainable social development that considers not only economic growth but also human well‐being and environmental sustainability. Some scholars argue that the central paradigm of design should focus more on the societal perspective. This article refers to such a socially oriented design approach as design for social innovation (DfSI). Our study identified key insights for designing and promoting a DfSI education programme by investigating and analysing a Japanese pilot case, the Design School at National Institute of Advanced Industrial Science and Technology (AIST‐DS). Based on an analysis of in‐depth interviews that we conducted with the AIST‐DS programme managers and learners, we clarified the effectiveness and challenges of the programme. Furthermore, this article presents relevant design considerations for better planning and promotion of the DfSI education programme. Our case study findings are derived from a deep and detailed analysis, with practical implications for educators and researchers. Simultaneously, from an academic perspective, we hope that these findings will constitute a foothold for accumulating knowledge on DfSI education in the future.

The significance of task shifting for surgeons in high-income countries: an examination of the Japanese case

The significance of task shifting for surgeons in high-income countries: an examination of the Japanese case

Short Stature and Anemia in Pediatric Eosinophilic Gastroenteritis

A 4.5-year-old male child with short stature (-2.8 SD), who had a history of asthma and with high RAST values of IgE antibodies to specific food allergens, visited our clinic with chronic vomiting and severe anemia (Hb 4.4 g/dL). He was also noted to have peripheral eosinophilia (2,049/µL) and high serum IgE (RIST: 8,761 U/mL). With Eosinophilic Gastrointestinal Diseases (EGIDs; eosinophilic gastritis, EG and Eosinophilic Gastroenteritis, EGE) being suspected, an upper gastrointestinal endoscopy was performed, which confirmed the pathological histology of eosinophilic gastritis. His short stature was not familial but was thought to be related to EG/EGE. To determine if short stature is one of the EG/EGE-related symptoms, a literature survey was performed in Japanese pediatric EGE cases. We have analyzed 4 such cases including this case report. Probable pathological involvement of EG/EGE in the physical growth in pediatric patients was speculated because short stature improved after treatment for EG/EGE in 3 of the four cases. Further studies are required on the impaired growth in patients with EG/EGE.

Limited impact of weekend admissions on hip fracture outcomes in elderly patients: A study from a Japanese nationwide medical claims database.

The effectiveness of early surgery in preventing complications in elderly Japanese hip fracture patients and the impact of weekend hospitalization need further investigation. The purpose of this study was to determine whether weekend hospitalization affects the incidence of various sequelae and death during hospitalization in elderly hip fracture patients using a comprehensive Japanese hip fracture case database. We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. During this period, approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for the study. The study focused on weekend hospitalizations and investigated the associations with postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, dementia, and in-hospital mortality after propensity score matching. Owing to the large population size of the study, significance levels were strictly enforced, and a P-value < 0.001 was considered statistically significant. After performing propensity score matching based on age, sex, and comorbidities, 111 035 patient pairs were identified, comparing those admitted on weekends versus weekdays. The analysis showed no heightened risk of sequelae for those admitted during the weekend compared with weekdays. Additionally, there was a slight trend toward higher mortality risk during weekend hospital stays; however, the increase was insignificant, with a hazard ratio of 1.071 (95% confidence interval: 1.005-1.140, P = 0.03). The results of this study indicate that weekend hospitalization for elderly patients with hip fractures is not definitively associated with an increase in various sequelae or in-hospital mortality and that the importance of early surgery for elderly patients with hip fractures may be recognized and promoted in Japan. Geriatr Gerontol Int 2024; ••: ••-••.

