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Long-term monitoring of viruses and Varroa destructor within the same honey bee colonies is rare in Japan. Thus, we conducted a 4-year fixed-point survey of three Apis mellifera colonies in Tokyo with monthly screening for seven viruses (using polymerase chain reaction) and Varroa infestation. Deformed wing virus was detected year-round, whereas sacbrood virus and black queen cell virus peaked in spring and summer. Israeli acute paralysis virus appeared sporadically, without seasonal trends. Varroa infestation rates (monitored during the latter 2.5 years) did not correlate with the number of detected virus types and showed no seasonality. Although viral load was not quantified, this long-term dataset provides valuable baseline data on local virus dynamics, providing baseline information on seasonal virus dynamics in managed honey bee colonies in Tokyo.
Tuberculosis (TB) remains a major global health challenge, with delayed diagnosis perpetuating transmission in resource-limited settings. Although the sensitivity of molecular diagnostic methods is high, their dependence on the laboratory infrastructure limits accessibility in many regions. Serological approaches that detect host antibody responses represent a technically simple diagnostic strategy; however, the performance of currently available TB serodiagnostic tests is inconsistent, largely due to suboptimal antigen selection and heterogeneity in host immune responses. Therefore, the identification of conserved antigens naturally recognized during human infection is essential for improving serological diagnostics. A cDNA expression library derived from Mycobacterium bovis BCG Tokyo was constructed and screened by colony immunoblotting using pooled sera from patients with active TB. Immunoreactive clones were sequenced and analyzed bioinformatically. The full-length coding sequence of the identified antigen was expressed recombinantly using a cold-shock expression system in Escherichia coli. The recombinant protein was purified and evaluated for immunoreactivity using a Western blot analysis. Serological reactivity was further assessed using a dot-blot assay with individual serum samples from microbiologically confirmed TB patients (n = 40) and healthy controls (n = 40) from the Lao People's Democratic Republic. Diagnostic performance was evaluated by a receiver operating characteristic (ROC) curve analysis. Immunoscreening identified a conserved hypothetical protein corresponding to Rv1073 of M. tuberculosis, designated MtbAg1073, for which no antigenicity had been previously reported. The protein was highly conserved among members of the M. tuberculosis complex. Recombinant expression using a cold-shock system produced soluble His-tagged MtbAg1073, which was specifically recognized by sera from TB patients in the Western blot analysis. Dot-blot assays showed significantly higher antibody responses in TB patients than in controls (median intensity: 761.2 vs. 471.9; the Mann-Whitney U test, P = 0.0002). The ROC analysis demonstrated moderate discriminatory performance (AUC = 0.734; 95% CI: 0.624-0.844), with a sensitivity of 70.0% and specificity of 67.5% at the optimal cut-off value. MtbAg1073 is a conserved and immunoreactive antigen that elicits detectable antibody responses in active TB. These findings provide preliminary evidence of its immunoreactivity and warrant further investigation into its potential utility in serological approaches.
The case involved a 35-year-old female patient in the fifth month of pregnancy. The patient complained of dysphagia in the early stages of pregnancy and was referred to our hospital after developing dyspnea. An MRI revealed an 8 cm tumor in the anterior mediastinum compressing the airway. The fetus was delivered via emergency cesarean section, and a cervical lymph node biopsy confirmed squamous cell carcinoma. The tumor was diagnosed as an anterior mediastinal tumor of unknown primary origin, and treatment with nanoparticle albumin-bound paclitaxel (nab-PTX) plus Carboplatin (CBDCA) resulted in significant tumor shrinkage. Following shrinkage, the tumor was ultimately diagnosed as esophageal cancer. Subsequently, recurrence in the esophagus and brain metastasis were detected. Still, after undergoing radiation therapy, surgical treatment, and chemotherapy, no recurrence was observed for more than one year after the final treatment. The results of this study demonstrate that the combination therapy of nab-PTX plus CBDCA is highly effective not only for lung squamous cell carcinoma but also for esophageal squamous cell carcinoma.
