Abstract We analyzed the impact of the diagnosis-to-treatment interval (DTI) on survival in patients with CD5-positive diffuse large B-cell lymphoma (CD5 + DLBCL), using a data set of newly diagnosed patients. Among the 336 eligible patients, 247 (74%) received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), and 89 (26%) were treated with dose-adjusted (DA)-EPOCH-R (etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, and rituximab). The median DTI was 18 days (range 0–118). The short DTI (≤ 14 days) group included 135 patients (40%), and the long DTI (> 14 days) group included 201 patients (60%). Compared with the long DTI group, the short DTI group had more aggressive disease characteristics. Both the progression-free survival (PFS) (P = 0.01) and the overall survival (OS) (P < 0.01) were significantly inferior in the short DTI group compared with those in the long DTI group. Among 89 patients who received DA-EPOCH-R, no significant differences in PFS (P = 0.92) or OS (P = 0.86) were observed between the two groups. Multivariate analysis revealed that no DA-EPOCH-R was a risk factor for PFS in the short DTI group (P = 0.06). A short DTI was a negative prognostic factor in our CD5 + DLBCL cohort. DA-EPOCH-R could be considered a potential treatment option for patients with a short DTI.
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
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.
Background: The rising global older population increases the incidence of atrial fibrillation (AF), a major cause of stroke and heart failure, necessitating access to effective treatment. Catheter ablation (CA) has evolved into a primary treatment option, driven by significant advancements in device innovation, but is not available in all facilities. Methods and Results: According to public data from Japan (the Vital Statistics survey of Japanese events in 2022, the Japanese government Survey of Household Economy, the Survey on the Impact of the Diagnosis Procedure Combination System, and publicly available data from the Japan Heart Rhythm Society), a severe regional disparity exists in access to CA due to the uneven distribution of arrhythmia specialists. Ablation procedures per 10,000 population across the 47 prefectures averaged 6.67 (95% CI: 6.19-7.12), with a range of 3.02-9.24. This access gap is the "paradox of technological innovation", associated with inequitable treatment outcomes, higher AF-related hospitalization, and poorer quality of life in underserved prefectures. Structural threats, including a shrinking cardiologist workforce and new work constraints (Restrictions under the Work Style Reform-related Laws by the Japanese Government), risk worsening this disparity. Addressing this requires a paradigm shift toward equitable dissemination of CA. Conclusions: The future of arrhythmia care rests not only on pursuing cutting-edge technology but also on formulating evidence-based, policy-oriented action plans to fulfill the professional and societal responsibility of eliminating treatment inequity.
This study aimed to evaluate postoperative outcomes, including clinical results, radiological assessments, and complications, in patients over 50 years old with nondisplaced femoral neck fractures (Garden classification I–II) treated with cannulated cancellous screw (CCS) fixation with or without a side-plate. This multicenter retrospective study analyzed 620 patients aged ≥ 50 years with nondisplaced femoral neck fractures who underwent osteosynthesis between 2018 and 2020 across 12 affiliated hospitals. After propensity score matching, 41 patients were included in each group. All patients were followed for at least one year postoperatively. Patients were categorized into a CCS group (Group C) and a CCS with side-plate group (Group P). Walking ability, radiological evaluations, operative time, and complications were assessed. At six months postoperatively, femoral neck shortening did not differ significantly between Group C and Group P (C: 4.20 ± 5.37 vs P: 3.63 ± 3.29 mm, p = 0.701). At one year postoperatively, femoral neck shortening was significantly greater in Group C than in Group P (C: 5.58 ± 4.38 vs P: 2.99 ± 3.64 mm, p = 0.009). Walking ability at final follow-up did not differ between groups (p = 0.142). Operative time was longer in Group P (C: 33.85 ± 15.56 vs P: 56.37 ± 21.63 min, p < 0.001). Postoperative complications were comparable between groups. Plate augmentation reduced femoral neck shortening but increased operative time, without significant differences in complications or walking ability. CCS fixation without a side-plate may be sufficient for selected patients with nondisplaced femoral neck fractures.
