Analysis of the clinicopathologic factors influencing the survival after surgical treatment showed that the macroscopic type, surgical curability, lymph node metastasis, tumor size, and cancer-free margin were the most predictive.

Although hypervirulent Klebsiella pneumoniae (hvKp) has been associated with severe community-acquired infections that occur among relatively healthy individuals, information about hvKp infections in health care settings remains limited. Here, we systematically analyzed the clinical and molecular characteristics of K. pneumoniae isolates causing bloodstream infections in a cross-sectional study. Clinical characteristics of K. pneumoniae bloodstream infections from hospitals across Japan were analyzed by a review of the medical records. Whole-genome sequencing of the causative isolates was performed. Bacterial species were confirmed and hvKp were identified using whole-genome sequencing data. Clinical characteristics of hvKp infections were compared with those of non-hvKp infections by bivariate analyses. Of 140 cases of K. pneumoniae bloodstream infections, 26 cases (18.6%) were caused by various clones of hvKp defined by the carriage of cardinal virulence genes. Molecular identification revealed that 24 (17.1%) and 14 (10%) cases were caused by Klebsiella variicola and Klebsiella quasipneumoniae, respectively. Patients with hvKp infections had higher proportions of diabetes mellitus (risk ratio [RR], 1.75; 95% confidence interval [CI], 1.05 to 2.94), and their infections had significantly higher propensity to involve pneumonia (RR, 5.85; 95% CI, 1.39 to 24.6), liver abscess (RR, 5.85; 95% CI, 1.39 to 24.6), and disseminated infections (RR, 6.58; 95% CI, 1.16 to 37.4) than infections by other isolates. More than one-half of hvKp infections were health care associated or hospital acquired, and a probable event of health care-associated transmission of hvKp was documented. hvKp isolates, which are significantly associated with severe and disseminated infections, are frequently involved in health care-associated and hospital-acquired infections in Japan.

the geriatric nutritional risk index (GnRi) and creatinine (cr) index are indexes often used as nutritional surrogates in patients receiving hemodialysis. However, few studies have directly compared the clinical characteristics of these two indexes. We investigated 3,536 hemodialysis patients enrolled in the Japan DOPPS phases 4 and 5. The primary outcome was all-cause mortality and the main exposures were the GNRI and Cr index. We confirmed and compared the association between these indexes and mortality risk as estimated by a multivariable-adjusted cox proportional hazards model. During the median 2.2-year follow-up period, 414 patients died of any cause. In the multivariable-adjusted model, lower GnRi and cr index were both associated with increased risk of all-cause mortality, and these associations were further confirmed by restricted cubic spline curves. The predictability of all-cause mortality, as represented by the c-statistic, was comparable between the two indexes. furthermore, baseline nutritional surrogates that corresponded with lower GnRi or cr index values were comparable between the two indexes. Given that calculating the GnRi is simpler than calculating the cr index, our data suggest that the GnRi may be preferable to the cr index for predicting clinical outcomes in patients undergoing maintenance hemodialysis.Malnutrition is highly prevalent in patients receiving maintenance hemodialysis 1-3 . Inflammation often coexists with malnutrition. Because these two pathologies synergistically promote clinically important complications, including atherosclerotic diseases, they are now jointly recognized by the integrated term "malnutrition-inflammation-atherosclerosis (MIA) syndrome" or "malnutrition-inflammation complex/cachexia syndrome (MICS)" 4,5 . Identification of objective markers that both reflect MIA syndrome and can be used for daily evaluation of nutritional and inflammatory status in this population is now urgently required.A wide variety of nutritional and inflammatory markers and tools have been reported for the evaluation of MIA syndrome or MICS in hemodialysis patients. Because these markers and indexes are insufficient when used alone, many clinicians use them in combination in clinical practice. These include subjective global assessment (SGA); malnutrition-inflammation score (MIS); serum levels of albumin, creatinine (Cr), and C-reactive protein (CRP); body mass index (BMI); normalized protein catabolic rate (nPCR); interleukin-6; geriatric nutritional risk index (GNRI); Cr index; Objective Score of Nutrition on Dialysis (OSND); simple protein energy wasting score; Subjective Global Assessment-Dialysis Malnutrition Score (SGA-DMS); bioelectrical impedance analysis (BIA); and dual energy X-ray absorptiometry (DEXA) 3,5-15 . Of these, the GNRI and Cr index are often used to evaluate nutritional status in hemodialysis patients 9,10 . The GNRI is calculated by serum albumin level and BMI, while the Cr index is determined by age, gender, Kt/V for urea, and pre-dialysis serum Cr level. Thes...

This review and analysis suggests that de-escalation therapy is safe and effective for most infections, although higher quality studies are needed in the future.

Background Accidental hypothermia is a serious condition that requires immediate and accurate assessment to determine severity and treatment. Currently, accidental hypothermia is evaluated using the Swiss grading system which uses core body temperature and clinical findings; however, research has shown that core body temperature is not associated with in-hospital mortality in urban settings. Therefore, we developed and validated a severity scale for predicting in-hospital mortality among urban Japanese patients with accidental hypothermia. Methods Data for this multi-center retrospective cohort study were obtained from the J-point registry. We included patients with accidental hypothermia who were admitted to an emergency department. The total cohort was divided into a development cohort and validation cohort, based on the location of each institution. We developed a logistic regression model for predicting in-hospital mortality using the development cohort and assessed its internal validity using bootstrapping. The model was then subjected to external validation using the validation cohorts. Results Among the 572 patients in the J-point registry, 532 were ultimately included and divided into the development cohort ( N = 288, six hospitals, in-hospital mortality 22.0%) and the validation cohort ( N = 244, six hospitals, in-hospital mortality 27.0%). The 5 “A” scoring system based on age, activities-of-daily-living status, near arrest, acidemia, and serum albumin level was developed based on the variables’ coefficients in the development cohort. In the validation cohort, the prediction performance was validated. Conclusion Our “5A” severity scoring system could accurately predict the risk of in-hospital mortality among patients with accidental hypothermia. Electronic supplementary material The online version of this article (10.1186/s40560-019-0384-2) contains supplementary material, which is available to authorized users.