To determine whether excluding low-signal-strength optical coherence tomography (OCT) scans from training improves deep learning-based visual field (VF) estimation from macular OCT volumes. We retrospectively analyzed 79,803 paired OCT and VF examinations from 8511 patients at five institutions. A three-dimensional convolutional neural network (3DCNN) estimated 24-2 and 10-2 pointwise sensitivities and mean deviation (MD) from NIDEK OCT volumes. Using patient-wise 10-fold cross-validation, we compared training on all scans with filtering at signal strength indices (SSIs) ≥ 7; training sets differed in size and SSI composition, and both models were tested on identical held-out samples stratified by SSI. Outcomes were pointwise mean absolute error (MAE) and absolute MD error. Mean SSI was 8.03 ± 1.65; 85.5% of scans had SSI ≥ 7. In the SSI < 7 subgroup, the all-SSI-trained model yielded lower errors for all endpoints, with reductions of 0.439 dB (24-2 MAE), 0.473 dB (10-2 MAE), 0.417 dB (24-2 MD error), and 0.453 dB (10-2 MD error; all adjusted P < 0.001). In the SSI ≥ 7 subgroup, no significant differences were observed. Error increased as SSI decreased, without a clear threshold at SSI = 7. In this EfficientNet 3D-based segmentation-free 3DCNN framework, using OCT scans across the full SSI range was associated with lower error in low-SSI held-out scans, with no significant penalty in higher SSI held-out scans in the primary comparison within this dataset. Including lower-signal-strength NIDEK macular OCT scans in development may improve robustness to lower-SSI inputs in this segmentation-free OCT-based VF framework.
A simple combination of a 3D carbon architecture and electrodeposition of Zn and Mn oxide enables the concept of a 3D Zn-ion battery. A CNT network-embedded porous 3D carbon framework enables uniform electrodeposition, realizing fully three-dimensional electrodes with stable electrochemical operation.
C-CAT lacks patient-level data on Japanese Society of Medical Oncology (JSMO) specialist involvement. We assessed facility-level registry-listed JSMO specialist availability and C-CAT-reconstructable treatment-process and endpoint-ascertainment measures in colorectal cancer. This nationwide retrospective C-CAT facility-level analysis included 11,906 patients at 261 facilities. The primary exposure was facility-level JSMO specialist count (0-3 vs 4 +); the secondary exposure was gastrointestinal-domain JSMO specialist presence. The primary endpoint was time from systemic therapy start to recorded second-line treatment end. Facility-cluster robust Cox models were used. Endpoint ascertainment, missingness-focused sensitivity analyses, and overall survival (OS) were supportive/contextual. Overall, 5349 patients at 181 facilities were in the 0-3 group and 6557 patients at 80 facilities in the 4 + group. Median time to recorded second-line treatment end was 20.2 versus 23.1 months (log-rank p < 0.001). In facility-cluster robust Cox models, the unadjusted HR for 4 + versus 0-3 specialists was 0.840 (95% CI 0.761-0.927; p < 0.001), attenuating after facility-category adjustment (HR, 0.948; 95% CI 0.853-1.055; p = 0.329) and clinical adjustment (HR, 0.968; 95% CI 0.866-1.082; p = 0.565). Second-line end-date availability was lower in the 4 + group (61.6% vs 69.1%). Supportive OS showed no specialist-associated survival advantage (median, 50.2 vs 51.3 months; clinically adjusted HR, 0.962; 95% CI 0.816-1.135; p = 0.648). C-CAT can reconstruct facility-level treatment-process and endpoint-ascertainment measures, but current C-CAT data do not support specialist-attributable clinical interpretation. Direct evaluation requires chemotherapy-specific national database elements.
Fesaviruses, members of the group of picorna-like viruses, were discovered in 2014 in stool samples from cats in an animal shelter in the United States. In this study, we investigated the serological evidence of fesavirus 4 infection in domestic cats in Japan using a purified recombinant antigen corresponding to a portion of the large open reading frame of fesavirus 4. An enzyme-linked immunosorbent assay was developed and used to test 100 cat plasma samples to detect specific antibodies against the fesavirus 4 antigen and Western blotting confirmed presence of specific antibodies against the fesavirus 4 antigen in 12 samples. These findings highlight the importance of investigating newly discovered viruses circulating in companion animals in Japanese animal shelters.
