BACKGROUND:The Japanese version of the high bleeding risk (J-HBR) criteria was proposed to identify Japanese patients at HBR after percutaneous coronary intervention. However, the diagnostic ability of the J-HBR in patients with lower extremity peripheral arterial disease (LEAD) remains unclear. METHODS AND RESULTS:This multicenter registry included 818 LEAD patients undergoing endovascular treatment (EVT). Based on J-HBR major (1 point) and minor (0.5 points) criteria, patients were grouped into LEAD with (≥2.0 points) and without (1.0-1.5 points) additional J-HBR. LEAD itself is a major criterion. The primary endpoint was major bleeding events and major adverse cardiovascular and limb events (MACLE), a composite of cardiovascular death, myocardial infarction, ischemic stroke, acute limb ischemia, and major amputation. Of the 818 patients in the study, 683 (83.5%) had LEAD with additional J-HBR. During the median follow-up period of 729 days, the risk of major bleeding events did not differ significantly between the 2 groups, although the risk of MACLE was higher in the LEAD with than without additional J-HBR group (12.4% vs. 5.9%; P=0.03). The probability of major bleeding and MACLE increased progressively with an increase in the number of J-HBR major and minor criteria. CONCLUSIONS:Among patients with LEAD undergoing EVT, the J-HBR criteria successfully stratified ischemic and bleeding risks. This risk-predicting model may be useful in patients with LEAD.
Although robot-assisted minimally invasive esophagectomy (RAMIE) reportedly provides better short-term and comparable long-term outcomes compared with open esophagectomy, its long-term outcomes versus those of minimally invasive esophagectomy (MIE) remain insufficiently investigated. This multicenter retrospective cohort study aimed to investigate the perioperative safety, efficacy, and long-term survival of patients of RAMIE versus MIE for esophageal cancer. We included patients with cStage 0-IVa thoracic esophageal cancer who underwent esophagectomy through the right thoracic cavity between January 2016 and December 2019 in six Japanese hospitals. The short- and long-term outcomes between RAMIE and MIE were compared by using propensity score matching. After matching, 268 of 396 patients were analyzed. Compared with MIE, RAMIE had a longer operative time (629 vs. 574 min, p < 0.01), a trend toward less severe morbidity (Clavien–Dindo grade ≥ III: 18
Pseudomonas aeruginosa is an important pathogen responsible for life-threatening infections. The exoU gene, encoding a type III secretion system phospholipase, is one of the most potent virulence determinants and has been correlated with disease severity and mortality. Here, we report a fatal case of community-acquired P. aeruginosa infection in a 65-year-old woman without known immunodeficiency. Despite immediate antimicrobial therapy, the patient died on the day of admission. Genomic analysis revealed the isolate belonged to sequence type (ST) 319 and carried the exoU gene. Our review identified 24 ST319 isolates in the literature and the PubMLST database. Analysis of 22 isolates with available whole-genome sequencing data revealed that 20 (91%) carried exoU. These findings suggest that ST319, though rarely reported, is characterized by frequent exoU carriage and may possess significant virulence potential.
Post-transplant relapse remains a major cause of treatment failure in adult B-cell acute lymphoblastic leukemia (ALL). The introduction of inotuzumab ozogamicin (InO) and blinatumomab (Blina) has expanded salvage options; however, their impact on outcomes and safety in patients relapsing after allogeneic stem cell transplantation has not been fully defined. To evaluate the impact of the availability of InO and Blina on clinical outcomes in adult B-cell ALL patients with post-transplant relapse, and to assess the safety of these agents in the post-transplant setting. We retrospectively analyzed 150 adult patients with B-cell ALL who relapsed after the first allogeneic stem cell transplantation. Patients were divided according to the time of their post-transplant relapse based on the approvals of InO and Blina in Japan: the pre-InO/Blina group (n = 95) and the post-InO/Blina group (n = 55). Outcomes were analyzed separately for Philadelphia chromosome (Ph)-negative and Ph-positive ALL. Overall survival (OS) after post-transplant relapse, complete remission (CR) rates as the best response before a second transplantation or last follow-up, and outcomes after a second transplantation were compared between groups. Adverse events associated with post-transplant use of InO and Blina were also evaluated. Among 95 patients with Ph-negative ALL, outcomes were significantly better in the post-InO/Blina group than in the pre-InO/Blina group, with the 2-year OS after post-transplant relapse improving from 19% to 51% (P = .003) and, among 88 treated patients, the CR rate increasing from 36% to 77% (P < .001). Multivariable analyses identified the time of post-transplant relapse and disease status at the first transplantation as independent prognostic factors for OS. Among 43 patients who underwent a second transplantation, the 2-year OS after second transplantation improved from 27% in the pre-InO/Blina group to 55% in the post-InO/Blina group (P = .029). In contrast, among 55 patients with Ph-positive ALL, OS after post-transplant relapse did not differ between groups. Among 32 patients treated with InO after post-transplant relapse, no patient developed veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) during InO therapy; however, 5 of 17 patients (29%) who subsequently underwent the second transplantation developed VOD/SOS. An interval of <2.5 months between InO and the second transplantation was associated with a higher VOD/SOS risk (56% versus 0%, P = .029). Among 30 patients treated with Blina, cytokine release syndrome occurred in 53% (grade 3 to 4, 7%) and immune effector cell-associated neurotoxicity syndrome in 13% (grade 3, 3%), with no fatal events. The prognosis of adult Ph-negative B-cell ALL after post-transplant relapse improved substantially in the post-InO/Blina era, including improved survival after a second transplantation. Overall, the safety profiles of InO and Blina in the post-transplant setting were acceptable, although VOD/SOS remains an important concern in patients proceeding to a second transplantation after InO.
Clinical evidence of the impact of corticosteroid use and pleurodesis outcomes in malignant pleural effusion (MPE) remains limited. This study aimed to explore the relationship between corticosteroid exposure and pleurodesis outcomes in patients with MPE. This retrospective cohort study included 138 consecutive patients with MPE who received pleurodesis between April 2012 and September 2024. Based on pleurodesis outcomes, the 138 patients were divided into two groups as follows: success group (n = 99) and failure group (n = 39). Failure was defined as recurrent pleural effusion within 28 days after chest-tube removal, tube removal owing to intolerance, or death with chest-tube in situ; the other outcomes were defined as constituting success. Patients who received systemic corticosteroids during chest-tube usage were classified as steroid users. The cumulative corticosteroid dose was calculated as the prednisolone (PSL)-equivalent dose multiplied by the duration of steroid administration. Multivariate analysis of 138 patients demonstrated that poor performance status (PS), such as PS 3–4, and multi-day steroid use during chest-tube usage were associated with pleurodesis failure in patients with MPE. Furthermore, a subgroup analysis of 15 patients who received steroids during chest-tube usage showed that the cumulative steroid dosage was positively correlated with chest-tube usage duration. In this retrospective cohort study, multi-day corticosteroid exposure during chest-tube placement was associated with pleurodesis failure in patients with MPE. These findings should be considered hypothesis-generating and interpreted with caution because of potential confounding factors. Further prospective multicenter studies are needed to clarify this association.
