Prevalence of common aneuploidy in twin pregnancies.

The incidence of chromosomal abnormalities in twin pregnancies is not well-studied. In this retrospective study, we investigated the frequency of chromosomal abnormalities in twin pregnancies and compared the incidence of chromosomal abnormalities in dichorionic diamniotic (DD) and monochorionic diamniotic (MD) twins. We used data from 57 clinical facilities across Japan. Twin pregnancies of more than 12 weeks of gestation managed between January 2016 and December 2018 were included in the study. A total of 2899 and 1908 cases of DD and MD twins, respectively, were reported, and the incidence of chromosomal abnormalities in one or both fetuses was 0.9% (25/2899) and 0.2% (4/1908) in each group (p = 0.004). In this study, the most common chromosomal abnormality was trisomy 21 (51.7% [15/29]), followed by trisomy 18 (13.8% [4/29]) and trisomy 13 (6.9% [2/29]). The incidence of trisomy 21 in MD twins was lower than that in DD twins (0.05% vs. 0.5%, p = 0.007). Trisomy 21 was less common in MD twins, even when compared with the expected incidence in singletons (0.05% vs. 0.3%, RR 0.15 [95% CI 0.04-0.68]). The risk of chromosomal abnormality decreases in twin pregnancies, especially in MD twins.

Ineffectiveness of antenatal guidance intervention for vitamin D insufficiency and deficiency in pregnant women in Kyoto, Japan.

AIM: The aim of this study was to investigate the vitamin D status among healthy pregnant women in Japan, and to evaluate the effectiveness of the antenatal health guidance intervention for the pregnant women who were informed about their low vitamin D levels. METHODS: We measured the level of 25-hydroxyvitamin D (25[OH]D) using chemiluminescent immunoassay among the singleton pregnant women who received at antenatal routine check-up (8-24 weeks of gestation) with written consent during September 2017-September 2018. The measurement values were informed by the concerned physician and health guidance intervention was given to the pregnant women with inadequate Vitamin D status (25[OH]D < 30 ng/mL). At around 36 weeks of gestation, the measurement of 25(OH)D and a questionnaire regarding behavioral changes after the guidance was conducted. RESULTS: The average value of 25(OH)D of 1192 pregnant women before the guidance was 14.89 ± 4.85 ng/mL, and the prevalence of sufficient vitamin D status (25(OH)D ≥ 30 ng/mL) was 0.67% (8/1192). Nine hundred eighty-two pregnant women who had inadequate vitamin D status were followed, thereafter-guidance prevalence of sufficiency was 1.02% (10/982); insufficiency, 14.66% (144/982); and deficiency, 84.32% (828/982), respectively. Although the prevalence of deficiency was decreased after guidance intervention significantly, the prevalence was still high and the effect on behavioral changes was a little. CONCLUSION: The prevalence of vitamin D sufficient status among pregnant women in Japan was extremely low, which is a serious condition. It was also revealed the effectiveness of the antenatal health guidance intervention for pregnant women was not enough.

Factors associated with prolonged length of hospital stay of elderly patients in acute care hospitals in Japan: a multilevel analysis of patients with femoral neck fracture.

OBJECTIVE: To analyze possible factors associated with prolonged length of stay (LOS) in hip fracture patients in Japan, such as the availability of beds in medical and nursing care facilities at the community level, as well as patient factors, clinical factors and hospital structural characteristics. METHODS: The sample for analysis consisted of 8318 hip fracture cases from 199 hospitals throughout Japan. We conducted multilevel analyses to investigate whether LOS and the discharge destinations of patients are associated with the availability and utilization of medical and nursing care resources in the communities where each hospital is located. RESULTS: After adjusting for patient factors, clinical factors and hospital structural characteristics, a higher number of long-term care beds at the community level was observed to be significantly correlated with both shorter LOS and increased rate of discharge to other facilities. DISCUSSION AND CONCLUSION: Although the Japanese government is attempting to reduce acute care hospital LOS and the number of long-term care beds in order to reduce health care costs, the results of this study suggest that a reduction in the number of long-term care beds would not necessarily reduce the LOS of acute care hospitals, and may instead exacerbate the problem.

Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan.

OBJECTIVES: In 2003, Japan introduced the prospective payment system (PPS) with diagnosis-related groups (DRG) rearranged grouping system called the diagnostic procedure combination/per-diem payment system (DPC/PDPS). Even after eight years, little is known about the effects of DPC/PDPS. The purpose of this study was to examine the effects of DPC/PDPS on resource usage and healthcare quality. METHODS: Using 2001-2009 (fiscal year) administrative data of acute myocardial infarction patients, four indices, including inpatient total accumulated medical charges, length of stay (LOS), mortality rate, and readmission rate, were compared between patients reimbursed by DPC/PDPS or by fee-for-service. RESULTS: DPC/PDPS significantly reduced total accumulated medical charges by $1061 (95% confidence interval [CI], -2007, -116) and LOS by 2.29 days (95% CI, -3.71, -0.88) after risk adjustment. However, mortality rate (Odds ratio [OR], 0.94; 95% CI, 0.73, 1.21) was unchanged. Furthermore, DPC/PDPS increased the readmission rate (OR, 1.37; 95% CI, 1.03, 1.82). CONCLUSIONS: This study showed that DPC/PDPS was associated with reduced resource usage, but not improved healthcare quality, as with DRG/PPSs in other countries. To achieve successful healthcare reform, further discussion on additional motives will be required.

Factors affecting survival after lobectomy with pulmonary artery resection for primary lung cancer.

OBJECTIVE: Prognostic factors in patients who underwent pulmonary angioplasty remain controversial. Here, we report a case-series study of this surgical procedure based on our 20-year single-center experience. METHODS: Medical records of patients, who underwent a major lung cancer operation with pulmonary artery resection, were reviewed retrospectively. RESULTS: From 1986 to 2006, 61 (3%) of 2296 patients required pulmonary artery resection to avoid pneumonectomy for lung cancer surgery. We performed 34 circumferential resections and 27 wedge resections accompanied by lobectomy or bilobectomy, and all repairs were performed with end-to-end anastomoses or direct suturing. Patch reconstruction, synthetic/biological prosthesis, and pericardial conduit were not used. Forty-nine patients (80%) underwent concomitant carinoplasty (n = 2) or bronchoplasty (n = 47). After surgery, two patients died (mortality 3.3%) and major complications were noted in 14 patients (morbidity 23.0%). Although seven patients had local recurrences (four intrathoracic and three lymph nodes), no recurrence was observed along the pulmonary artery suture line. With a mean follow-up period of 46.0 ± 40.5 months, overall and disease-free survival rates for all cases were 47.0% and 40.0% at 5 years, and 40.2% and 33.6% at 10 years. According to the nodal status, the 5-years' overall and disease-free survivals were 76.0% and 62.9% for pN0 cases (n = 14), 45.7% and 43.5% for pN1 cases (n = 27), and 28.9% and 20.0% for pN2 + pN3 cases (n = 20), respectively (p = 0.014 and 0.036). Multivariate analysis indicated that nodal status was the only prognostic factor on both overall and disease-free survival. CONCLUSIONS: A major anatomical lung operation with pulmonary artery resection is feasible for selected patients with primary lung cancer. Long-term outcomes are significantly influenced by nodal status and are comparable to those of conventional lobectomy. Most operative complications are controllable with acceptable mortality and morbidity rates. The anastomosed site was not placed at risk for local recurrence. These data support pulmonary angioplasty as a valuable option in the treatment of lung cancer.