Background: Muscle weakness in older adults elevates mortality risk and impairs quality of life, with the phase angle (PhA) indicating cellular health. Polypharmacy, common in geriatric care, could influence PhA. This investigates whether the number of medications and polypharmacy with PhA as a biomarker of muscle quality in older inpatients aged ≥65 and determines the extent to which multiple medications contribute to the risk of reduced muscle quality. Methods: This retrospective cross-sectional study analyzed data from older inpatients requiring rehabilitation. PhA was measured using bioelectrical impedance analysis. The number of medications taken by each patient was recorded at admission. Polypharmacy was defined as the concurrent use of five or more medications at admission. Results: In this study of 517 hospitalized older adults (median age 75 years; 47.4% men), 178 patients (34.4%) were diagnosed with sarcopenia. Polypharmacy was present in 66% of patients. The median PhA was 4.9° in men and 4.3° in women. Multivariate linear regression analysis was performed separately for men and women. In men, PhA was negatively correlated with the number of medications (β=–0.104, p=0.041) and polypharmacy (β=–0.045, p=0.383). In women, PhA was negatively correlated with the number of medications (β=–0.119, p=0.026) and polypharmacy (β=–0.098, p=0.063). Analyses were adjusted for age, body mass index, sarcopenia, C-reactive protein, and hemoglobin levels. Conclusion: The number of medications at admission negatively impacted PhA in older inpatients, highlighting the importance of reviewing prescribed drugs and their interactions.
Background The prognosis and recurrence patterns of early-diagnosed pancreatic ductal adenocarcinoma (PDAC), particularly following surgical resection, remain unclear. Methods This multicenter retrospective study analyzed patients who underwent surgical resection for PDAC between 2005 and 2023. Patients were categorized according to pathological stages 0, I, and II. Recurrence patterns and survival outcomes were compared among the three groups. Multivariate analysis was performed to identify independent risk factors for remnant pancreatic recurrence, including early-stage disease, postoperative follow-up of more than 5 years, and receipt of adjuvant chemotherapy. Results A total of 349 patients were included: 51 with stage 0, 77 with stage I, and 221 with stage II PDAC. The 5-year overall survival rates were 87%, 71%, and 49% for patients with stage 0, I, and II PDAC, respectively. Remnant pancreatic recurrence was observed in 10% of patients with stage 0 PDAC and 18% of patients with stage I PDAC, compared with 5% of those with stage II PDAC. Recurrence was significantly more frequent in stage I (P < 0.001) and tended to be higher in stage 0 (P = 0.062) than in stage II. Multivariate analysis identified pathological stage 0-I and postoperative follow-up of > 5 years as independent risk factors for remnant pancreatic recurrence. Conclusions Patients with early-stage PDAC exhibit a higher risk of remnant pancreatic recurrence than those with stage II disease. These findings underscore the importance of long-term pancreas-focused surveillance in early-stage PDAC to enable timely detection of late recurrence and potentially improve patients outcomes.
Objectives:The purpose of this study was to evaluate the results of endovascular therapy (EVT) with common femoral artery (CFA) endarterectomy site access for lower extremity artery disease (LEAD). Methods:Records were reviewed retrospectively for patients who underwent EVT with CFA endarterectomy site access from 2014 to 2023 at 7 hospitals. Results:A total of 74 EVT procedures with CFA endarterectomy site access were performed in 65 patients with LEAD. The median [interquartile range] interval between CFA endarterectomy and the first EVT access was 435 [237-1153] days. Technical success of EVT was achieved in 72 procedures (97%). Technical success of the puncture was achieved in all 74 procedures (100%). The median [interquartile range] puncture time and hemostasis time were 4 [2-6] and 13 [10-20] min, respectively. Two cases (3%) had access site hematoma, which was cured with conservative treatment. Conclusions:The CFA after endarterectomy may be a safe and suitable access site for EVT.
BACKGROUND:Longitudinal data on seasonal variations in nighttime blood pressure (BP) obtained through home blood pressure monitoring (HBPM) are scarce. We examined whether nighttime BP is elevated in summer compared to winter in patients undergoing hypertension treatment. METHODS:Nighttime BP was measured for seven days using an HBPM device in 419 participants at baseline, and 136 of those underwent follow-up nighttime BP measurements at 6 months without any modification of antihypertensive therapy. Morning BP was also measured in some participants. RESULTS:The baseline cross-sectional analysis indicated that nighttime systolic BP was elevated in summer compared to winter (adjusted mean difference, 8.3 mmHg; 95% confidence interval [CI], 4.7-11.8). The longitudinal analyses revealed that nighttime systolic BP was higher in summer than in winter among winter-to-summer participants (mean difference, 5.1 mmHg; 95% CI, 3.1-7.0; n = 36) and among summer-to-winter participants (mean difference, 2.6 mmHg; 95% CI, 0.3-5.0; n = 23). Conversely, morning systolic BP was lower in summer than in winter among winter-to-summer participants (mean difference, 3.8 mmHg; 95% CI, 0.7-7.0) and among summer-to-winter participants (mean difference, 3.7 mmHg; 95% CI, 1.0-6.4). In sensitivity analyses, seasonal variations in room temperature were positively correlated with changes in nighttime systolic BP (r = 0.43; 95% CI, 0.21-0.60) and negatively correlated with changes in morning systolic BP (r=-0.46; 95% CI, -0.63 to -0.25). CONCLUSIONS:Nighttime systolic BP increased from winter to summer in association with higher room temperature and exhibited an inverse seasonal pattern compared to morning BP.
BACKGROUND AND OBJECTIVE:Severe checkpoint inhibitor pneumonitis (CIP), particularly when it develops within 6-12 weeks, is a potentially fatal adverse event in patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs). Although neutrophil-to-lymphocyte ratio (NLR) has been reported to predict immune-related adverse events, its role in severe CIP remains unclear. METHODS:The discovery cohort retrospectively enrolled 102 patients with NSCLC treated with ICI monotherapy at Hiroshima University Hospital. The validation cohort prospectively enrolled 191 NSCLC patients receiving first-line treatment, including ICI, at 15 institutions. Severe CIP was defined as grade 3-5 pneumonitis occurring within 3 months of treatment initiation. The cut-off level of the baseline NLR was identified by receiver operating characteristic curve analysis in the discovery cohort, and the predictive accuracy was analyzed and confirmed in both cohorts. RESULTS:Severe CIP was observed in seven (6.9%) and 11 (5.8%) patients in the discovery and validation cohorts, respectively. In the discovery cohort, the baseline NLR was higher in patients with severe CIP than in those without (17.29 [4.76-20.73] vs. 3.70 [2.64-6.68], p = 0.006), and the cut-off level of the baseline NLR was set at 4.75 (AUC 0.81; sensitivity 85.7%, specificity 64.2%). The incidence of severe CIP was significantly higher in patients with higher baseline NLR levels (≥ 4.75) than in those without, in both cohorts (discovery: 15.0% vs. 1.6%, p = 0.009; validation: 10.3% vs. 3.3%, p = 0.046). CONCLUSION:Baseline NLR is a promising risk stratification marker for severe CIP.