Balancing Continuity and Change: Japan’s Pursuit of a ‘Small and Strong’ State Within the Neo-Weberian State Framework

This paper discusses the development of Japanese public administration within its historical and socio-political context, focusing on the question, “How well does the neo-Weberian State (NWS) travel outside Europe?” In the late 19th century, Japan established a Weberian public administration based on the German model. Since the late 1940s, it has consistently pursued the goal of “small and strong government”, but its strategy for achieving has changed over time. It was first driven by a bureaucracy fragmentally allied with the ruling party and business. From the 1980s, it promoted various NPM-type reforms, and since the 1990s, political control has been centralised, depriving the bureaucracy of its ministerial autonomy. Nevertheless, the anticipated shift in public attitudes has not materialized. While the demand for infallible protection by the administration persists, the vulnerabilities in implementation caused by these reforms have become evident during crises such as the COVID-19 pandemic. These findings show that the NWS has a normative affinity with traditional Japanese values, including expectations that the state realises the public good and ensures security. The Japanese case also implies that the collective memory of past successes driven by hierarchy can simultaneously hinder the NWS by creating unrealistic expectations. Whether the NWS will become a sustainable model for future reforms depends on whether the public confronts the reality of resource constraints.

Second Japanese Case of Relapsing Fever since 1956

Second Japanese Case of Relapsing Fever since 1956

A case of indeterminate cell histiocytosis with ETV3-NCOA2 translocation.

Indeterminate cell histiocytosis (ICH) is a rare histiocytic disorder characterized by a proliferation of CD1a+ and CD207/langerin- cells. Recent molecular analyses have identified ETV3-NCOA2 translocation as a possible aetiopathogenesis of ICH. Herein, we describe the first Japanese case of ICH with ETV3-NCOA2 translocation. A 79-year-old Japanese man presented with a 1-year history of pruritic erythematous papules and nodules on his trunk and extremities. Histological examination revealed a dense and diffuse sheets-like infiltration of medium-sized histiocyte-like cells from the epidermis to the deep dermis. Immunohistochemically, the atypical cells were positive for CD1a but negative for CD207/langerin. Fluorescence insitu hybridization using NCOA2 break-apart probes confirmed a chromosomal break occurring on NCOA2 monoallele in the tumor cells. Furthermore, ETV3 exon 4-NCOA2 exon 14 translocation was identified in formalin-fixed paraffin-embedded skin samples using reverse transcription polymerase chain reaction and subsequent direct DNA sequencing. He also presented with interspersed eczematous plaques on his trunk and reactive dermatopathic lymphoadenopathy without any infiltration of ICH. He was treated with topical corticosteroids and narrowband UVB phototherapy. Four months later, his ICH skin eruptions, eczematous plaques, and lymphoadenopathy gradually regressed. Our case supports the notion that the detection of ETV3-NCOA2 translocation can be useful for diagnosis of ICH.

Phenotypes and clinical laboratory data for polycystic ovary syndrome cases: A nationwide survey in Japan.

Describe the current phenotypes and clinical laboratory data regarding polycystic ovary syndrome (PCOS) in Japan, taking into account ethnic differences and obesity status. Data for 986 PCOS cases and 965 control cases were collected using a nationwide survey in Japan. Obese/overweight (body mass index [BMI] ≥25 kg/m2) and non-obese/overweight (BMI <25 kg/m2) cases were compared. Japanese PCOS cases predominantly involved non-obese/overweight patients, accounting for 75% of all cases. Among non-obese/overweight PCOS cases, the incidence of both amenorrhea and clinical/biochemical hyperandrogenism was significantly lower than in obese/overweight PCOS cases, whereas the rate of elevated serum luteinizing hormone (LH) level was significantly higher. Even though the incidence of hirsutism in Japan is only 13.5%, the detection rate for hyperandrogenism increased by as much as 30.4% when hirsutism was added to the Japan Society of Obstetrics and Gynecology (JSOG) criteria for the diagnosis of hyperandrogenism in addition to elevated serum total testosterone level. When evaluated based on timing of blood sampling, the LH level and LH/follicle-stimulating hormone ratio determined at the initial consultation involving a chief complaint of irregular menstrual cycle (after confirming the absence of follicles measuring ≥1 cm in diameter) were significantly higher than on days 2-3 or 4-6 of the menstrual cycle. Ethnic differences, including obesity status, affected the phenotype and clinical laboratory data of Japanese PCOS patients, such as the incidence rates of clinical/biochemical hyperandrogenism and the rate of elevated basal LH level. Adding hirsutism to the JSOG 2024 criteria would enhance the accuracy of PCOS diagnosis and enhance consistency with the Rotterdam 2003 criteria. Measuring basal LH level is useful for assessing the endocrinologic characteristics of Japanese PCOS cases, as well as lean Asian PCOS cases, but the timing of blood sampling can affect the result.

