Early identification of patients at high risk of deep surgical site infection after open extremity fractures is crucial for timely intervention and improved outcomes. This study aimed to develop and internally validate a clinical prediction model, the BIGB2OSS score, for predicting deep surgical site infection within three months of injury using variables easily obtained in early post-injury phase. A prospective cohort study was conducted at two university hospitals in Japan, including 570 consecutive patients with open extremity fractures. Data on 18 candidate predictors were collected in the early post-injury phase. The primary outcome was the occurrence of deep surgical site infection within three months of injury. A backward stepwise logistic regression model was used to build the prediction model. Model performance was assessed using the area under the curve (AUC) and internal validation with bootstrap methods. The BIGB2OSS score was a 5-point model based on four predictors: BMI ≥ 25 (1 point), Gustilo-Anderson classification IIIA (1 point), Gustilo-Anderson IIIB or IIIC (2 points), OTA-OFC skin = 3 (1 point), and smoking history (1 point). The model showed fair discriminative ability with an AUC of 0.76 (95% CI 0.70-0.83). Internal validation using bootstrap resampling with 1000 repetitions yielded an optimism-adjusted C-statistic of 0.76 (95% CI 0.70-0.83). The estimated probabilities of deep surgical site infection were 2.7% for scores 0-1, 11% for scores 2-3, and 30% for scores 4-5, closely matching the actual prevalence. The BIGB2OSS score is a simple clinical prediction model with fair discrimination for deep surgical site infection in patients with open extremity fractures. It uses early post-injury variables and may support timely risk communication and follow-up planning. Further external validation is needed to confirm its utility in diverse clinical settings.
Benzodiazepines (BZPs) continue to be widely prescribed in non-psychiatric settings, despite clinical guideline recommendations favouring selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) for the treatment of anxiety and depressive disorders. Long-term, hospital-based evidence comparing these prescribing patterns in Japan remains limited. The study aim was to evaluate long-term trends in BZP prescribing relative to SSRI/SNRI use and to identify factors associated with anxiolytic BZP versus SSRI/SNRI prescriptions. We conducted a database study of all 16,886,524 prescriptions issued between April 2001 and March 2022 at a tertiary university hospital in Japan. Anxiolytic and hypnotic BZPs, SSRIs, SNRIs, and related antidepressants were identified. The ratio of anxiolytic BZP to SSRI/SNRI prescriptions (B/S ratio) was calculated according to department group. Factors associated with anxiolytic BZP versus SSRI/SNRI prescribing were examined using multiple logistic regression analysis. Anxiolytic BZP prescriptions accounted for 2.3% of all prescriptions and declined over time, whereas SSRI/SNRI prescriptions (1.4%) remained largely stable throughout the study period. The B/S ratio was consistently higher in internal medicine than in psychiatry, although a gradual reduction was observed over time. Multivariable analysis demonstrated that anxiolytic BZP prescribing was independently associated with the internal medicine department, female sex, outpatient status, younger age, and earlier calendar years. Despite a temporal decline, anxiolytic BZPs continue to be preferentially prescribed over SSRIs/SNRIs in non-psychiatric settings. These findings underscore persistent gaps between evidence-based recommendations and clinical practice and highlight the need for targeted educational and policy interventions to optimise psychotropic prescribing.
This study aimed to characterize the spectrum of anatomical variations in the origin and course of the suprascapular artery. We investigated the origin and course of 239 suprascapular arteries from 134 Japanese cadavers donated to Juntendo University School of Medicine for anatomical education. The suprascapular arteries were classified into six types based on their origin and course. Type 1, originating from the thyrocervical trunk, represented the most common and standard morphology (158/239, 66.1%). Type 2 arose from the proximal portion of the internal thoracic artery (15/239, 6.3%), and Type 3 originated directly from the second part of the subclavian artery (10/239, 4.2%). Types 1-3 passed superior to the superior transverse scapular ligament to enter the supraspinous fossa. Type 4 originated directly from the third part of the subclavian artery (50/239, 20.9%), whereas Types 5 and 6 arose from the superior thoracic artery (4/239, 1.7%) and the superficial subscapular artery (2/239, 0.8%), respectively. Types 4-6 traversed the scapular notch inferior to the superior transverse scapular ligament, accompanying the suprascapular nerve, to enter the supraspinous fossa. The brachial plexus sheath, which envelops the brachial plexus and adjacent arteries, was identified as a potential anatomical determinant of the correlation between the origin and course of the suprascapular artery. Type 1 represented the standard morphology of the suprascapular artery. Consistent with previous studies, the suprascapular artery exhibited considerable anatomical variation, with a distinct correlation between origin and course.
