Immune checkpoint inhibitors (ICIs) are essential for treating esophageal squamous cell carcinoma (ESCC). As antibiotics (Abx) may reduce ICI efficacy, and immune-related adverse events (irAEs) relate to better outcomes, we investigated their association. We retrospectively analyzed 121 advanced or metastatic ESCC patients treated with ICIs, assessing outcomes based on Abx use and irAEs. Forty-one patients (33.9
We report a case with pilocytic astrocytoma (PA) morphology carrying a histone H3 K27M mutation (H3-K27M) that progressed to PA with anaplasia. A 34-year-old woman presented with headache due to obstructive hydrocephalus from a tectal lesion. She underwent subtotal tumor resection. Histology showed a biphasic architecture with piloid cells, consistent with PA. Five months later, she developed recurrence. A second, partial resection was performed, with pathology again indicating PA. Despite subsequent radiation and chemotherapy, the tumor progressed. A third resection was done 15 months after the second. This time, histology revealed PA with anaplasia. The patient died of progressive disease 25 months after initial treatment. KIAA1549::BRAF fusion, H3-K27M, and loss of p16 expression due to promoter methylation were detected in all specimens. In all specimens, the presence of NF1 Y2285fs*1 was confirmed by Sanger sequencing, with an increasing proportion of the aberrant sequence at the third resection. DNA methylation profiling revealed that the second and third specimens were classified as diffuse midline glioma, H3 K27-altered. This case suggests that the H3-K27M mutation, MAPK pathway activation, and loss of p16 expression contribute to tumorigenesis, while clonal proliferation of the tumor harboring the NF1 mutation may play a role in malignant progression.
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
Abstract Background Clinical ethics consultation is a system primarily implemented in healthcare facilities to address “clinical ethical issues, value conflicts, and dilemmas faced by staff, providing advice and recommendations after timely deliberation by a multidisciplinary team.” When uncertainty arises regarding the best course of treatment for a patient, the system helps organize issues, facilitates discussions among multidisciplinary teams, and fosters consensus building. Methods We analyzed cases from the past 8 years at our hospital that required ethics consultations related to kidney replacement therapy. Results Various ethical issues were identified for patients with kidney failure requiring kidney replacement therapy, including not only the nature of kidney replacement therapy as end-of-life care but also fairness in the distribution of healthcare costs in advanced medical care, the futility of life-sustaining treatment, and the extent to which patient self-determination should be protected. Conclusions The ethical challenges inherent in kidney replacement therapy were addressed through a process in which the healthcare team, including the patient and their family, engaged in discussions to reach a conclusion.
Smoking is a potentially modifiable risk factor for adverse outcomes after total hip arthroplasty (THA), but evidence on early postoperative complications in Asian populations remains limited. This study examined the association between smoking and early postoperative complications after elective THA using a nationwide inpatient database in Japan. This retrospective cohort study analysed data from the Japanese Diagnosis Procedure Combination (DPC) database between December 2011 and March 2023. Patients undergoing elective primary THA for osteoarthritis, osteonecrosis of the femoral head, or rheumatoid arthritis were included. Smoking status was identified using administrative codes. One-to-one propensity score matching was used to balance baseline characteristics between smokers and non-smokers. Primary outcomes were early postoperative surgical complications, medical complications, and in-hospital mortality. Dose-dependent effects were assessed using the Brinkman Index, with heavy smoking defined as ≥ 600. After propensity score matching, 52,551 patients were included in each group. Smoking was associated with a higher risk of postoperative infection (odds ratio [OR] 1.31; 95
