Purpose: To evaluate long-term outcomes and identify prognostic factors for stoma construction following loose seton placement in patients with Crohn disease (CD)-associated perianal fistulas. Methods: This single-center, retrospective study included 136 patients who underwent initial loose seton placement for CD-associated perianal fistulas between 1999 and 2021, with at least 3 years of follow-up. Patient demographics, anorectal findings, and perioperative pharmacotherapy were assessed. Prognosis was defined as the cumulative incidence of stoma formation. Independent risk factors were identified using multivariate logistic regression. The association between postoperative molecular-targeted therapy and stoma-free survival was further analyzed in patients with severe anal ulceration and rectal stricture (high-risk features). Kaplan-Meier curves and log-rank tests were used for comparisons. Results: During follow-up, 42 patients required stoma construction. Severe anal ulceration (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.04–5.38; P=0.039), rectal stricture (OR, 2.84; 95% CI, 1.09–7.37; P=0.032), and absence of postoperative molecular-targeted therapy (OR, 0.36; 95% CI, 0.15–0.84; P=0.018) were independent risk factors. In patients with severe anal ulceration, the cumulative stoma construction rate was significantly lower with postoperative molecular-targeted therapy (P=0.018). No significant difference was observed in patients with rectal strictures (P=0.058). Conclusion Severe anal ulceration, rectal stricture, and absence of postoperative molecular-targeted therapy were independently associated with stoma construction. Postoperative molecular-targeted therapy improved stoma-free survival in patients with severe anal ulceration. Individualized treatment strategies, including early pharmacological intervention, may improve long-term outcomes and preserve anorectal function. Tailoring treatment according to lesion characteristics may reduce stoma formation and enhance quality of life in CD-associated perianal disease.

Introduction: This study examined the association between the use of home nursing care and the consultation time of emergency home visits among patients using home health care. Methods: Participants were recruited from three urban clinics in Japan between September 1 and November 30, 2019. Univariate analysis and multivariate negative binomial regression analysis considering institutional clusters were performed on the relationship between the two. Results: A total of 278 patients were included in the analyses. The use of home nursing care was significantly associated with a decrease in the time spent during emergency home visits in both univariate and multivariate analyses (P < 0.018 and P < 0.001, respectively). The multivariate analysis estimated the mean reduction in consultation time to be 10.3 minutes (95% confidence interval, 9.9-10.8). Conclusion: The use of home nursing care reduced the consultation time in emergency home visits. This study suggested that home nursing care can reduce the burden on physicians providing home visits, but further studies are needed to improve collaboration.

Background and aims:Lenvatinib(LEN)is a newly developed tyrosine kinase inhibitor,and is approved as a first-line treatment for advanced hepatocellular carcinoma(HCC)in Japan.This retrospective multi-center study investigated the effect of the relative dose intensity(RDI)of LEN on response rate,progression-free survival(PFS),and overall survival(OS). Methods:This retrospective study enrolled 123 patients with advanced HCC who were treated with LEN at six hospitals in Japan between March 2018 and December 2019.These patients were divided into two groups:RDI ≥70％(RDI 70 group,N=70)or RDI＜70％(control group,N=53)in the first 30 days.The following data were compared between groups:patient backgrounds,adverse events,treatment out-comes,PFS,and OS.PFS and OS were analyzed using the Kaplan-Meier method,followed by the log-rank test.To identify significant factors that contributed to response,PFS,and OS,multivariate analysis was performed using factors for which P-values were ＜0.10 in univariate analysis. Results:The proportion of patients with Child-Pugh class 5A was significantly greater in the RDI 70 group than that in the control group(64.3％ vs. 28.3％,P＜0.01).Dose interruption due to adverse events was significantly more common in the control group.The response rate was significantly higher in the RDI 70 group than that in the control group(35.7％ vs. 11.3％,P＜0.01).Median PFS was significantly longer in the RDI 70 group(9.4 vs.4.7 months,P＜0.01).Multivariate analysis showed that RDI ≥70％(hazard ratio(HR)=0.55,P=0.025),hypertension grade ≥2(HR=0.47,P=0.019),and response(HR=0.52,P=0.033)were independently associated with improved PFS.Median OS was also significantly longer in the RDI 70 group(20.0 vs.13.3 months,P=0.045).Multivariate analysis showed that female sex(HR=0.33,P=0.034)and disease control(HR=0.31,P＜0.01)were independently associated with improved OS.RDI ≥70％ was not statistically significant in multivariate analysis. Conclusions:Our study revealed the importance of achieving RDI ≥70％ in the first 30 days of treatment to maximize the effects of LEN.

Patients with Behçet disease often develop postoperative valve detachment and pseudoaneurysm as a potentially fatal complication following aortic valve surgery, necessitating re-operation in a few cases. A 37-year-old man underwent 5 aortic valve and aortic root surgeries for the management of valve detachment after initial aortic valve replacement. Evaluation during the course of his disease revealed incomplete Behçet disease. He presented with high fever and Staphylococcus epidermidis bacteremia during the introduction of immunosuppressive therapy with infliximab. Contrast computed tomography revealed a pseudoaneurysm around the aortic root, and an aortic root replacement was performed using an aortic homograft after administration of a 6-week course of vancomycin. The patient is being observed at our outpatient clinic and has demonstrated no complications after 5 years from his last surgery.