Autoimmune pancreatitis is a rare immunoglobulin G4-related disease characterized by a favorable response to steroids. However, its association with pancreatic cancer remains unclear. We report the case of a 71-year-old male who developed pancreatic cancer 1 month after completing a 7-year course of steroid therapy for autoimmune pancreatitis. Initially diagnosed based on elevated serum immunoglobulin G4 levels and characteristic imaging findings, the patient's autoimmune pancreatitis remained in remission during steroid therapy. Post-treatment imaging, positron emission tomography revealed a pancreatic tail mass leading to the differential diagnosis of autoimmune pancreatitis relapse versus pancreatic cancer. Histopathological examination confirmed adenocarcinoma, and the patient underwent successful neoadjuvant chemoradiotherapy and surgical resection. This case highlights the diagnostic challenges in distinguishing autoimmune pancreatitis from pancreatic cancer and emphasizes the importance of vigilant and long-term surveillance of patients with autoimmune pancreatitis, even in those with prolonged remission. Advanced imaging modalities and histopathological confirmation are essential for timely and accurate diagnosis.
This comment proposes that the diagnostic waiting period (DWP), defined as the interval from the first specialist visit to anticancer treatment initiation, should be recognized as an opportunity for early supportive care in patients with advanced lung cancer. We discuss the clinical rationale for initiating low-burden supportive care at the first specialist visit, drawing on prior observations of clinical deterioration before treatment initiation and feasibility data from a home-based exercise program during the DWP. The DWP is often necessary for imaging, tissue sampling, staging, molecular testing, and treatment planning, but patients may experience anxiety, inactivity, anorexia, weight loss, and functional decline during this period. A first-visit supportive care model could include patient education, safe physical activity guidance, nutritional screening, symptom assessment, and timely referral to rehabilitation, dietetic, nursing, or palliative care services. Reframing the DWP from passive waiting to active preparation may help preserve physical reserve, confidence, and treatment readiness before systemic therapy. Future studies should evaluate which patients should be prioritized, which interventions are most useful, and which outcomes best capture the value of this early supportive care approach.
The effects of using triethylene glycol dimethacrylate (TEGDMA) as a crosslinker on the mechanical properties of an additively manufactured occlusal splint material were evaluated via mechanical testing in two print orientations. Thirty-two test pieces containing 0 or 5 mass% TEGDMA were additively manufactured using a digital light-processing 3D printer with a photopolymer resin at 0° and 90° relative to the printer build platform. The flexural strength (FS), flexural modulus (FM), and Vickers hardness (HV) were evaluated. For fracture toughness (KIC) evaluation, 32 additional test pieces were printed. The FS and KIC results were analyzed using a two-way analysis of variance, whereas the FM and HV results were tested using the Mann-Whitney U test. Pairwise comparisons were performed with Bonferroni correction (α = 0.05). TEGDMA incorporation influenced the properties of the additively manufactured occlusal splints in a print-orientation-dependent manner. It reduced the FS and FM in the 90° orientation and increased the HV in the 0° orientation. By contrast, a smoother surface morphology was observed after TEGDMA incorporation. TEGDMA incorporation influenced the properties of the additively manufactured occlusal splints in a print-orientation-dependent manner. While changes in the surface morphology were observed, unfavorable effects on certain mechanical properties were also identified. These findings suggest that print orientation should be considered when incorporating crosslinkers into additively manufactured occlusal splint materials.
GC content-the proportion of guanine and cytosine nucleotides-varies widely among organisms and viruses. Although GC content is recognized to have biological significance, its functional role in viruses remains poorly understood. Here, we examined the impact of GC-content bias using three positive-sense single-stranded RNA viruses with distinct GC profiles: severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), Japanese encephalitis virus (JEV), and hepatitis C virus (HCV). Variants of the NanoLuc (Nluc) reporter gene, engineered with synonymous mutations to alter GC content, were inserted into each viral genome. Serial passaging experiments revealed strong effects on genome stability and viral fitness. In SARS-CoV-2, which has low GC content, the introduction of a GC-rich Nluc gene disrupted genome stability, leading to frequent deletions of Nluc. In both SARS-CoV-2 and HCV, Nluc with mismatched GC levels accumulated substitutions that optimized GC content toward that of the viral genome, predominantly at the third codon position. tRNA-seq analysis revealed a shift in the host tRNA pool toward a more GC-rich composition during HCV infection, consistent with this substitution bias. In contrast, JEV (intermediate GC content) maintained the Nluc variants across serial passages, suggesting reduced selective pressure. Taken together, these findings demonstrate that mismatches between viral genome GC content and inserted sequences profoundly affect genetic stability, suggesting evolutionary constraints that may shape RNA virus composition more broadly. This study provides mechanistic insight into how GC content influences viral genome maintenance and offers a framework for designing genetically stable recombinant reporter viruses.IMPORTANCEGC content is a fundamental genomic feature that influences gene expression, genome architecture, and adaptation. Although its role in cellular genomes has been extensively studied, the functional significance of GC content in viral genomes remains poorly understood. In this study, we show that incompatibility in GC content between a viral genome and an inserted transgene destabilizes RNA secondary structures, compromising viral genome integrity, and is accompanied by changes in the host tRNA pool consistent with this compositional bias. These findings identify GC content as a previously underappreciated determinant of virus-host compatibility and viral fitness. Importantly, our results provide mechanistic insight into how the GC content of a viral genome can be matched to its host cellular environment. By demonstrating that GC content matching is critical for the stability of recombinant viruses, this study provides a basis for the rational design of reporter viruses, vaccine platforms, and antiviral screening tools.