Study DesignMulticenter prospective observational study.ObjectivesTo determine the responsiveness, reliability, and construct validity of commonly used clinician-reported and patient-reported outcome measures in surgically treated thoracic myelopathy, a condition for which standardized outcome assessment has not been established.MethodsAdults undergoing surgery for MRI-confirmed thoracic myelopathy were prospectively enrolled at nine tertiary centers. Clinician-reported measures included the Japanese Orthopaedic Association (JOA) score, a thoracic-adapted JOA subtotal (JOAt), and the modified JOA (mJOA). Patient-reported outcomes included the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and EuroQOL 5-dimension (EQ-5D). Assessments were performed preoperatively and at 3-6 months postoperatively. Internal responsiveness was evaluated using Wilcoxon's r, test-retest reliability using ICC(1,1), and construct validity using Spearman's correlation with EQ-5D.ResultsFifty-one patients were included (mean age 65.6 years; 59% male). Significant postoperative improvement was observed across major clinician-reported and patient-reported outcomes. Large internal responsiveness was demonstrated for JOA (r=0.64), JOAt (0.63), mJOA (0.68), and JOACMEQ lower-extremity function (LF) (0.59). Test-retest reliability was high for JOA, JOAt, mJOA, JOACMEQ-LF, and EQ-5D (ICC range 0.78-0.85). JOACMEQ-LF showed the strongest construct validity with EQ-5D at both baseline (ρ=0.62) and follow-up (ρ=0.72).ConclusionsJOAt, mJOA, and JOACMEQ lower-extremity function demonstrated robust psychometric performance in thoracic myelopathy. These measures represent suitable candidates for standardized outcome assessment and provide a methodological foundation for future clinical studies and guideline development in this under-studied condition.
The AirPods Pro 2® (Apple Inc., Cupertino, CA, USA) recently received regulatory approval in Japan as a Class II medical device incorporating a self-administered hearing assessment feature ("Hearing Check") and a hearing assistance program ("Hearing Aid Program"). Unlike conventional prescription hearing aids fitted using prescriptive algorithms such as NAL-NL2 and DSL v5, the amplification characteristics of the AirPods Pro 2 Hearing Aid Program are automatically determined by proprietary algorithms based on device-derived thresholds, and internal processing parameters are not publicly disclosed. To characterize the level-dependent real-ear insertion gain (REIG) generated by the AirPods Pro 2 Hearing Aid Program across representative audiometric profiles and to compare its gain characteristics with NAL-NL2 and DSL v5 prescriptive targets. Five representative audiometric profiles (30-dB flat, 50-dB flat, low-frequency hearing loss, gradually sloping high-frequency loss, and steeply sloping high-frequency loss) were selected from an independent dataset obtained using the AirPods Hearing Check. These profiles were sequentially programmed into the device for real-ear measurements in 10 adult volunteers (10 right ears). REIG was measured using the International Speech Test Signal at input levels of 50, 65, and 80 dB SPL in a calibrated sound-treated booth. Measured REIG was descriptively compared with prescriptive targets calculated from the same device-derived thresholds. REIG varied according to audiometric profile and input level. Gain generally increased toward mid- and high-frequency regions relative to low frequencies. Insertion gain progressively decreased as input level increased, with marked attenuation at 80 dB SPL. Compared with prescriptive targets, measured REIG was generally lower and showed less pronounced frequency-specific gain variation. The AirPods Pro 2 Hearing Aid Program exhibits nonlinear, level-dependent amplification with moderate frequency shaping and attenuation at higher input levels. Its gain characteristics differ from conventional prescriptive targets, suggesting emphasis on listening support and output control rather than strict prescriptive matching. Further studies are needed to clarify the clinical role of consumer-oriented hearing devices.