7055 Metabolic Disorders In Thalidomide Embryopathy

Abstract Disclosure: A. Tanabe: None. Thalidomide embryopathy (TE) is a congenital limb defect that occurs in neonates born to pregnant women who have taken thalidomide. Typical abnormalities of the TE are upper limb hypoplasia and and/or auditory dysfunction. In Japan, thalidomide was marketed as an agent for sleep-induce and digestive ulcers from 1958 to 1962. Up to now, approximately 290 cases have been certified and are supported by the government as drug-induced disease. Currently, many of the victims are in their late 50s, and in addition to congenital disabilities, various health issues such as lifestyle-related diseases can be developed. We investigated their metabolic condition using data of medical health checkup between 2017 and 2018. Fifty-one Japanese cases of TE (28 men and 23 women) were included in this study. The mean age was 56.4±1.6 years in men and 55.9±1.2 years in women. The prevalence of upper limb deformities was 64% in men and 74% in women; the remaining patients had only hearing impairment. The mean body mass index (BMI) was 22.7±2.1 in men and 22.5±4.0 in women. Eleven percent of men and 17% of women had a BMI between 25-30, while 9% of women and no men had a BMI of 30 or greater. Liver dysfunction was seen in 32% of men and 9% of women. The mean high-density lipoprotein cholesterol level was 60±17 mg/dL in men and 68±18 mg/dL in women. The mean low-density lipoprotein (LDL) cholesterol level was 120±28 mg/dL in men and 136±35 mg/dL in women, with 25% of men and 48% of women had LDL level of 140 mg/dL or greater. The mean triglyceride (TG) level was 144±85 mg/dL in men and 116±61 mg/dL in women, with 43% of men and 17% of women had a level of 150 mg/dL or greater. The mean HbA1c level was 6.0±1.0% in men and 5.9±0.4% in women. The prevalence of impaired glucose tolerance was 25% in men and 13% in women. Fatty liver (FL) evaluated by ultrasonography or CT scan was 61% in men and 39% in women. The patients with FL showed significantly high body fat percentage and TG level in men, high alanine aminotransferase, γ-glutamyl transpeptidase and TG levels in women, respectively, compared to the patients without FL. The prevalence of hypertriglyceridemia was significantly higher in men with FL compared with men without FL. There was no significant difference in with or without the upper limb abnormalities in both groups. Although without obvious overweight, more than 40 % of the patients had dyslipidemia and 50% of the patients had FL. The limb abnormalities can result in movement limitations however other factors may be involved in the development of metabolic disorders in TE. The results of this study provide valuable information for future health management in thalidomide embryopathy. (This study was conducted by a research grant from the National Center for Global Health and Medicine, Japan: 21A1015 and a Grant-in-Aid from the Ministry of Health, Labour, and Welfare, Japan: 20KC2005, 23KC2017). Presentation: 6/2/2024

The first Japanese case of autosomal dominant cutis laxa with a frameshift mutation in exon 30 of the elastin gene complicated by small airway disease with 8 years of follow-up