Although positive associations between fewer remaining teeth and an increased risk of various systemic diseases have been reported, the precise dose-response relationship has not been fully clarified. This study aimed to evaluate the non-linearity of the dose-response association between the number of lost teeth and the risk of cardiovascular diseases among middle-aged adults. This retrospective cohort study, with over 5 years of follow-up, was based on medical claims and health check-up data. Participants were adults aged 40-64 in Japan. The outcome was the incidence of cardiovascular diseases. Exposure variables were the number of lost teeth, which was modeled using a restricted cubic spline. A Cox proportional hazards model was fitted to estimate hazard ratios (HRs) and 95% confidence intervals. Among the 551,386 participants (mean age = 50.0 years [SD = 6.7], male = 52.0%), the incidence rate of cardiovascular diseases was 0.70 per 100 person-years. A significant non-linear dose-response association was observed between the number of lost teeth and cardiovascular disease risk (p = 0.004). Although the risk increased with greater tooth loss, the dose-response curve bent at around four lost teeth, with an HR of 1.09 (1.05-1.14) at four teeth lost and 1.21 (1.08-1.37) at 27 teeth lost (reference: "no tooth loss"). These findings suggest no clear threshold exists in the non-linear dose-response association between tooth loss and cardiovascular disease risk. Comprehensive public health strategies to prevent periodontal diseases and dental caries are essential throughout life to minimize tooth loss and its systemic consequences. This retrospective cohort study of 551,386 middle-aged adults found a significant non-linear dose-response association between tooth loss and the risk of cardiovascular diseases. Cardiovascular disease risk increased as the number of lost teeth increased; however, the dose-response curve showed an inflection at around four lost teeth, with no clear threshold observed in the association between tooth loss and cardiovascular disease risk.
This study aimed to investigate the effects of simulated molar loss on masticatory function, with a focus on the preferred chewing side (PCS). Twenty-eight participants with intact dentition were enrolled. Experimental occlusal splints (OSs) were fabricated to simulate a unilateral shortened dental arch in which the molars on one side did not contact the opposing teeth. Participants were randomly assigned to two groups. In the first group, OSs with the molar region removed on the PCS (PCS removal) were tested first, followed by repaired OSs with the molar region removed on the non-PCS (non-PCS removal). The second group underwent the reverse sequence. Outcome measures included maximum occlusal force (MOF), masticatory efficiency (ME), and subjective masticatory ability (SMA) (α=0.05). No significant difference in full-arch MOF was observed between the conditions. However, the second premolar on the removal side exhibited a significantly higher MOF after PCS removal, whereas ME and SMA significantly decreased after PCS removal (P < 0.05). Moreover, the reduction in full-arch MOF following PCS removal was significantly smaller in participants whose main occluding area (MOA) was located at the second premolar compared with those with the MOA at the first molar (P < 0.05). Loss of molar occlusal contact on the PCS impairs both objective and subjective masticatory function and increases the occlusal load on the second premolar. These findings suggest that molar loss on the PCS may necessitate prosthetic intervention, whereas the impact may be attenuated in individuals whose MOA is located more anteriorly.