Severe caffeine intoxication can cause life-threatening complications, yet serum caffeine measurements are rarely available at presentation. We aimed to develop a simple clinical prediction model using readily available clinical parameters to predict severe caffeine intoxication. This retrospective study involved patients with acute caffeine intoxication admitted between April 2016 and March 2022. Data on clinical variables at presentation were collected. Severe intoxication was defined as serum caffeine concentration ≥ 80 mg/L (412 μmol/L). Candidate predictors included heart rate and serum potassium and bicarbonate levels. A ridge logistic regression model was developed and evaluated using the area under the receiver operating characteristic curve, calibration plots, and Hosmer-Lemeshow test. Internal validation was performed using bootstrap resampling and leave-one-out cross-validation. Conventional logistic regression was performed as a sensitivity analysis. Clinical utility was assessed using decision curve analysis. Of 30 patients included, 13 (43%) had serum caffeine concentration ≥ 80 mg/L (412 μmol/L). Patients with severe intoxication had higher ingested doses, shorter time to presentation, higher heart rates and respiratory rates, lower bicarbonate and potassium levels, and more frequent use of hemodialysis and activated charcoal. The ridge model retained heart rate and bicarbonate and potassium levels as predictors. Internal validation demonstrated excellent discrimination and good calibration. Decision curve analysis indicated net clinical benefit across a range of threshold probabilities. Sensitivity analysis using conventional logistic regression revealed consistent results, with heart rate remaining a significant predictor. The selected predictors are biologically plausible and reflect key pathophysiological features of severe caffeine intoxication. Internal validation demonstrated excellent discrimination and calibration, supporting the robustness of the model. We developed a practical bedside prediction model for caffeine intoxication using heart rate and bicarbonate and potassium levels. The model demonstrated excellent discrimination and calibration. It may support early risk stratification and guide intensive monitoring or extracorporeal therapy.
Influenza A and B viruses are considerable public health threats. Annual seasonal epidemics are driven by antigenic drift and cause an estimated 3-5 million severe cases and 290,000-650,000 deaths annually. The clinical presentation of seasonal influenza is typically an abrupt, uncomplicated acute respiratory illness with full recovery; however, it can lead to severe, life-threatening complications in individuals at high risk. Antigenic shift caused by reassortment of a seasonal influenza A virus with avian and/or swine influenza A viruses has led to unpredictable pandemics. The successful cross-species transmission of influenza A viruses requires key viral adaptations, including changes in receptor specificity and compatibility with host factors such as ANP32A. Host defence involves a layered innate response, which is antagonized by proteins, such as non-structural protein 1, and a robust adaptive immunity comprising cytotoxic CD8+ T cells targeting conserved internal proteins and B cells producing neutralizing antibodies. Diagnosis primarily depends on highly sensitive PCR-based methods and multiplexed rapid antigen tests. Prevention involves annually updated seasonal vaccines (including inactivated, live attenuated and protein-based vaccines), while treatment relies on early use of neuraminidase and polymerase acidic protein inhibitors. Research priorities include the development of improved vaccines and a better understanding of influenza virus transmission from animals to humans.
