Konan Medical Center

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are indicated for patients with all phenotypes of heart failure (HF). Despite the current unprecedented super-aged society in real-world settings, the efficacy of SGLT2 inhibitors in super-aged HF patients, especially those of ≥80 years, remains unknown.

This study was conducted across three hospitals in Japan, including 238 HF patients ≥80 years (mean 84.2 ± 3.3 years), who were treated with SGLT2 inhibitors (dapagliflozin or empagliflozin). SGLT2 inhibitors were used for HF, with preserved ejection fraction in 131 patients (55.0 %), mildly-reduced ejection fraction in 54 patients (22.7 %), and reduced ejection fraction in 53 patients (22.3 %). Among 238 patients, 191 (80.3 %) continued SGLT2 inhibitors, while 47 (19.7 %) discontinued SGLT2 inhibitors (for any reason) during follow-up. The primary outcome was a composite of cardiovascular death or worsening HF, with a median follow-up duration of 2.73 (2.08-3.52) years.

Cumulative incidence curves modified by the Simon-Makuch method with a time-varying Cox regression analysis showed that HF patients with continued SGLT2 inhibitor treatment had significantly favorable outcomes, which remained consistent after adjustment for baseline characteristics by propensity score matching, and discontinuation of SGLT2 inhibitors was the strongest contributing factor to the outcome by a multivariable analysis. Moreover, the multivariable analysis identified a higher clinical frailty scale score as an independent factor associated with discontinuation of SGLT2 inhibitors.

This study provides real-world evidence supporting the use of SGLT2 inhibitors in super-aged patients with HF, emphasizing the importance of appropriately assessing the continuation of SGLT2 inhibitors.

This study aimed to clarify the effects of possible sarcopenia at admission-defined using calf circumference (CC) and handgrip strength-on adverse events, including recurrence and death, in patients with acute stroke.

This retrospective cohort study was conducted at two acute care hospitals between November 2020 and March 2022. All patients admitted within 48 h of stroke onset during the study period were included. Possible sarcopenia was defined according to the AWGS 2019 criteria, using CC (men <34 cm, women <33 cm) for case finding and identified by the presence of low handgrip strength (men <28 kg, women <18 kg). The primary outcomes were adverse events after discharge, including recurrence, readmission, and death. After adjusting for confounders, we applied the Cox proportional hazards regression analysis to examine whether possible sarcopenia was associated with outcomes.

Out of the 511 patients included in the study, possible sarcopenia was identified in 229 patients (44.8 %). Possible sarcopenia (hazard ratio [HR] = 3.94; 95 % confidence interval [CI] 1.83-8.50; p < 0.001) were significantly associated with adverse events after adjusting for confounders, whereas low CC (HR = 2.37; 95 % CI 0.99-5.62; p = 0.050) and low handgrip strength (HR = 1.97; 95 % CI 0.85-4.59 p = 0.116) were not.

The findings of the study reveal that possible sarcopenia at the time of admission in patients with stroke is associated with adverse outcomes after discharge. These findings suggest that the identification of sarcopenia may facilitate prognostic prediction.

Epithelioid sarcoma (ES) is a very rare malignant tumor with few effective treatments other than surgical resection. In this study, the efficacy of BNCT for ES was examined using human ES-derived VA-ES-BJ cell-bearing nude mice. Only tumors in the BNCT group injected with p-borono-_L-phenylalanine-fructose complex and irradiated with neutrons were destroyed. This study suggests the potential of BNCT as a new option for the treatment of human ES.