Objective Infectious mononucleosis (IM) is most commonly caused by Epstein-Barr virus (EBV). However, recent epidemiological shifts have increased the proportion of adult cases attributable to cytomegalovirus (CMV). Early distinction of EBV-related IM (EBV-IM) using routine laboratory parameters may reduce unnecessary testing and facilitate timely counseling regarding activity restriction. This study aimed to identify the laboratory features that distinguish EBV-IM from non-EBV IM and to develop a simple diagnostic scoring system. Methods We retrospectively analyzed 39 consecutive patients with IM (EBV-IM, n = 22; non-EBV IM, n = 17, including CMV-IM, n =8). The laboratory parameters and inflammatory indices were compared between the groups, and receiver operating characteristic curve analyses were used to determine the optimal cutoff values for score development. Results EBV-IM patients had higher alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels than non-EBV IM patients, whereas the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels were lower in EBV-IM patients. Four variables were used for scoring: ALT ≥ 120 U/L, ALP ≥ 200 U/L, NLR ≤ 0.6, and CRP ≤ 2.0 mg/dL, collectively termed the EBV-IM Laboratory Score (EL-Score). A score ≥ 2 predicted EBV-IM with an area under the curve of 0.95 (95% confidence interval: 0.88-1.00), a sensitivity of 0.91, and a specificity of 0.94. Conclusions The EL-Score, based on routinely available laboratory parameters, may enable the early distinction between EBV-IM and non-EBV IM in internal medicine practice.
This study aimed to elucidate the clinical relevance of the cachexia index (CXI), an integrative metric encompassing sarcopenia, nutritional status, and systemic inflammatory burden, in patients undergoing surgery for gastric cancer (GC). We retrospectively reviewed 1,166 patients who underwent curative gastrectomy for GC. The CXI was calculated as follows: skeletal muscle index (SMI) × serum albumin concentration (g/dL) / neutrophil-to-lymphocyte ratio (NLR). Patients were dichotomized according to sex-specific lowest quartile cutoff values (61.6 for men and 49.2 for women). The impact of the CXI on overall survival (OS), disease-free survival (DFS), and the recurrence patterns was studied. Multivariate Cox regression analyses were performed to identify any independent predictive factors for a poor survival. A low CXI was significantly associated with advanced age (≥ 65 years), a higher comorbidity burden, an advanced pathological stage, and a higher incidence of postoperative complications. Patients in the low-CXI group had a significantly poorer OS than those in the high-CXI group (5-year OS: 63.4% vs. 78.5%, P < 0.001), with a consistently inferior survival across pathological stages I-III. A low CXI was also significantly associated with a poorer DFS (5-year DFS: 61.0% vs. 76.7%, P < 0.001). Among the patients with stage II/III disease, hematogenous recurrence occurred more frequently in the low-CXI group than in the high-CXI group (13.6% vs. 6.9%, P = 0.026). A multivariate analysis revealed that a low CXI was an independent predictor of a poor OS (HR 1.58, 95% CI: 1.20-2.07, P = 0.001). The CXI is useful for predicting the survival outcomes of GC patients, irrespective of tumor stage. A low CXI was associated with a higher incidence of recurrence, especially hematogenous recurrence.
Although adrenaline auto-injector (AAI) prescribing has increased in Japan following insurance coverage expansion, real-world utilization during pediatric anaphylaxis remains insufficiently characterized. This study aimed to describe current AAI prescription patterns, actual utilization rates, and factors potentially associated with appropriate use. This retrospective descriptive study analyzed AAI prescriptions and anaphylaxis hospitalizations at a tertiary care hospital in Shizuoka, Japan (2023-2024). We reviewed 124 AAI-prescribed children and 34 hospitalized anaphylaxis cases. For hospitalized patients possessing AAI (n = 8), we conducted detailed interviews assessing prior education quality, including hands-on training with expired AAI and smartphone application utilization. Among 124 AAI-prescribed patients, only 5 (4.0%) used AAI during follow-up. Among 34 hospitalized anaphylaxis cases, more than half (55.9%) occurred on first known allergen exposure, particularly for seafood (92.9%). Only 8 patients (23.5%) possessed an AAI prior to the event; among them, 4 (50%) used their AAI. Notably, AAI use appeared to differ by concordance between the triggering allergen and the allergen for which AAI was prescribed: 4/5 (80%) used AAI when allergens matched versus 0/3 (0%) when they differed. This study characterized current AAI prescription patterns and real-world utilization during pediatric anaphylaxis in Japan. Only 23.5% of hospitalized anaphylaxis cases possessed AAI, and utilization among possessors differed markedly depending on whether the triggering allergen matched the prescription indication. These findings suggest that AAI education should emphasize use for any anaphylaxis symptoms regardless of trigger.