Global longitudinal strain (GLS) is a well-established prognostic marker for the early detection of cancer therapy-related cardiac dysfunction (CTRCD). We previously developed machine learning (ML) models to predict reduced GLS (Low-GLS, defined as absolute GLS < 16%) from conventional echocardiographic parameters in patients with cancer. This study aimed to externally validate the performance and generalizability of the previously developed ML models in an independent cohort. This multicenter study included patients from the Tokyo Metropolitan Tama Medical Center (TMC, n = 1484) and Shizuoka Cancer Center (SCC, n = 141) who underwent echocardiography with GLS measurements before or after anticancer chemotherapy. The exclusion criterion was left ventricular ejection fraction < 50%. Low-GLS was predicted using 25 conventional echocardiographic parameters. The previously developed ML models (Random Forest, Extra Trees, and CatBoost) were directly applied, without retraining, to an independent external validation cohort from SCC. A conventional logistic regression model was included as a reference for comparison. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), and other metrics. In the internal validation cohort, the ML models demonstrated discriminative comparable performance (AUCs 0.722-0.748), whereas logistic regression achieved an AUC of 0.729. In the external validation cohort, performance was generally preserved; the Random Forest model demonstrated the highest discriminative ability (AUC 0.772), while the remaining models achieved AUCs of 0.725-0.746. Logistic regression achieved an AUC of 0.738. ML models trained on conventional echocardiographic parameters retained moderate predictive ability for reduced GLS upon external validation.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an increased risk of cardiovascular events and frequently coexists with other atherosclerosis risk factors, including obesity, metabolic syndrome, sleep apnea, and insulin resistance. Lipoprotein(a) [Lp(a)] is a low-density lipoprotein-like particle bound to apolipoprotein(a), that has been studied to have pro-thrombotic and pro-inflammatory properties and is an established independent risk factor for atherosclerotic disease. However, the association between MASLD and Lp(a) and their impact on long-term clinical outcomes have not been evaluated previously. We performed a secondary analysis of the prospectively collected data from the Multi-Ethnic Study of Atherosclerosis (MESA). Baseline MASLD was defined as either a liver-to-spleen (L:S) attenuation ratio less than 1.0 or liver attenuation <40 HU on computed tomography (CT) imaging, excluding individuals with excess alcohol consumption (>15 drinks/week for men and > 10 drinks/week for women) and the presence of at least one cardiometabolic risk factor, including elevated BMI or waist circumference, type 2 diabetes mellitus, hypertension, hypertriglyceridemia, or reduced HDLC. Baseline Lp(a) levels were measured using a latex-enhanced turbidimetric immunoassay (Denka Seiken, Tokyo, Japan). Median Lp(a) levels were significantly lower in those with baseline MASLD compared to those without MASLD (11.9 vs 18.1 mg/dL, p-value <0.001). Individuals with MASLD and low Lp(a) levels (≤ 50 mg/dL) had a significantly higher risk of all-cause mortality compared to those without MASLD and with low Lp(a) (HR 1.28; 95% CI: 1.025-1.56), independent of traditional cardiovascular risk factors. Additionally, individuals with baseline MASLD and elevated Lp(a) were independently associated with an increased risk of hard cardiovascular disease (HR 2.07, 95% CI: 1.39-3.09), compared to individuals without MASLD and with Lp(a) ≤ 50 mg/dL. MASLD is independently associated with lower levels of Lp(a). Patients with baseline MASLD and elevated levels of Lp(a) exhibit nearly twice the risk of cardiovascular diseases as compared to the cohort with no MASLD and lower Lp(a) levels. Importantly, even in the absence of elevated Lp(a), MASLD is associated with increased all-cause mortality. These findings suggest that while Lp(a) is a strong contributor to cardiovascular risk, MASLD itself is an independent determinant of long-term mortality.
We aimed to evaluate the role of medical therapy before and after balloon pulmonary angioplasty (BPA) for non-operable chronic thromboembolic pulmonary hypertension (CTEPH) in the modern management era. This Japanese nationwide, multicenter, prospective observational registry, including 37 centers, analyzed data newly registered from August 2018-December 2023. Pretreatment before BPA was analyzed in patients who were treatment naïve or received medical therapy only at registration (n = 557). De-escalation or escalation of medical therapy after BPA was analyzed in patients who underwent BPA (n = 966). The BPA pretreatment analysis in 557 patients showed that approximately 70% of the patients received medical therapy, of which 18% received combination therapy. Patients who received monotherapy or combination therapy had more severe baseline hemodynamics than those who did not. The 3-year survival did not significantly differ between the no, mono, and combination pretreatment groups (94%, 98%, and 97%, respectively; p = 0.852). The BPA post-treatment analysis in 966 patients showed that 20% of patients underwent de-escalation of medical therapy. Patients with de-escalation of medical therapy had lower mean pulmonary artery pressure (PAP) (20.9 ± 5.8 vs. 24.1 ± 7.3 mmHg, p < 0.01); however, they had a lower cardiac index at last follow-up compared to patients without de-escalation (2.66 ± 0.61 vs. 2.84 ± 0.70 L/min/m2, p = 0.01). Patients with severe disease tended to undergo pre-treatment before BPA; however, patient survival did not differ across pretreatment types. De-escalation of medical therapy after BPA can affect cardiac index. Therefore, de-escalation or continuation of medical therapy should be carefully considered even after mean PAP normalizes after BPA.
In antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, infection risk exceeds that of the general population, and infection is a leading cause of death. However, the impact of the COVID-19 pandemic on serious infections and mortality in this population remains uncertain. This observational study used data from the nationwide registry in Japan (Japan Collaborative Registry of ANCA-Associated Vasculitis), which includes patients with newly diagnosed and relapsed ANCA-associated vasculitis from 29 sites between January 2017 and March 2023. The primary outcome was serious infection requiring hospitalisation; the secondary outcome was all-cause mortality. The impact of COVID-19 was estimated using an interrupted time-series analysis, with the boundary between April and May 2020 as the change point, following the first declaration of a state of emergency in Japan. Monthly incidence rates were modelled using segmented Poisson regression. Rate ratios (RRs) for level and slope changes with 95% CI were reported. Several sensitivity analyses were performed. Among 1064 patients, total follow-up was 37,535 person-months; 205 serious infections and 96 deaths occurred. For serious infection, the level-change RR was 0.54 (95% CI: 0.31-0.94) and the slope-change RR was 1.01 (0.98-1.04). For all-cause mortality, the level-change RR was 0.35 (0.12-0.98) and the slope-change RR was 1.001 (0.94-1.06). Findings were robust across sensitivity analyses. Immediately after the onset of the COVID-19 pandemic, a clear reduction in serious infections and mortality was observed without major changes in patient characteristics. These findings may reflect the impact of social and personal infection control measures.
Advances in therapeutics and interventions have enabled the comprehensive management of patients with heart failure (HF); however, real-world clinical practice remains poorly characterized. This study aimed to evaluate temporal changes in HF management and their impact on patient outcomes. Two large-scale Japanese HF registries were compared: the JROADHF (2013, n = 13 238) and JROADHF-NEXT (2019-21, n = 4016). Propensity score matching (1:1) was performed to compare patient outcomes between cohorts and identify factors associated with outcome improvements. Propensity score matching yielded 2972 patients in each cohort. After matching, guideline-recommended therapy increased for renin-angiotensin system inhibitors (70.9% vs 73.1%), beta-blockers (74.9% vs 80.8%), mineralocorticoid receptor antagonists (54.2% vs 61.1%), cardiac rehabilitation (43.5% vs 88.8%), and nutritional guidance (2.9% vs 56.1%) in the 2013 and 2019-21 cohorts, respectively. The 2019-21 cohort demonstrated 26.7% and 52.1% reductions in 1-year mortality and HF readmission rate (P < .001 for both), respectively, compared with the 2013 cohort. Improved mortality was associated with pharmacotherapy [renin-angiotensin system inhibitors: hazard ratio (HR) .71, 95% confidence interval (CI) .64-.80, P < .001; beta-blockers: HR .85, 95% CI .75-.96, P = .012] and patient education (nutritional guidance: HR .76, 95% CI .64-.89, P = .001). The cohort effect was the strongest predictor of HF readmission (subdistribution HR .49, 95% CI: .43-.57, P < .001). Long-term outcomes of patients with HF improved between 2013 and 2019-21. Guideline-recommended therapy was associated with survival benefit, whereas marked reduction in HF readmission rates coincided with broader changes in post-discharge care and healthcare system.
Lecanemab and donanemab are recently approved disease-modifying therapies (DMTs) for early Alzheimer's disease (AD), indicating amyloid positivity, with Mini-Mental State Examination (MMSE) requirements. Prior analyses using North American population data suggested that baseline Clinical Dementia Rating-Global Score (CDR-GS) and MMSE may define the "therapeutic time window," but generalizability to Asian populations remains uncertain. To investigate the duration and predictors of the therapeutic time window, defined as the period until patients with early AD no longer meet eligibility criteria in Japanese patients. We retrospectively analyzed amyloid-positive participants from Japanese Alzheimer's Disease Neuroimaging Initiative, classified as lecanemab-eligible (MMSE 22-30, n = 129) or donanemab-eligible (MMSE 20-28, n = 143). Kaplan-Meier survival was estimated over 24 months, and Cox proportional-hazards models included age, sex, MMSE, CDR-GS, and baseline diagnosis. Education years, apolipoprotein-E ε4 (APOE-ε4), and CDR-Sum of Boxes (CDR-SB) were tested individually. At 12 and 24 months, survival probabilities for remaining eligible were 82% and 69% (MCI) versus 51% and 38% (AD) in the lecanemab group, and 92% and 81% (MCI) versus 69% and 52% (AD) in the donanemab group. Baseline CDR-GS of 1 versus 0.5 predicted shorter eligibility for donanemab (HR = 2.50, 95% CI: 1.20-5.21), but not for lecanemab (HR = 0.48, 95% CI: 0.18-1.29). Each one-point increase in MMSE above threshold was protective (HR = 0.67-0.68). Baseline CDR-GS and MMSE strongly predict the therapeutic time window in Japanese patients, supporting cross-population generalizability and contributing to the management of AD DMTs under resource constraints.
