Understanding real-world calcitonin gene-related peptide monoclonal antibodies’ (CGRP mAbs) use in patients with migraine is necessary to potentially guide treatment strategies. This retrospective cohort study analyzed administrative claims data from the IQVIA claims data for Japan. It included CGRP mAb-naïve individuals with confirmed migraine diagnosis and ≥ 1 CGRP mAb prescription (January 2021–June 2023). Index date was the first CGRP mAb prescription. Patient characteristics, treatment patterns, adherence (proportion of days covered ≥ 0.80), persistence, and migraine-related direct costs were assessed. Persistence was measured as the proportion of patients continuing treatment for ≥ 3 or ≥ 6 months (≤ 90-day gap between fills). Factors predicting adherence to CGRP mAb treatment were assessed using multivariate logistic regression. Subgroup analyses were conducted for galcanezumab users. Of the 1781 patients included (mean age 41.8 years [standard deviation, SD 10.3]; 79.3
Small vessel disease and brain atrophy are linked to cognition in later life, but whether these associations persist in the oldest old is unclear, as lesion burden and survivorship may change effect sizes. We analyzed 249 adults aged 89–94 years from the Kawasaki Aging and Wellbeing Project. White matter hyperintensities (WMHs) were segmented on fluid-attenuated inversion recovery; gray and white matter volumes were derived from T1-weighted magnetic resonance imaging; and peak width of skeletonized mean diffusivity (PSMD) indexed diffuse white matter damage. Global cognition was assessed with the Mini-Mental State Examination (MMSE). Robust multivariable regression related MMSE to age, education, sex, apolipoprotein E ε4 status, WMH burden, volumetric measures, PSMD, and a PSMD × education interaction. Voxel-wise lesion–symptom mapping and tract-based spatial statistics evaluated tract-level effects. Older age and higher WMH burden were associated with lower MMSE, whereas higher education was associated with higher MMSE. PSMD showed no independent main effect after covariate adjustment. An exploratory PSMD × education interaction was nominally significant in the primary model but attenuated in sensitivity analyses. Exploratory spatial analyses suggested that WMHs in the inferior fronto-occipital fasciculus (IFOF) and inferior longitudinal fasciculus, as well as higher axial diffusivity in the left IFOF, were associated with lower MMSE. Overall, the principal contribution of this study is confirmatory evidence, in a rare oldest-old cohort, that WMH burden and education remain associated with global cognition; spatial and interaction findings are hypothesis-generating and should not be interpreted as confirmatory evidence of tract-specific mechanisms.
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
BACKGROUND:Neoadjuvant chemotherapy (NAC) may improve outcomes in perihilar cholangiocarcinoma (PHC); however, its efficacy compared with upfront surgery (US) for resectable PHC remains unclear. We compared survival and clinicopathological characteristics between NAC and US in patients with technically resectable PHC, using propensity score matching (PSM). METHODS:We retrospectively analyzed 261 patients with resectable PHC who underwent surgical treatment (2016-2024) across multiple institutions. Among them, 50 received NAC and 199 underwent US. The 38 patients receiving NAC were matched 1:1 with patients undergoing US using PSM. Overall survival (OS) and progression-free survival (PFS) were compared between groups. Pathological response to NAC and its association with chemotherapy doses were also evaluated. RESULTS:Before PSM, OS and PFS did not differ significantly between the US and NAC groups. After PSM, OS did not differ significantly between groups, but PFS was significantly longer in the NAC group, where patients with a therapeutic-effect grade ≥1b had better PFS than those with US. Grade ≥1b response was associated with receiving ≥7 NAC doses. DISCUSSION:NAC may improve PFS in selected patients with resectable PHC, especially those showing major pathological responses. Prospective studies should validate these findings and define optimal selection criteria and regimens.
CD44v6-positive extracellular vesicles (EVs) released by cancer cells drive tumor progression and liver metastasis. This study aimed to evaluate CD44v6-positive extracellular vesicles (EVs) as prognostic markers for pancreatic ductal adenocarcinoma (PDAC), a disease with poor prognosis. Plasma samples from 100 patients with hepatobiliary and pancreatic diseases were retrospectively analyzed. Non-pancreatic and unresectable pancreatic cancer cases were included as control groups for cross-sectional comparisons, whereas prognostic analysis using preoperative plasma samples was limited to resected PDAC. EVs were defined based on CD9, CD63, and CD81 membrane antigens, and the proportion of CD44v6-positive EVs was measured using nano-flow cytometry. CD44v6 expression in resected PDAC tissues was assessed using immunohistochemistry. The proportion of CD44v6-positive EVs was significantly higher in patients with pancreatic cancer than in those without cancer (P = 0.0009). High CD44v6 expression in resected PDAC tissues correlated with elevated CD44v6-positive EVs in the plasma. Patients with CD44v6-positive EVs ≥ 31