Mitochondrial transcription factor A (TFAM) is a key regulator of mitochondrial DNA transcription and replication. T cell-specific TFAM-deficient mice are immunocompromised, often succumbing to viral infection, and their T cells are unresponsive to T-cell antigen receptor (TCR) stimulation, suggesting that TFAM-mediated mitochondrial activity regulates T-cell activity, such as effector function and memory formation. In contrast to the attenuation of immune response, TFAM deficiency may also induce inflammatory responses, raising the possibility that TFAM deficiency results in inflammation-mediated autoimmune responses. Thus, besides regulating T-cell function, TFAM plays important roles in autoimmune responses. However, its role in autoimmune diseases remains uncertain. We aimed to investigate the role of TFAM in autoimmune diseases using T cell-specific TFAM-deficient mice. We detected anti-double-strand (ds) DNA antibody, and interferon alpha (IFNα) and IFNγ in the serum of TFAMfl/fl CD4Cre mice after 30 weeks of age. Mononuclear cell infiltration was observed in the kidneys. TFAM-deficient T cells exhibited leakage of mitochondrial DNA into the cytoplasm. Cytoplasmic mitochondrial DNA was associated with activation of TANK-binding kinase 1 (TBK1) and IFN regulatory factor 3 (IRF3)-the downstream molecules of the nucleic acid sensor cyclic guanosine monophosphate-adenosine monophosphate synthase/stimulator of IFN genes (cGAS/STING) machinery. mRNA expression of type I IFN genes was elevated in T cells from TFAMfl/fl CD4Cre mice. The suppressive function of Foxp3+ regulatory T (Treg) cells, which play a major role in establishment of peripheral tolerance, was reduced in the absence of TFAM. Our findings suggest that T cells in TFAM-deficient conditions may contribute to immune instability and autoimmune responses by inducing type I IFN-mediated inflammatory responses.
Pancreatic ductal adenocarcinoma (PDAC) frequently recurs early after resection, resulting in a poor prognosis. Although neoadjuvant chemotherapy with gemcitabine plus S-1 (NAC-GS) is the standard strategy in Japan, predictors of early recurrence (ER) remain unclear. We retrospectively analyzed 102 patients with resectable pancreatic ductal adenocarcinoma (PDAC) who underwent NAC-GS followed by pancreatectomy at four institutions. ER was defined as recurrence within 6 months of surgery. Clinicopathological variables were evaluated to identify the predictors of ER. ER occurred in 9% of patients and was independently associated with significantly worse overall survival. Tumor progression during NAC-GS and elevated pre-treatment CA19-9 levels (> 292 U/mL) were identified as independent preoperative predictors of ER. A novel scoring system incorporating these factors effectively stratified ER risk (ER rates: 1%, 13%, and 100% for scores of 0, 1, and 2, respectively; AUC = 0.85). The score was also associated with the long-term prognosis. Tumor progression during NAC-GS and elevated CA19-9 levels are significant predictors of ER in patients with resectable PDAC. The proposed scoring system may aid in identifying patients who could benefit from alternative or intensified treatment strategies.
Long-term medical needs after definitive surgery for esophageal atresia (EA) are incompletely understood. The real-world patterns of home medical care and medication use after hospital discharge remain underexplored. Using the Japanese national inpatient Diagnosis Procedure Combination database, we identified infants who underwent definitive surgery for EA between July 2010 and March 2023. We described patients' background characteristics, perioperative information, long-term home medical care (home tracheostomy care, home mechanical ventilation, home oxygen therapy, and home enteral nutrition), and medication use (antacids, prokinetic agents, and anti-asthmatics) at 1, 3, 5, and 7 years post-definitive surgery. Subgroup analysis based on congenital heart disease (CHD) was conducted. Overall, 806 patients met the eligibility criteria. Home enteral nutrition was the most frequently performed home medical care (22.0% of patients at 1 year post-surgery), whose proportion decreased gradually over time. Antacid and prokinetic agent use also declined over time. Subgroup analysis revealed that patients with CHD required home oxygen therapy and home enteral nutrition more frequently than those without CHD. A substantial proportion of patients required home longitudinal nutritional and respiratory support post-definitive surgery for EA. Our findings provide important information for long-term healthcare needs of patients receiving definitive surgery for EA. III (retrospective comparative study).
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