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A 77-year-old man was referred for an evaluation of persistent left-sided pleural effusion that progressively increased after treatment for acute alcoholic pancreatitis, which had been managed without any intra-abdominal procedures. Thoracentesis yielded a milky pleural fluid with markedly elevated triglyceride levels, consistent with a diagnosis of chylothorax. Although lymphangiography failed to identify the exact site of chyle leakage, chylothorax was considered to be associated with pancreatitis, as no alternative causes were identified. Chylothorax can develop after pancreatitis, even in the absence of structural pancreatic abnormalities or prior abdominal interventions.
Despite growing research efforts to prevent hypertensive disorders of pregnancy (HDP) and preeclampsia (PE), the global incidence of HDP continues to rise. This trend parallels the increasing prevalence of chronic hypertension (CH) and obesity among women of reproductive age. HDP is associated with significant maternal and perinatal morbidity, and can contribute to multiple cardiovascular diseases. Therefore, preventing HDP and PE may improve pregnancy outcomes and holds promise for long-term cardiovascular health. Recent studies highlight the use of individualized prevention strategies, including tailored low‑dose aspirin regimens based on maternal pathophysiology. Angiogenic biomarkers such as the soluble fms-like tyrosine kinase-1/ placental growth factor ratio are used clinically to stratify PE risk, enabling the timely identification of high-risk women for targeted intervention. Growing recognition of the preconception and postpartum period as a critical window underscores the need for systematic follow‑up of blood pressure, lifestyle factors, and cardiovascular risk. Emerging evidence supports a life-course approach that views HDP not as a transient pregnancy complication but as a critical sentinel event of future cardiovascular diseases, emphasizing cardiovascular health from preconception to postpartum.
SKYSCRAPER-03 (NCT04513925) was a phase III, open-label, randomized, study that evaluated consolidation therapy with tiragolumab plus atezolizumab versus durvalumab in patients with locally advanced, unresectable, stage III, non-small cell lung cancer (NSCLC) after platinum-based concurrent chemoradiation. Eligible patients were randomized (1:1) to receive either atezolizumab (1680 mg every 4 weeks [Q4W]) plus tiragolumab (840 mg Q4W) on day 1 of each cycle, or durvalumab (10 mg/kg every 2 weeks or 1500 mg Q4W for those ≥30 kg body weight) on days 1 and 15 of each cycle, for 13 x 28-day cycles. The primary endpoint was Independent Review Facility (IRF)-assessed progression-free survival (PFS) in patients with programmed cell death ligand-1-positive (PD-L1+; tumor cells [TC] ≥1%) NSCLC. Key secondary endpoints were overall survival (OS) and safety. The PD-L1 all-comers population included 413 patients randomly assigned to tiragolumab plus atezolizumab and 416 to durvalumab; the PD-L1+ population included 209 and 210 patients in each arm, respectively. After a median follow-up of 33.0 months, median IRF-assessed PFS in PD-L1+ patients was 19.4 months with tiragolumab plus atezolizumab versus 16.6 months with durvalumab (stratified hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.75-1.23; p = 0.76); median PFS in PD-L1 all-comers was 14.2 versus 13.8 months, respectively (stratified HR 1.00; 95% CI, 0.84-1.19). Median OS in PD-L1+ patients was not estimable with tiragolumab plus atezolizumab versus 54.8 months with durvalumab (stratified HR 0.99; 95% CI 0.73-1.34); in PD-L1 all-comers, median OS was 45.6 versus 45.8 months, respectively (stratified HR 0.98; 95% CI 0.80-1.20). The safety profile of the combination was consistent with prior observations, and there were no new or unexpected findings. The primary endpoint of the SKYSCRAPER-03 study was not met. Tiragolumab plus atezolizumab was tolerated but did not offer additional benefit over durvalumab.
