Summary:There exists limited information about the usefulness of hemopoietic stem cell transplantation (HSCT) for the treatment of patients with refractory Langerhans cell histiocytosis (LCH). We report here four Japanese pediatric patients with multisystem LCH disease who underwent HSCT between 1994 and 1997. Two of the four patients are doing well without any relapse. However, neither of them shows improved sequelae 3 to 4 years after allogeneic HSCT, although the graft was rejected in one of the cases. The remaining two patients died of septic shock. A review of the literature of 11 patients revealed four fatalities after the use of HSCT in the treatment of LCH. Three of these were due to active LCH and three deaths occurred within 2 months after HSCT. To establish the usefulness of HSCT for refractory LCH, further studies are required.

In response to multiple problems faced by pregnant or parenting teens, or both, many alternative school-based comprehensive programs have been established to provide the teens with multiple services. However, few of these programs have been evaluated to assess their impact on the teens. In this study, we have made a systematic evaluation of such a school-based comprehensive program-the Paquin School Program in Baltimore City-to assess its impact on contraceptive use, future contraceptive intention, and desire for more children. We used data collected from a sample of 371 pregnant and parenting teens who attended the Paquin School Program between 1999 and 2001, and from a sample of 506 comparable teens, who did not attend the Program. Our findings showed that the percentages of the Paquin School enrollees who were using contraceptives or who expressed intention to use contraceptives in the future were higher than those of their counterpart nonenrollees from the comparison schools. The findings also showed that the use of Depo-Provera and desire for no more children were higher among the Paquin School enrollees than among the enrollees from the comparison schools. Because the Paquin School enrollees self-selected into its program, some unobserved differences between them and their counterpart nonenrollees might have affected the outcomes of this article. However, the consistent patterns of positive outcomes for the Paquin School enrollees with regard to contraceptive use, future intention to use contraceptives, and desire for no more children, compared to those from the comparison schools, seem to suggest that the Paquin School's alternative comprehensive program has been successful in its effort to promote family planning. One possible reason for this success of the effort to promote family planning is its integration with the multiple services of the comprehensive program of the Paquin School that enables its teens to plan their fertility.

The present study aimed to identify the clinical significance of differences in detection timings of left ventricular reverse remodeling (LVRR) on heart failure (HF) prognosis in patients with idiopathic dilated cardiomyopathy (IDCM). We investigated 207 patients with IDCM who underwent pharmacotherapeutic treatment. LVRR was defined as improvements in both LV ejection fraction ≥10 % and indexed LV end-diastolic dimension (LVEDDi) ≥10 %. Patients were stratified into 3 groups by LVRR timing: patients with LVRR <24 months (Early LVRR), those with LVRR ≥24 months (Delayed LVRR), and those without LVRR during the entire follow-up period (No LVRR). The major endpoint was first detection of composite event including readmission for decompensated HF, major ventricular arrhythmias, or all-cause mortality. LVRR was recognized in 108 patients (52 %): Early LVRR in 83 (40 %), Delayed LVRR in 25 (12 %), and No LVRR in 99 (48 %). The survival rate for the major endpoint was significantly higher for Delayed LVRR than for No LVRR (P = 0.001); there was no significant difference between Early and Delayed LVRR. Among patients without LVRR <24 months (Delayed + No LVRR), receiver operating characteristic curve analysis showed that the area under the curve for improvement in LVEDDi during the first 6 months for predicting subsequent LVRR (Delayed LVRR) [0.822 (95 % confidence interval, 0.740-0.916; P = 0.038)] was greater than that for improvement in LVEF. In conclusion, LVRR was a favorable prognostic indicator in patients with IDCM irrespective of its detection timing. Reduced LVEDDi during the first 6 months was predictive for subsequent LVRR in the later phase.