BackgroundCutis laxa constitutes a diverse group of connective tissue diseases, both inherited and acquired, characterized by loose skin and varying systemic involvement, including pulmonary lesions. While cutis laxa has been linked to conditions like emphysema, asthma, and bronchiectasis, the specific pathological and radiological characteristics underlying pulmonary complications related to cutis laxa remain unclear.Case presentationA 36-year-old woman, diagnosed with cutis laxa at birth, presented to our outpatient clinic with severe obstructive ventilatory impairment, evident in pulmonary function tests (expiratory volume in one second (FEV1)/forced vital capacity (FVC): 34.85%; %residual volume [RV]: 186.5%; %total lung capacity [TLC]: 129.2%). Pulmonary function tests also indicated small airway disease (%FEF50%, 7.9%; %FEF75%, 5.7%; and %FEF25–75%, 6.8%). Computed tomography (CT) revealed the lack of normal increase in lung attenuation on expiratory CT scan, with no discernible emphysematous changes. Exome sequencing was performed to confirm the association between the pulmonary lesions and cutis laxa, revealing a frameshift variant in exon 30 of the elastin gene (ELN). Further analysis employing a parametric response map revealed a longitudinal increase in the percentage of functional small airway disease (fSAD) from 37.84% to 46.61% over the 8-year follow-up, despite the absence of overt changes in CT findings, specifically the lack of normal increase in lung attenuation on expiratory CT scan. Over the same follow-up interval, there was a modest reduction of 25.6 mL/year in FEV1 coupled with a significant increase in %RV. Pulmonary function test metrics, reflective of small airway disease, exhibited a continual decline; specifically, %FEF50%, %FEF75%, and %FEF25–75% diminished from 7.9% to 7.0%, 5.7% to 4.6%, and 6.8% to 5.4%, respectively.ConclusionsThis case highlighted an instance of autosomal dominant cutis laxa arising from a frameshift variant in exon 30 of ELN, accompanied by small airway disease. Comprehensive investigation, utilizing quantitative CT analysis, revealed a longitudinal increase in fSAD percentage with a mild reduction in FEV1. These findings indicate that elastin deficiency may not only diminish elastic fibers in the skin but also be implicated in small airway disease by impacting components of the extracellular matrix in the lungs.

Measuring Household Thermal Discomfort Time: A Japanese Case Study

This study proposes a metric to measure households’ discomfort related to thermal consumption time (hereafter referred to as t-discomfort). This metric relies on an ideal thermal consumption and calculates the gap between the usage times of thermal devices in vulnerable households compared to the ideal household. The t-discomfort is quantified using thermal data collected from 1298 households in the Tokyo and Oita prefectures in Japan. To create the ideal usage times of thermal devices, households are categorized into three clusters—Vulnerable (Vu), Semi-vulnerable (SVu), and Invulnerable (IVu)—based on their energy poverty ratio, and t-discomfort is subsequently calculated for each group. The IVu households are used as the ideal reference point for measuring thermal device usage in the other two categories. The findings of the study indicate that energy poverty does not necessarily lead to t-discomfort. Interestingly, the consumption time of heating devices among Vu households in both prefectures is longer than that of IVu households, despite the high energy prices. Conversely, SVu households, which do not experience severe energy poverty, tend to sacrifice their comfort by reducing their thermal consumption time. Additionally, the consumption time of cooling devices among Vu households in Oita is longer than that of IVu households, whereas in Tokyo, it is shorter. Two treatment strategies are evaluated to mitigate thermal discomfort in households without compromising resource availability. The first strategy integrates the thermal device consumption time with Japan’s current regulated time-of-use rates plan (daytime and nighttime). The results propose a three-tiered tariff plan (off-peak, mid-peak, and peak) to reduce the energy cost burden for Vu households. The second strategy recommends the installation of 12 rooftop solar panels for households in Tokyo and 11 panels for households in Oita. This strategy aims to maintain thermal comfort via a sustainable natural energy resource while minimizing energy costs.

Autopsy of a futures market failure: Japan’s Dojima rice futures in the early 21st century

Futures markets promise improved price transparency and risk mitigation for staple commodities important to many developing countries, but they can fail even in developed economies with modern financial institutions. We investigate rice futures trading in Japan at the Osaka Dojima Exchange to identify the reasons underlying its failure in 2021. Our analysis reviews the multiple necessary conditions for a successful commodity futures market. We find the Japanese rice market did not meet many of these conditions. The spot market was fragmented with heterogeneous goods and a single dominant firm. Futures trading was unable to facilitate price discovery or effective hedging activity. To the extent it was traded, the Dojima rice futures contract was instead used as a forward contract for making and taking physical delivery. In addition, there was political opposition and regulatory uncertainty around futures trading. Using detailed data on trader positions in the futures market, we show how these factors contributed to diminished interest in futures trading from firms who handle physical commodities. The lessons from the Japanese case are useful for traders, exchanges, and policy makers, especially those in countries where futures markets may face similarly unfavorable economic and political conditions.