Discrepancies between endoscopic and histological diagnoses occasionally occur after colorectal polypectomy. This study aimed to evaluate the diagnostic impact of additional histological sections on serrated polyps. We conducted a retrospective cross-sectional study of resected colorectal polyps between June 2023 and August 2023. Polyps that were endoscopically suspected to be sessile serrated lesions (SSLs) or hyperplastic polyps and resected en bloc were included. Lesions initially diagnosed as normal mucosa were subjected to deeper sectioning and histopathological re-evaluation. Clinicopathological and endoscopic features, including endoscopic SSL diagnosis score, were analysed. Among the 276 eligible lesions, 117 were initially diagnosed as normal mucosa. Deeper sectioning corrected the histopathological diagnosis in 50% of these cases, identifying 5 SSLs and 53 hyperplastic polyps. The lesions reclassified in deeper sections were significantly smaller than those diagnosed in the first sections (P < 0.001). Compared with the "normal mucosa by first and deeper sections" group, the "SSL by deeper section" group showed significantly higher SSL diagnosis scores, including features such as larger size, mucus cap, and indistinct borders (P < 0.01). Additional histological sectioning significantly improved the diagnostic yield for serrated polyps initially diagnosed as normal mucosa, particularly in small lesions. This effect was most evident in lesions that were ultimately classified as hyperplastic polyps. Endoscopic features suggestive of SSLs were also associated with upgraded diagnoses, although the number of SSL cases was limited.
Pustulotic arthro-osteitis (PAO) is a clinically important osteoarticular comorbidity affecting approximately 9%-28% of patients with palmoplantar pustulosis (PPP), yet early recognition and standardized activity assessment remain challenging, particularly in routine dermatology practice. This exploratory analysis evaluated patients with PAO to identify potential indicators of disease activity. A magnetic resonance imaging (MRI)-based scoring system for the anterior chest wall (ACW) in patients with PAO was developed. This post hoc analysis used data from the PAO subgroup of patients with PPP enrolled in a previous phase 3 trial. Correlations were assessed between clinical indicators-Ankylosing Spondylitis Disease Activity Score, Assessment of SpondyloArthritis international Society Health Index score, physicians' Numeric Rating Scale-PAO (NRS-PAO) activity score, and patients' NRS-PAO pain score-and MRI indicators, including active lesions such as bone marrow edema extent and intensity, and structural lesions in the ACW, spine, and sacroiliac joints (Spondyloarthritis Research Consortium of Canada [SPARCC] score); the correlations between MRI indicators and plain radiographic indicators were also evaluated. Of 20 included patients (mean age: 56.6 years), the majority were female. MRI examinations detected bone marrow edema in all patients. None of the clinical indicators showed a clear association with MRI indicators. There was no clear association between radiographic indicators and the bone marrow edema extent or intensity scores of lesions in the ACW. The spine SPARCC score was positively correlated with the osteosclerosis score of the ACW (|r| = 0.70; p = 0.0218) and the modified Stoke Ankylosing Spondylitis Spinal Score of the spine (|r| = 0.93; p < 0.001). The MRI-based ACW scoring system may provide a feasible method to standardize disease activity assessment in PAO in clinical practice. Further external validation is warranted, and additional clinical indicators are needed to predict disease activity. Trial Registration: NCT04061252, UMIN000055398.
We describe an unusual case of a 60-year-old Japanese woman who developed atypical anorexia nervosa (AN) after undergoing bariatric surgery and postoperative semaglutide and tirzepatide therapy. At 57 years of age, due to severe obesity with a body weight of 113 kg (BMI 47.0), she underwent laparoscopic sleeve gastrectomy, and semaglutide and tirzepatide were started one month after surgery. Three years post-surgery, her weight drastically decreased to 50.3 kg (BMI: 20.9). Her rapid weight reduction, intense fear of weight gain, obsession with her body image, and normal weight (BMI >18.5) led to the diagnosis of atypical AN according to the DSM-5.