Endomyocardial biopsy (EMB) and late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging performed at baseline are both used to evaluate the extent of myocardial fibrosis. However, no study has directly compared the effectiveness of these diagnostic tools in the prediction of left ventricular reverse remodeling (LVRR) and prognosis in response to therapy in patients with idiopathic dilated cardiomyopathy (IDCM). Seventy-five patients with newly diagnosed IDCM who were undergoing optimal therapy were assessed at baseline using LGE-CMR imaging and EMB; the former measured LGE area and the latter measured collagen volume fraction (CVF) as possible predictive indices of LVRR and cardiac event-free survival. Among all the baseline primary candidate factors with P < 0.2 as per univariate analysis, multivariate analysis indicated that only LGE area was an independent predictor of subsequent LVRR (β = 0.44; 95 % confidence interval (CI) 0.87–2.53; P < 0.001), as indicated by decreasing left ventricular end-systolic volume index over the 1-year follow-up. Kaplan–Meier curves indicated significantly lower cardiac event-free survival rates in patients with LGE at baseline than in patients without (P < 0.01). By contrast, there was no significant difference in prognosis between patients with CVF values above (severe fibrosis) and below (mild fibrosis) the median of 4.9 %. Cox proportional hazard analysis showed that LGE area was an independent predictor of subsequent cardiac events (hazard ratio 1.06; 95 % CI 1.02–1.10; P ≤ 0.01). The degree of myocardial fibrosis estimated by baseline LGE-CMR imaging, but not that estimated by baseline EMB, can predict LVRR and cardiac event-free survival in response to therapy in patients with newly diagnosed IDCM.

Stented Patients) and CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) scores were developed from Western and Japanese PCI populations, respectively, with both including thrombotic and bleeding risk scores. 9,10 However, these scores have not been well validated in a different cohort, specifically in patients with acute MI. The aim of the present study was to evaluate the predictive ability of PARIS and CREDO-Kyoto thrombotic and bleeding risk scores in patients with acute MI undergoing contemporary primary PCI. Methods Study Design and PopulationThis was a retrospective 2-center observational study. P rimary percutaneous coronary intervention (PCI)for patients experiencing acute myocardial infraction (MI) reduces subsequent cardiac events and improves clinical outcomes, and has become a standardof-care procedure. 1 In patients undergoing PCI, previous studies have shown that both ischemic and bleeding events have a significant and similar magnitude effect on mortality. 2-4 Recent guidelines recommend risk assessment for both ischemic and bleeding events, and several risk predicting models have been proposed. 5,6 Although the DAPT (Dual Antiplatelet Therapy) and PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) scores are guideline-recommended risk scoring systems, they were developed to guide DAPT duration after PCI and thus do not have capability to evaluate ischemic and bleeding risks individually. 7,8 In this context, the PARIS

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Treatment beyond progressive disease (PD) is a concept that even after drugs become ineffective, their continued use is more beneficial for patients than their discontinuation. In recent years, a concept of bevacizumab beyond PD (BBP) has attracted attention in the treatment of various cancers, and the usefulness of this concept has been evaluated. BBP has been proven to prolong overall survival (OS) in recurrent colorectal cancer and progression-free survival (PFS) in recurrent breast and lung cancers. With regard to the treatment of ovarian cancer, the MITO16/MaNGO-OV2B study (the Multicenter Phase III Randomized Study with Second Line Chemotherapy Plus or Minus Bevacizumab in Patients with Platinum Sensitive Epithelial Ovarian Cancer Recurrence After a Bevacizumab/Chemotherapy First Line) was conducted in patients with platinum-sensitive recurrence and the JGOG3023 study (the Open-Label, Randomized, Phase II Trial Evaluating the Efficacy and Safety of Standard of Care with or Without Bevacizumab in Platinum-Resistant Ovarian Cancer Patients Previously Treated with Bevacizumab for Front-Line or Platinum-Sensitive Ovarian Cancer) was conducted in patients with platinum-resistant recurrence. The MITO16/MaNGO-OV2B study, reported in the 2018 annual meeting of the American Society of Clinical Oncology, showed that BBP achieved prolonged PFS. In the JGOG3023 study, enrollment of patients was completed in December 2018, and the follow-up period has been initiated. Proving the effectiveness of BBP in the treatment of ovarian cancer may provide a new therapeutic strategy and contribute to improved treatment outcomes in patients with poor prognosis and limited therapeutic options.

The temporal change of LGE-CMR score during the clinical course was significantly correlated with following LVRR.