Power and theory: toward a multidimensional explanation of the dynamic political field

ABSTRACT What theories explain a dynamic political field and its outcome? Can we judiciously combine theories into a better hybrid explanation? To be valid, a theory’s claimed causal factor must manifest in the field as a representative mode of micro power used between actors in dyads (its mechanism). The modes’ relative presence indicates the theories’ relative causal validity. The Integrated Structurational Analysis method analyzes (hundreds of) actor dyads to find evidence on the relative presence of the modes. The results indicate a shifting, multidimensional causal timescape driving the field and its outcome. Findings from a Japanese case study illustrate the method.

New Law Responding to Imitations of Designs that Intersect Real and Virtual Space: Amendment of the Unfair Competition Prevention Act in Japan

Abstract Digital items that have the appearance of real utilitarian products are often tied to NFTs (Non-Fungible Tokens) in the virtual space known as the metaverse, and sold as goods. The designs of real utilitarian products are increasingly being converted into the designs of such NFT goods without the permission of their developers. In order to deal with these imitations, which intersect the real and the virtual worlds, the Japanese legislator decided to utilize the existing provision for the protection of forms of goods in the unfair competition prevention law (UCPA 1993). The law was amended in June 2023 to newly define ‘the act of offering through telecommunication line’ goods that imitate the form of another person’s goods as an act of unfair competition. Copyright protection under Japanese case law has rarely been granted to designs of utilitarian products, and under Japanese design law the product design is identified not only by its shape but also by its product type. The protection of image designs is almost exclusively limited to specific images unrelated to the NFT goods. However, the revised provision of UCPA 1993 has also been generally interpreted as the provision prohibiting the imitation of designs between homogeneous products. The amendment effectively negates this interpretation. This paper reveals the impact on the existing interpretation of the relevant provision of UCPA 1993 and the issues arising from other legal provisions with respect to such imitations.

Löfgren syndrome, characteristics of Japanese cases: A case and a review of the literature.

Löfgren syndrome (LS) is a sarcoidosis subtype characterised by an acute disease course, bilateral hilar lymphadenopathy (BHL), erythema nodosum (EN), and ankle arthritis. LS in Caucasians appears to be self-limiting; however, our patients require glucocorticoid (GC) treatment. Here, we present a case of LS and review the literature to identify the characteristics of Japanese patients with LS. A 66-year-old woman was referred to Kobe City Medical Center General Hospital; she initially presented with an acute onset of low-grade fever and ankle arthritis, followed by EN. Skin biopsy revealed a noncaseating granuloma, and a chest computed tomography scan displayed BHL; she was diagnosed with LS. Her arthralgia ameliorated spontaneously, but the erythema persisted, necessitating GC treatment. A literature review revealed that the Japanese LS patients showed more fever, were more frequently treated with GCs, and more patients seemed to relapse, which may be explained by the absence of human leucocyte antigen-DR isotype 3, a good prognostic allele in Caucasians. Japanese LS may cause severe symptoms after development because of the differences in human leucocyte antigens from foreign countries. For early diagnosis, it is important to evaluate EN and BHL in patients with polyarthritis involving ankle arthralgia.

Serial Murderers In Japan (1882-2017): A Narrative Analysis

A retrospective narrative analysis of 61 serial murder-ers (a few, belonging to health care profession, such as physicians, midwives and paramedic) in Japan was attempted. Materials available in the online databases including Wikipedia entries on individual criminals were studied. Among the studied total of 61 serial murderers covering the time span from 1882 to 2017, 59 were convicted and 2 were non-convicted. All five categories of Deitz typology of serial murderers were represented among the convicted sample. These include, psychopathic sex-ual sadists (e.g: Ryuun Daimai, Yoshio Kodaira, Genzo Kurita, Kiyoshi Okubo, Takahiro Shiraishi), crime spree killers (e.g: Kanae Kijima, Chisako Kakehi), custodial killers (e.g: Shige Sakakura, Miyuki Ishikawa and Hayato Imai), psychotic, religious-cult killers (e.g: Sachiko Eto, Shoko Asahara and his 12 collaborators) and organized crime functionaries (e.g: Satoru Nomu-ra). Tomomasa Nakagawa, personal doctor of the Aum Shinrikyo Buddhist religious-cult leader Shoko Asakara, may hold a record for a scientist on death row to publish a paper in a peer-reviewed journal.Limitations of this study include, (1) omission of the methods of killing used by the murderers from analysis (2) total reliance on media reports for information, in preference to voluminous records of Japanese court cases. Despite these limitations, details presented in this analysis of 59 convicted and 2 non-convicted se-rial murderers in 45 court cases held in Japan may be useful for comparative studies in forensic science and law enforcement.

