Background Deterioration of sagittal spinal alignment, particularly global kyphosis (GK), negatively impacts range of motion (ROM) after reverse total shoulder arthroplasty (rTSA). Therefore, this study aimed to investigate the clinical outcomes of rTSA performed after corrective spinal surgery, hypothesizing that this sequential approach would improve post-operative ROM. Methods We categorized 129 patients (followed >2 years) into 3 groups: those without GK (n = 72), those with untreated GK (n = 42), and those who underwent prior corrective spinal surgery (n = 15). Post-operative ROM was compared among these cohorts. For the corrective spinal surgery group, we measured the C7-hip axis (C7-HA) distance, sagittal vertical axis (SVA), and lumbar lordosis (LL) before and after spinal intervention, but prior to rTSA. Results In the corrective spinal surgery group, significant improvements were observed in LL, C7-HA, and SVA. The non-GK group demonstrated significantly greater flexion, abduction, and internal rotation than the other 2 groups and significantly greater external rotation than the GK group; external rotation did not differ significantly from the corrective spinal surgery group. Following corrective spinal surgery, patients exhibited significant improvements in LL, C7-HA, and SVA, achieving better post-operative C7-HA and SVA measurements than the untreated GK group. However, despite these partial alignment improvements, forward flexion and abduction in the corrective spinal surgery group were significantly lower at 24 months than those in the GK group. Conclusion Prior corrective spinal alignment surgery was not associated with improved post-operative ROM after rTSA.
Background Postoperative regional nodal irradiation (RNI) is a standard treatment for breast cancer at high risk of regional recurrence; however, the necessity of including the internal mammary node (IMN) region in the radiation field remains unclear. This study aimed to evaluate treatment outcomes in a large cohort of patients who received postoperative radiotherapy with RNI excluding the IMN region. Methods This study included patients with breast cancer who underwent surgery followed by RNI without IMN irradiation between 2007 and 2018. The primary endpoint was disease-free survival (DFS), and the secondary endpoints were overall survival (OS), breast cancer-specific mortality (BCM), distant metastasis-free survival (DMFS), recurrence patterns, and treatment-related adverse events. Results In total, 799 patients were included. The 5-year DFS, OS, BCM, and DMFS rates were 75.9, 88.3, 9.7, and 77.1%, respectively. Worse outcomes were associated with a higher number of positive lymph nodes and estrogen receptor (ER)-negative disease. Medial/central tumor location and younger age were each significantly associated with poorer outcomes, being associated with worse DFS and DMFS. Bone was the most common recurrence site. ER-negative disease, a higher number of positive lymph nodes, medial/central location, and younger age were significant risk factors for recurrence, particularly distant metastasis. IMN recurrence was rare. Conclusions In this cohort, medial/central tumor location, ER-negative disease, and extensive nodal involvement were associated with poorer outcomes, suggesting that these factors may identify patients who can benefit from IMN irradiation. These findings may serve as important reference data when determining the indication for IMN irradiation on an individual patient basis.
The ONCO DVT study demonstrated the benefit of extended anticoagulation therapy with edoxaban in patients with cancer-associated isolated distal deep vein thrombosis (DVT). However, it remains unclear whether these results can be applied regardless of the number of thrombosed venous segments. In this post-hoc subgroup analysis of the ONCO DVT study, 601 patients were stratified into the single-site (N=268) and multiple-sites (N=333) DVT subgroups based on the number of thrombosed venous segments at diagnosis. We compared 12-month and 3-month edoxaban treatment groups in each subgroup for the primary endpoint of symptomatic recurrent venous thromboembolism (VTE) or VTE-related death and the major secondary endpoint of major bleeding at 12 months. The cumulative 12-month incidence of the primary endpoint was significantly lower in the 12-month edoxaban group than in the 3-month edoxaban group both in the single-site (0.8
Nivolumab plus chemotherapy has shown efficacy in clinical trials for advanced or recurrent gastric cancer (GC). However, real-world utilization data are limited. In this study, we aimed to assess the effectiveness, safety, and treatment status of first line nivolumab plus chemotherapy in Japanese patients with treatment-naïve advanced or recurrent GC. Untreated patients with advanced or recurrent GC who initiated nivolumab plus chemotherapy as first line treatment from November 2021 to June 2023 across 23 Japanese sites were enrolled in this observational study (G-KNIGHT). This report focused on the objective response rate (ORR), real-world progression-free survival (rwPFS), and the treatment-related adverse event (TRAE) incidence. Furthermore, subgroup analyses for ORR and rwPFS were conducted for patients stratified by various factors including age and the programmed cell death ligand 1 (PD-L1) combined positive score (CPS). Among 527 patients (median age, 70.3 years; 25.2
Very high acute pacing thresholds (VHPT) during AVEIR-AR atrial leadless pacemaker (ALP) implantation often prompt device repositioning, although excessive manipulation may increase procedural risk. To evaluate the safety and early electrical performance of ALP release despite VHPT using a current-of-injury (COI)-guided strategy. We retrospectively analyzed 28 consecutive patients who underwent AVEIR-AR ALP implantation at two centers in Japan and compared procedural safety and short-term electrical performance between patients with normal PTs (NPT <5.5 V at 0.4 ms) and those with VHPT (≥5.5 V at 0.4 ms). In the VHPT group, ALP device release was permitted when pre-screw COI was adequate (≥1 mV). The mean age was 85±6 years, body weight was 54±8 kg, and 11 patients were female. Single-site pre-mapping successful implantation was achieved in 36
