Abstract Background The initiation of hemodialysis (HD) is a physiologically and functionally unstable period, often marked by abrupt fluid shifts, metabolic disturbances, and clinical decompensation. Frailty at HD initiation is associated with adverse outcomes. However, the link between unplanned dialysis initiation and frailty remains unclear. Because unplanned initiation often reflects insufficient predialysis care and acute systemic decline, it may be associated with frailty status at initiation. Methods This single-center cross-sectional study enrolled 93 patients with end-stage renal disease who initiated HD between September 2022 and September 2024. Frailty was assessed using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. The primary exposure was dialysis initiation type (planned versus unplanned). Prevalence ratios (PR) for frailty were estimated using modified Poisson regression. Sensitivity analyses included analyses excluding the weight-loss component, reanalysis using the Clinical Frailty Scale, and additional adjustment for delayed rehabilitation initiation. Results Frailty prevalence at dialysis initiation was 51.6%. It was significantly higher in the unplanned group than in the planned group (74.2% versus 40.3%, p = 0.002). Unplanned initiation was significantly associated with frailty (PR 1.65; 95% confidence interval [CI] 1.04–2.62). Conclusions Unplanned dialysis initiation was significantly associated with a higher prevalence of frailty at dialysis initiation. These findings suggest that patients undergoing unplanned initiation may represent a subgroup with a particularly high frailty burden at the time of dialysis transition, supporting the clinical importance of frailty assessment at dialysis initiation.
Treatment-free remission (TFR) is an emerging goal for patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors (TKI). However, long-term TFR durability in real-world settings remains understudied. The J-SKI study, a large observational study, was conducted to evaluate long-term TFR outcomes in Japanese patients with CML. This interim analysis included 795 eligible patients from the prospective (n = 283) and retrospective (n = 512) cohorts. With a median follow-up of 32 months (range 0.8–168) after TKI discontinuation, the 5-year TFR rate was 65.2
In the Phase III TASUKI-52 trial, nivolumab with carboplatin, paclitaxel (CP), plus bevacizumab significantly prolonged progression-free survival (PFS), and resulted in longer overall survival (OS) in patients with advanced nonsquamous non-small cell lung cancer (NSCLC). This final analysis evaluated 4-year treatment outcomes in terms of OS, PFS and duration of response (DOR) by investigator assessment and safety, as well as the background characteristics and treatment courses associated with 4-year survivors. Patients were randomized 1:1 to receive nivolumab (n = 275) or placebo (n = 275) in addition to CP plus bevacizumab. With a minimum follow-up of 53.1 months, nivolumab with CP plus bevacizumab continued to show improvement in OS (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.58-0.88) and PFS (HR: 0.61; 95% CI: 0.50-0.74) compared to placebo with CP plus bevacizumab. The 4-year OS rate was 34.7% in the nivolumab arm versus 22.1% in the placebo arm, and the 4-year PFS rate was 13.7% in the nivolumab arm versus 3.3% in the placebo arm. Among 4-year survivors, the median DOR was numerically longer in the nivolumab arm than in the placebo arm (34.7 vs. 13.5 months). No new safety signals were observed. Four-year survival in the nivolumab arm was associated with the absence of bone metastases and age < 65, but not with PD-L1 status and tumor size. In conclusion, treatment with nivolumab demonstrated long-term survival benefit and durable response, which supports nivolumab with CP plus bevacizumab as a first-line treatment option for advanced nonsquamous NSCLC. Trial Registration: ClinicalTrials.gov identifier: NCT03117049.
Patients undergoing hemodialysis often experience impaired exercise tolerance and circulatory instability due to fluid removal and metabolic alterations during dialysis. Although rehabilitation is recommended for this population, the physiological effects of exercise performed after dialysis remain unclear. This study aimed to compare circulatory dynamics and skeletal muscle oxygenation during exercise performed post-dialysis and on non-dialysis days in maintenance hemodialysis patients, to characterize physiological differences that may inform rehabilitation timing. Twelve stable hemodialysis patients from Seirei Sakura Citizen Hospital participated in this cross-sectional study. After a graded exercise test to determine peak work rate (Peak WR), participants performed constant-load cycling exercise at 40
Backgrounds/Aims:Incident sarcopenia after pancreaticoduodenectomy (PD) can negatively impact postoperative recovery, but its occurrence during hospitalization has not been well documented. This study aimed to describe operationally defined incident in-hospital sarcopenia after PD and to explore associated preoperative characteristics. Methods:We conducted a retrospective study of patients undergoing PD who did not have sarcopenia preoperatively. Incident in-hospital sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 criteria. This postoperative definition was operational and descriptive and was not intended to indicate established chronic sarcopenia. Analyses were performed on two prespecified descriptive subcohorts: patients discharged within 30 postoperative days and assessed before discharge, and patients hospitalized for ≥ 30 days and assessed around postoperative days 28-35. Baseline, operative, and perioperative characteristics were summarized descriptively. Exploratory logistic regression models, including age, sex, a composite body-composition index, and prognostic nutritional index, were fitted separately. Results:Among 49 patients, operationally defined incident in-hospital sarcopenia occurred in 15 patients (30.6%) overall, including 26.3% in the discharge dataset and 33.3% in the postoperative day 28-35 dataset. Vascular resection was performed in 5 patients (10.2%). The mean operative time was 495.5 ± 85.5 minutes, and mean blood loss was 654.8 ± 415.1 mL. Exploratory models showed moderate in-sample discrimination, with area under the curves of 0.745 and 0.771, but coefficient estimates were imprecise. Conclusions:Operationally defined incident in-hospital sarcopenia was observed in approximately one-third of patients after PD. These findings should be interpreted cautiously due to the small sample size, limited events, and the operational nature of the outcome definition.
