Background: Patients with appropriately selected low-risk pulmonary embolism (PE) can be treated at home, although it has been controversial whether applies to patients with cancer, who are considered not to be at low risk. Methods and Results: The current predetermined companion report from the ONCO PE trial evaluated the 3-month clinical outcomes of patients with home treatment and those with in-hospital treatment. The ONCO PE trial was a multicenter, randomized clinical trial among 32 institutions in Japan investigating the optimal duration of rivaroxaban treatment in cancer-associated PE patients with a score of 1 using the simplified version of the Pulmonary Embolism Severity Index (sPESI). Among 178 study patients, there were 66 (37%) in the home treatment group and 112 (63%) in the in-hospital treatment group. The primary endpoint of a composite of PE-related death, recurrent venous thromboembolism (VTE) and major bleeding occurred in 3 patients (4.6% [0.0-9.6%]) in the home treatment group and in 2 patients (1.8% [0.0-4.3%]) in the in-hospital treatment group. In the home treatment group, there were no cases of PE-related death or recurrent VTE, but major bleeding occurred in 3 patients (4.6% [0.0-9.6%]), and 2 patients (3.0% [0.0-7.2%]) required hospitalization due to bleeding events. Conclusions: Active cancer patients with PE of sPESI score=1 could be potential candidates for home treatment.
OBJECTIVE:To examine the prevalence of thiamine deficiency and its potential risk factors in cancer outpatients. METHODS:A cross-sectional study of cancer outpatients aged ≥20 years at a regional hospital in Kyoto, Japan (January-February 2022). Thiamine deficiency was defined as ≤23 ng/mL by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Multivariable logistic regression was used to estimate ORs and 95% CIs for potential risk factors for thiamine deficiency. RESULTS:A total of 106 patients were included in this study (mean age 68.3 years, 61% female). Of the 106 patients, 27 (25.5%) had low thiamine levels despite the absence of recognised deficiency symptoms. In multivariable logistic regression analysis, the adjusted OR was 4.05 (95% CI 0.88 to 18.60). CONCLUSIONS:The prevalence of thiamine deficiency was 25.5% among cancer outpatients without recognised symptoms. An association between low dietary intake and thiamine deficiency was suggested, though further large-scale studies are needed to confirm risk factors and guide management strategies.
OBJECTIVE:Although it is known that parents caring for adolescent and young adult (AYA) cancer patients experience physical and psychological stress, to our knowledge, there are no reports regarding thiamine deficiency (TD) in this population. METHOD:From a series of cancer patient caregivers, we identified TD in a mother caring for an AYA cancer patient and report our experience with this case, as treatment enabled the prevention of Wernicke encephalopathy (WE). RESULTS:A 49-year-old woman who had been caring for her 18-year-old son after he developed graft-versus-host disease following bone marrow transplantation for leukemia visited our psycho-oncology department at the recommendation of her son's attending physician after witnessing her son experience a seizure. Thirteen months after the initial consultation, she developed difficulty climbing stairs, suggesting a possible physical abnormality. Blood tests revealed a markedly decreased hemoglobin level of 5.7 g/dL, and subsequent evaluation led to a diagnosis of iron deficiency anemia. Five days later, her thiamine level was found to be markedly reduced at 19 ng/mL (reference range: 24-66 ng/mL), and oral thiamine at a dose of 75 mg was initiated. No progression to WE, such as disturbance of consciousness, was observed. SIGNIFICANCE OF THE RESULTS:Parents caring for AYA cancer patients are profoundly affected both physically and psychologically by their child's condition. In the future, attention should be paid to the nutritional status (including TD) of families caring for AYA cancer patients, as this may contribute to improving quality of life for both patients and their families.
Abstract Background The processes of remodeling and reverse-remodeling of left atrial (LA) and LA appendage (LAA) after catheter ablation for atrial fibrillation (AF) are insufficiently evaluated. Methods A total of 372 consecutive AF patients undergoing ablation procedure with contrast CT images and whose follow-up CT images were acquired after the procedure were enrolled. From those CT images, LA volume (LAV), LA emptying fraction (LAEF), LAA volume (LAAV), and LAAEF were measured. Results Mean age of patients was 70 years, and CHA2DS2-VASc score was 2.5±1.7. Mean LAV, LAEF, LAAV, and LAAEF were 121.3 ml, 22.1%, 18.6 ml, and 23.5%, respectively. For patients with LA and LAA remodeling, non-paroxysmal AF (non-PAF) was more prevalent and strongly correlated with heart failure-related parameters. All types of remodeling were associated with recurrent post-procedure atrial tachyarrhythmias, and LAV emerged as an independent risk factor for recurrent tachyarrhythmias (adjusted hazard ratio 1.01, P=0.02) in multivariable analysis. Follow-up CT images showed that LAV and LAAV significantly decreased, while LAEF and LAAEF significantly increased accompanied by a reduction in filling defects in the LAA. After the procedure, reverse-remodeling was prominent in non-PAF patients, while LAEF significantly decreased in PAF patients. The decrease in LAEF for PAF patients was significantly larger in those who received additional ablation beyond pulmonary vein isolation (PVI) than those who received PVI alone. On the other hand, in non-PAF patients, post-procedure LA reverse-remodeling was consistent regardless of ablation strategy, but significantly poor in those with recurrence. Conclusions LA and LAA remodeling were more prevalent in non-PAF patients. LA and LAA reverse-remodeling after the ablation procedure were remarkable in non-PAF patients, especially those without recurrence. Meanwhile, LAEF decreased after the procedure in PAF patients, particularly in those who received additional ablation beyond PVI.
