This study examined changes in practice patterns and outcomes of allogeneic hematopoietic cell transplantation (HCT) over the past 20 years. Data were analyzed from a Japanese nationwide registry of consecutive adult patients with acute myeloid leukemia who underwent allogeneic HCT between 2001 and 2020. The study population included 17,553 patients, of whom 6653 underwent allogeneic HCT in 2001–2010 and 10,900 in 2011–2020. Patients in the later period were older, were more likely to be in first complete remission, and more frequently received umbilical cord blood transplantation. After adjusting for major covariates, the 2011–2020 cohort had lower risks of overall mortality (hazard ratio [HR], 0.84; 95
BACKGROUND:Evidence guiding first-line antihypertensive drug choice in adults aged 75 years or older is limited, despite widespread use of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) in late older age. METHODS:We conducted a target trial emulation using a new-user design in a nationwide linked healthcare claims database in Japan. Adults aged ≥ 75 years who had no prescription of either drug class in the preceding 12 months and initiated an ARB (n = 10,037) or a CCB (n = 19,785) were followed from treatment initiation. The primary outcome was all-cause mortality; secondary outcomes included hospitalization for heart failure, myocardial infarction, stroke, and major adverse cardiovascular events (MACE). Intention-to-treat effects were estimated using inverse probability of treatment and censoring weighting with pooled logistic regression models. RESULTS:Among 29,822 patients, median follow-up was 4.0 years. During follow-up, 3487 deaths occurred. ARB therapy was associated with lower all-cause mortality than CCB therapy (hazard ratio [HR], 0.885; 95% CI, 0.823-0.951). The estimated 5-year risk of death was 12.7% for ARB users and 14.8% for CCB users (absolute risk difference, -2.1 percentage points; 95% CI, -3.1 to -1.0). ARB therapy was also associated with lower risks of heart failure hospitalization (HR, 0.843; 95% CI, 0.774-0.918), myocardial infarction (HR, 0.867; 95% CI, 0.795-0.945), stroke (HR, 0.931; 95% CI, 0.869-0.998), and MACE (HR, 0.889; 95% CI, 0.848-0.931). Associations were consistent across age subgroups, including adults aged ≥ 85 years. CONCLUSION:In adults aged 75 years or older, ARB-based antihypertensive therapy was associated with lower risks of mortality and cardiovascular events compared with CCB-based therapy. These findings suggest that first-line antihypertensive drug choice may have prognostic implications in late older age.
Background Adequate occlusion after flow diversion for unruptured intracranial aneurysms is inconsistent when anatomical features predict device failure: a large diameter, convex parent-artery curvature, an incorporated branch, or intra-aneurysmal thrombus. We examined whether overlapping flow diversion with coiling (OFDC) achieves higher adequate-occlusion rates than other strategies in aneurysms harboring multiple difficult-to-cure factors, while maintaining safety. Methods This single-center retrospective study analyzed 86 consecutive unruptured intracranial aneurysms treated with flow diversion, classified as flow diverter alone (FD; n = 33), FD with coiling (FDC; n = 26), overlapping FD (OFD; n = 7), and OFDC (n = 20). The primary outcome was adequate occlusion (O'Kelly–Marotta grade C1–D) at last follow-up, assessed by multivariable logistic regression adjusting for four difficult-to-cure factors, with pre-specified subgroup analyses by cumulative factor count. Results Mean aneurysm diameter was 13.6 ± 6.8 mm; 31.4% measured ≥ 15 mm. Median follow-up was 12 months. Adequate occlusion was achieved in 73 of 86 aneurysms (84.9%); ischemic complications occurred in 3 (3.5%) with no hemorrhagic events. The OFDC group harbored the highest burden of difficult-to-cure factors yet achieved the highest adequate-occlusion rate (95.0%). On multivariable analysis, OFDC independently predicted adequate occlusion (adjusted odds ratio 12.60; 95% CI 1.04–152.10; p = 0.046), whereas aneurysm ≥ 15 mm was a strong negative predictor (aOR 0.06; p < 0.001). Among aneurysms with ≥ 2 difficult-to-cure factors, OFDC achieved adequate occlusion in 92.9% versus 50.0% (p = 0.02). Conclusions In aneurysms harboring multiple features predicting flow-diverter failure, OFDC was independently associated with higher adequate-occlusion rates without increased complications and may be preferred for anatomically complex unruptured aneurysms.
Background Accurate preoperative staging of upper tract urothelial carcinoma (UTUC) remains challenging. This study aimed to develop site-specific scoring systems for predicting muscle-invasive UTUC without ureteroscopic findings. Methods This retrospective multicenter study initially included 386 patients who underwent radical nephroureterectomy for UTUC at Tottori University Hospital and affiliated hospitals between January 2015 and December 2021. Patients with clinically node-positive disease or those who received neoadjuvant chemotherapy were excluded. Preoperative variables included age, sex, body mass index, hydronephrosis, urinary cytology, clinical T stage, tumor size, and multifocality. Univariable and multivariable logistic regression analyses were performed separately for ureteral and renal pelvic tumors to identify the predictors of muscle-invasive disease. Results Among 356 eligible patients, 157 (44.1%) had muscle-invasive UTUC. Multivariable analysis identified positive urinary cytology and clinical T stage as independent predictors of muscle-invasive disease in both ureteral and renal pelvic tumors, whereas hydronephrosis was an additional independent predictor in ureteral tumors. Scoring systems incorporating these variables achieved areas under the curve of 0.865 for ureteral cancer and 0.745 for renal pelvic cancer. Optimal cutoff scores based on the Youden index were ≥ 3 for ureteral tumors and ≥ 2 for renal pelvic tumors, with sensitivity rates of 85.4% and 68.0% and specificity rates of 77.4% and 73.6%, respectively. Conclusion Site-specific scoring systems based on routinely available preoperative variables accurately predicted muscle-invasive UTUC without requiring ureteroscopic findings. These models may facilitate preoperative risk stratification, although external validation is required.
To examine the association between preoperative body mass index (BMI)-adjusted sarcopenia, defined according to the Asian Working Group for Sarcopenia 2025 (AWGS 2025), and 1-year postoperative outcomes in patients undergoing surgery for lumbar spinal stenosis (LSS). This single-center prospective cohort study included 118 patients scheduled for LSS surgery. Handgrip strength was measured using a hand dynamometer, and appendicular skeletal muscle mass was estimated using bioelectrical impedance analysis. BMI-adjusted sarcopenia was defined as low handgrip strength and low BMI-adjusted muscle mass according to AWGS 2025 age- and sex-specific cutoffs. Patient-reported outcomes were assessed preoperatively and at 1 year using the visual analog scale (VAS), Hospital Anxiety and Depression Scale, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Multivariable analysis was adjusted for baseline scores and covariates. BMI-adjusted sarcopenia was present in 16 patients (13.6
