OBJECTIVES:This study aimed to identify predictors of clinical inertia in SLE management and to evaluate its impact on clinical outcomes. METHODS:A historical cohort study was conducted using data from the multicentre LUNA cohort in Japan. The 365 patients with active disease 1 year before baseline (SLE Disease Activity Index score >4 or active gastrointestinal lesions or haemolytic anaemia) were classified by baseline disease activity and treatment intensification status over 1 year into non-intensification (n = 247) vs intensification (n = 118) groups. Furthermore, the clinical inertia group (n = 116), defined as sustained active disease without intensification, was compared with the non-clinical inertia group (n = 249), which comprised all other patients. Regression analyses assessed predictors and outcomes, including damage accrual, disease activity, quality of life (QoL) and patient satisfaction. RESULTS:Non-intensification was associated with larger increases in glucocorticoid-related damage, while clinical inertia was linked to greater increases in overall and glucocorticoid-related damage. Non-intensification and clinical inertia correlated with a tendency towards reduced QoL across several domains. HCQ use and fewer concomitant immunosuppressants predicted non-intensification of treatment, whereas female sex and greater damage accrual predicted clinical inertia; older age showed similar but non-significant trends for both outcomes. CONCLUSION:Because clinical inertia can drive damage accrual and QoL deterioration, avoiding clinical inertia is a therapeutic priority. Regular reassessment of treatment strategy is essential for older patients, women and those with greater damage. Proactive tailoring of treatment to individual risk profiles can arrest clinical inertia and improve long-term outcomes.
BACKGROUND:Optical coherence tomography (OCT) can identify the underlying causes of acute coronary syndrome (ACS), including plaque rupture (PR), plaque erosion (PE), and eruptive calcified nodule (CN), which may have prognostic implications. However, the duration and extent of their impacts remain unclear. METHODS:The multicentre prospective TACTICS registry enrolled patients with ACS undergoing OCT-guided percutaneous coronary intervention within 24 hours of symptom onset. Two-year clinical outcomes were assessed in 617 patients with OCT-diagnosed PR, PE, or CN (n = 411, 178, and 28, respectively). Major adverse cardiac events (MACE), a composite of cardiovascular death, myocardial infarction, heart failure, or ischemia-driven revascularisation, were independently adjudicated. RESULTS:During a median follow-up of 736 days, MACE occurred most frequently in CN (46.4%), primarily driven by cardiovascular death and ischemia-driven revascularisation, followed by PR (13.9%) and PE (8.4%) (log-rank P < 0.001). Landmark Cox analysis demonstrated that within 180 days, CN and PR carried substantially higher MACE risk than PE (CN: HR 9.77, 95% CI 2.96-35.29 [P < 0.001]; PR: HR 3.19, 95% CI 1.32-9.94 [P = 0.008]). Beyond 180 days, CN continued to exhibit significantly elevated risk (HR 6.30, 95% CI 2.39-15.60; P < 0.001), whereas PR did not differ from PE (HR 1.04, 95% CI 0.53-2.17; P = 0.915). CONCLUSIONS:Compared with PE, CN was associated with persistently adverse outcomes, whereas PR conferred elevated risk primarily in the early phase. OCT-defined underlying causes of ACS may help to identify high risk phenotypes and provide prognostic insight into temporal risk profiles. CLINICAL TRIAL REGISTRATION:UMIN000039050.
To clarify sex-specific differences in the risk profiles of anastomotic leakage (AL) after rectal cancer surgery, for which sex is widely recognized as an important risk factor. This retrospective multicenter study included 1,854 patients (1,196 men and 658 women) who underwent rectal cancer surgery with anastomosis between 2015 and 2025 at our institution. Patients were stratified by sex, and risk factors for AL (grade ≥ B) were analyzed separately using logistic regression. Interaction analyses between sex and perioperative factors were also conducted. AL occurred more frequently in men than in women (9.9
BACKGROUND:Maintaining activities of daily living is of great importance for patients who have cancer, and dependency is associated with psychological distress. However, evidence for rehabilitation remains scarce in this setting. The objective of this study was to evaluate the efficacy of a structured rehabilitation program for maintaining activities of daily living among patients with terminal cancer. METHODS:This multicenter randomized controlled trial across 19 Japanese inpatient hospices/palliative care units enrolled patients who had terminal cancer with an Eastern Cooperative Oncology Group performance status of 2-3, a life expectancy ≥3 weeks, and no severe symptoms. Participants were randomly assigned (1:1, stratified by performance status and site) to either a 3-week structured rehabilitation program that incorporated key elements of rehabilitation for patients with terminal cancer or usual unstructured rehabilitation. The primary outcome was a change in the total modified Barthel Index from baseline to day 22. Secondary outcomes included the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 15-Palliative Care score and safety. RESULTS:Between July 8, 2019, and February 20, 2024, 130 patients were randomized (59 to the intervention group, 71 to the control group; 56 patients [43.0%] were women). The primary analysis included 77 participants who had complete data available. The mean change in total modified Barthel Index was -1.31 (95% confidence interval [CI], -10.89, 8.08) in the intervention group and -15.51 (95% CI, -24.02, -7.01) in the control group. The between-group difference was 14.21 (95% CI, 1.77, 26.64; p = .026), exceeding the minimally clinically important difference (9.25). Patient-reported physical functioning on the European for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 15-Palliative Care instrument was also significantly higher in the intervention group than in the control group. No serious harms occurred. CONCLUSIONS:Structured rehabilitation maintained activities of daily living better than unstructured rehabilitation in patients with terminal cancer, supporting its integration into routine care even in the last stage of cancer.