Can heterolocalism explain the residential patterns of small populations of foreigners in Japan? The cases of Afghans, Laotians, Bolivians and Turks

AbstractThis paper examines whether the residential patterns of small nationality‐based ethnic groups in Japan, such as Afghans, Laotians, Bolivians and Turks, can be successfully explained by the model of heterolocalism, which is well‐known for comprehensively explaining the patterns of new immigrants. This verification work is conducted based on census microdata, mapping and interviews with the foreigners. The model is characterized by five propositions, two of which are found not to apply to the Japanese case. Namely, regarding the ‘spatial dispersion’ proposition, a series of small‐sized clusters of foreign inhabitants was confirmed, suggesting that nodal heterolocalism as a modified model is better than the original model. As for the proposition of ‘spatial disjuncture between home and work’, we find that the places of work and residence show spatial proximity rather than separation, reflecting the fact that most of the foreign inhabitants are engaged in blue‐collar occupations. The obtained results serve as criticism of the heterolocalism model, which emphasizes that it is valid not only for the relatively privileged but also for certain lower‐status groups.

Surgery on admission and following day reduces hip fracture complications: a Japanese DPC study

IntroductionThe efficacy of early surgery in preventing complications among Japanese elderly patients with hip fractures requires further investigation. This study aims to use a comprehensive Japanese hip fracture case database to determine whether surgery within the day of admission and the following day reduces the incidence of complications and mortality during hospitalization in elderly hip fracture patients.Materials and methodsWe retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. Approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for research. The study investigated the association between postoperative pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization after propensity score matching, focusing on surgeries conducted on the day of admission and the following day.ResultsAfter one-to-one propensity score matching for age, gender, and comorbidity, we identified 146,441 pairs of patients who underwent surgery either within the day of admission and the following day or after the third day of admission. Surgery on the third day or later was independently associated with increased risks of pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization with risk ratios of 1.367 (95% CI 1.307–1.426), 1.328 (95% CI 1.169–1.508), 1.338 (95% CI 1.289–1.388), and 1.167 (95% CI 1.103–1.234), respectively.ConclusionA comprehensive study of elderly Japanese patients with hip fractures in the DPC database showed that surgery on admission and the following day is crucial for preventing complications like pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization.

Is Boundary Annotation Necessary? Evaluating Boundary-Free Approaches to Improve Clinical Named Entity Annotation Efficiency: Case Study.

Named entity recognition (NER) is a fundamental task in natural language processing. However, it is typically preceded by named entity annotation, which poses several challenges, especially in the clinical domain. For instance, determining entity boundaries is one of the most common sources of disagreements between annotators due to questions such as whether modifiers or peripheral words should be annotated. If unresolved, these can induce inconsistency in the produced corpora, yet, on the other hand, strict guidelines or adjudication sessions can further prolong an already slow and convoluted process. The aim of this study is to address these challenges by evaluating 2 novel annotation methodologies, lenient span and point annotation, aiming to mitigate the difficulty of precisely determining entity boundaries. We evaluate their effects through an annotation case study on a Japanese medical case report data set. We compare annotation time, annotator agreement, and the quality of the produced labeling and assess the impact on the performance of an NER system trained on the annotated corpus. We saw significant improvements in the labeling process efficiency, with up to a 25% reduction in overall annotation time and even a 10% improvement in annotator agreement compared to the traditional boundary-strict approach. However, even the best-achieved NER model presented some drop in performance compared to the traditional annotation methodology. Our findings demonstrate a balance between annotation speed and model performance. Although disregarding boundary information affects model performance to some extent, this is counterbalanced by significant reductions in the annotator's workload and notable improvements in the speed of the annotation process. These benefits may prove valuable in various applications, offering an attractive compromise for developers and researchers.