This multicenter retrospective cohort compared romosozumab outcomes between oral glucocorticoid users and non-users. Bone turnover marker responses and lumbar spine bone mineral density gains were similar, whereas total hip bone mineral density gains were smaller among glucocorticoid users. To investigate the impact of oral glucocorticoids (GC) on the effectiveness of romosozumab by comparing outcomes between GC users and non-users after adjusting for patient background. This multicenter, retrospective cohort study analyzed patients who completed 12 months of therapy (n = 428). Inverse probability of treatment weighting was employed to construct a pseudo-population with balanced baseline characteristics, yielding 40 GC users and 39.8 non-users (95.3
Heavy chain (AH) amyloidosis is a rare subtype of immunoglobulin-derived amyloidosis, comprising less than 1% of all systemic cases. While kidney involvement is frequently observed in systemic amyloidosis, presentations dominated by acute kidney injury (AKI) with glomerular bleeding and interstitial hemorrhage are uncommon. We report the case of a Japanese man in his 50s who developed AKI requiring dialysis. He had a history of proteinuria noted during previous health checkups but no known underlying diseases. Renal biopsy revealed amorphous mesangial and capillary wall deposits with weak periodic acid-Schiff and negative periodic acid-methenamine silver staining, and positivity for Congo red and direct fast scarlet. Electron microscopy showed non-branching fibrils, and laser microdissection followed by liquid chromatography-tandem mass spectrometry confirmed a diagnosis of AH amyloidosis. Of note, the biopsy also revealed numerous intratubular red blood cells and patchy interstitial hemorrhage in the absence of crescents or necrotizing lesions. The patient was initially treated with corticosteroids under the presumption of rapidly progressive glomerulonephritis. After histologic diagnosis, clone-directed daratumumab-based chemotherapy was introduced. Renal function gradually recovered, and dialysis was discontinued within 3 weeks of admission. This case highlights a rare but important phenotype of AH amyloidosis characterized by disruption of the glomerular capillaries and interstitial hemorrhage leading to reversible AKI. Early biopsy and appropriate therapeutic intervention may allow renal function to recover, even in severe presentations.
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
OBJECTIVES:To investigate the effectiveness of denosumab (DMAb), teriparatide (TPTD) and romosozumab (ROMO) in patients with glucocorticoid-induced osteoporosis (GIOP). METHOD:This multicenter, retrospective cohort study employed propensity score matching to select 42 patients per treatment group [92.1% female, mean age 73.5 years, 35.7% osteoporosis treatment naive, oral glucocorticoids (prednisolone equivalent) 5.4 mg/day, baseline bone mineral density (BMD) T-scores: lumbar spine (LS) -2.5]. Bone turnover markers (BTMs) and BMD were assessed over 12 months. RESULTS:DMAb suppressed BTM levels, whereas TPTD increased them. ROMO showed a dual effect, with increased and decreased levels of formation and resorption markers, respectively. At 12 months, LS BMD increases were greater with ROMO (9.5%) and tended to be higher with TPTD (8.4%) compared with DMAb (4.4%) (P = 0.008 for ROMO vs DMAb). At 6 months, total hip BMD increased with DMAb (2.6%) and ROMO (1.8%) but decreased with TPTD (-0.6%; P = 0.01 for DMAb vs TPTD; P = 0.042 for ROMO vs TPTD); no significant differences were observed at 12 months (3.2%, 2.6%, 2.2%, respectively). DMAb showed significant increases in femoral neck BMD at 6 (2.2%) and 12 (3.0%) months from baseline. CONCLUSION:BTM levels reflected expected pharmacological actions of each drug. ROMO showed greater LS BMD gains than DMAb, while TPTD demonstrated a similar response, whereas DMAb may provide earlier benefits at cortical-rich sites. These findings underscore the importance of site-specific, individualized treatment strategies for GIOP.
Abstract Background Quantitative Monte Carlo (MC) prediction of diagnostic x‐ray air kerma is limited by mismatch between theoretical spectra and measured beam quality and by the lack of a reproducible normalization from source‐photon tallies to mAs‐based exposures. Purpose To test whether HVL‐matched spectra combined with measurement‐anchored per‐electron normalization can predict free‐in‐air and transmitted air kerma under selected radiographic exposure settings and to evaluate the framework in PHITS and EGS5. Methods Birch‐Marshall spectra at 50, 80, and 120 kV were adjusted by tuning the Al‐equivalent filtration parameter so that the theoretical HVL agreed with the measured HVL. The matched spectra were used as common input for PHITS and EGS5. Free‐in‐air air kerma was measured for 102 exposure conditions, and transmitted air kerma was measured after 2.0‐cm PMMA or 0.5‐cm Al for seven conditions at each tube voltage. From measured air kerma and MC air‐kerma tallies expressed per source photon, we defined the normalization constant , the per‐electron correction factor , and the tube‐voltage‐averaged coefficient . Predictions based on were compared with measurements using percentage error. Performance on the full free‐in‐air dataset was interpreted as agreement within the calibration dataset, whereas held‐out‐condition performance was assessed by leave‐one‐out cross‐validation (LOOCV) on seven selected radiographic exposure settings at each tube voltage. Combined standard uncertainty was also summarized. Results After HVL matching, the free‐in‐air MC air‐kerma tallies expressed per source photon differed between PHITS and EGS5, a finding interpreted primarily in relation to differences in source definition and source normalization. After measurement‐based normalization with , predicted air kerma was generally consistent with measurements under both free‐in‐air and transmitted conditions. The largest mean percentage error was 7.8%, slightly exceeding the predefined ± 7.5% operational benchmark. The representative combined standard uncertainty was 5.6%; when the nominal tube‐voltage setting was used directly as a simulation input, inclusion of the tube‐voltage accuracy term increased it to 7.3%. Conclusions Within the tested radiographic system and slab‐transmission geometries, HVL‐matched spectra combined with measurement‐anchored per‐electron normalization enabled prediction of air kerma under actual exposure conditions. Despite differences in the MC air‐kerma tallies expressed per source photon, the final predicted values were generally consistent with measurements in both codes under the tested conditions.
