1.Comparison of the Efficacy of Piperacillin/Tazobactam and Meropenem, with or without Intravenous Immunoglobulin, as Second-Line Therapy for Febrile Neutropenia: A Prospective, Randomized Study
Hirozumi SANO ; Ryoji KOBAYASHI ; Satoru MATSUSHIMA ; Daiki HORI ; Masato YANAGI ; Koya KODAMA ; Daisuke SUZUKI ; Kunihiko KOBAYASHI
Clinical Pediatric Hematology-Oncology 2021;28(2):75-83
Background:
Febrile neutropenia (FN) remains an important complication in pediatric cancer patients. The present study compared the efficacy of meropenem (MEPM) and piperacillin/tazobactam (PIPC/TAZ) with or without intravenous immunoglobulin (IVIG) as second-line therapy for FN in pediatric patients.
Methods:
As first-line treatment for FN, 394 episodes in 99 patients were randomly assigned to receive PIPC/TAZ (360 mg/kg/day, maximum 18 g/day) or MEPM (120 mg/ kg/day, maximum 3 g/day). Eighty-four episodes in 42 patients were judged as failures, and, thus, were enrolled for second-line treatment. In second-line treatment, antibiotics were switched to MEPM or PIPC/TAZ, and episodes were further randomized for treatment with or without concomitant IVIG at 100 mg/kg/day (maximum 5 g/day) for 3 consecutive days.
Results:
The total success rate of second-line treatment was 50.0% (52.0% in PIPC/ TAZ and 47.2% in MEPM with or without IVIG, P=0.826). The success rates of patients treated with (IVIG+ group) and without IVIG (IVIG− group) were 53.8 and 46.7%, respectively (P=0.662). In the IVIG+ group, the success rate of patients younger than 8 years old was 78.6%, which was significantly higher than that of those aged 8 years and older (40.0%, P=0.043).
Conclusion
PIPC/TAZ and MEPM were equally effective as second-line treatment. Concomitant IVIG was also effective, particularly in patients younger than 8 years.
2.Cross-Sectional and Longitudinal Associations between Forearm Bone Mineral Density and Anthropometry in Adult Japanese Men and Women
Masahiro ISHIZAWA ; Kazuya FUJIHARA ; Junko YACHIDA ; Izumi IKEDA ; Takaaki SATO ; Takaho YAMADA ; Ayako KOBAYASHI ; Shiro TANAKA ; Yoshimi NAKAGAWA ; Takashi MATSUZAKA ; Hitoshi SHIMANO ; Minoru TASHIRO ; Satoru KODAMA ; Kiminori KATO ; Hirohito SONE
Journal of Bone Metabolism 2024;31(1):21-30
Background:
No consensus exists regarding which anthropometric measurements are related to bone mineral density (BMD), and this relationship may vary according to sex and age. A large Japanese cohort was analyzed to provide an understanding of the relationship between BMD and anthropometry while adjusting for known confounding factors.
Methods:
Our cohort included 10,827 participants who underwent multiple medical checkups including distal forearm BMD scans. Participants were stratified into four groups according to age (≥50 years or <50 years) and sex. The BMD values were adjusted for confounding factors, after which single and partial correlation analyses were performed. The prevalence of osteopenia was plotted for each weight index (weight or body mass index [BMI]) class.
Results:
Cross-sectional studies revealed that weight was more favorably correlated than BMI in the older group (R=0.278 and 0.212 in men and R=0.304 and 0.220 in women, respectively), whereas weight and BMI were weakly correlated in the younger age groups. The prevalence of osteopenia exhibited a negative linear relationship with weight among older women ≥50 years of age, and an accelerated increase was observed with decreasing weight in older men weighing <50 kg and younger women weighing <60 kg. When weight was replaced with BMI, the prevalence was low in most subgroups classified by weight.
Conclusions
Weight, rather than BMI, was the most important indicator of osteopenia but it might not be predictive of future bone loss.