The Lancet Regional Health: Western Pacific最新文献

{"title":"Corrigendum to “A comparison of gender diversity in transgender young people with and without autistic traits from the Trans 20 cohort study” [The Lancet Regional Health–Western Pacific Volume 47, 2024, 101084]","authors":"Michelle A. Tollit , Tiba Maloof , Monsurul Hoq , Kristina Haebich , Carmen C. Pace , Zamantha Munoz Rodriguez , Muhammad Sial , Jonathan M. Payne , Ken Pang","doi":"10.1016/j.lanwpc.2025.101631","DOIUrl":"10.1016/j.lanwpc.2025.101631","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101631"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of antimicrobial stewardship interventions upon antimicrobial consumption and appropriateness in Vietnamese district hospitals: a cluster randomised trial","authors":"Jaslyn Doshi ,&nbsp;Yen Pham Ngoc ,&nbsp;Thu Thuy Ma ,&nbsp;Linh Thuy Duong ,&nbsp;Van Thi Thuy Pham ,&nbsp;Van Giap Vu ,&nbsp;Rodney James ,&nbsp;Qingbin Li ,&nbsp;Quy Trinh Van ,&nbsp;Tu Son Nguyen ,&nbsp;Thi Thu Trang Tran ,&nbsp;Pham Minh Thu Vo ,&nbsp;Van An Ngo ,&nbsp;Huu Phuc Phan ,&nbsp;Ngoc Canh Hoang ,&nbsp;Justin Beardsley ,&nbsp;Thu Anh Nguyen ,&nbsp;Greg J. Fox","doi":"10.1016/j.lanwpc.2025.101620","DOIUrl":"10.1016/j.lanwpc.2025.101620","url":null,"abstract":"<div><h3>Background</h3><div>Inappropriate antimicrobial use is a key driver of antimicrobial resistance. Antimicrobial stewardship (AMS) promotes the judicious use of antimicrobials to address this problem. This study evaluated the effect of an AMS program on antimicrobial prescribing practices in district hospitals in Vietnam.</div></div><div><h3>Methods</h3><div>A cluster randomised controlled trial was conducted in 16 district hospitals in northern and southern Vietnam over four months. Hospitals were randomly assigned to intervention or control groups. Interventions included establishing AMS committees and teams, distributing antimicrobial guidelines, training healthcare workers, providing patient educational material, and conducting periodic audits with feedback on antimicrobial prescribing. Co-primary outcomes were the “difference in differences” in (i) total antimicrobial consumption and (ii) inappropriate prescribing according to standardised guidelines, before and after the intervention, between intervention and control groups. Secondary outcomes included antimicrobial costs and all-cause mortality. After the intervention period, control sites also received the AMS program. Trial registry: Australia and New Zealand Clinical Trials Registry (ANZCTR) number 12622000715774.</div></div><div><h3>Findings</h3><div>A total of 877 and 1220 antimicrobial prescriptions were reviewed in intervention hospitals, and 1277 and 1454 prescriptions in control hospitals at baseline and post-intervention. Inappropriate antimicrobial prescribing exceeded 60% in each hospital at baseline. After the intervention, inappropriate prescribing in the intervention group reduced by 6.3% (95% CI −10.9%, −1.7%) relative to the control group. Total antimicrobial consumption did not differ between groups, but antimicrobial costs reduced in the intervention group. No difference in all-cause mortality was observed.</div></div><div><h3>Interpretation</h3><div>AMS interventions modestly reduced inappropriate antimicrobial prescribing in district hospitals in Vietnam, underscoring the importance of AMS in resource-limited settings.</div></div><div><h3>Funding</h3><div>The <span>Australian Department of Foreign Affairs and Trade</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101620"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of germline BRCA1/2 pathogenic variants in unselected Korean patients with HER2-negative metastatic breast cancer: a nationwide prospective study (KCSG BR19-10)","authors":"Hee Kyung Ahn ,&nbsp;Jee Hung Kim ,&nbsp;Su-Jin Koh ,&nbsp;Joohyuk Sohn ,&nbsp;Myoung Joo Kang ,&nbsp;Kyung Hae Jung ,&nbsp;Kyoung Eun Lee ,&nbsp;Jieun Lee ,&nbsp;Sung Ae Koh ,&nbsp;Yee Soo Chae ,&nbsp;Jae Ho Byun ,&nbsp;In Hae Park ,&nbsp;Hee-Jun Kim ,&nbsp;Jee Hyun Kim ,&nbsp;Han Jo Kim ,&nbsp;Joo Young Jung ,&nbsp;Jung Lim Lee ,&nbsp;Yoon Young Cho ,&nbsp;Kyong Hwa Park ,&nbsp;Ji-Yeon Kim ,&nbsp;Yeon Hee Park","doi":"10.1016/j.lanwpc.2025.101622","DOIUrl":"10.1016/j.lanwpc.2025.101622","url":null,"abstract":"<div><h3>Background</h3><div>Assessment of germline (g) <em>BRCA1/2</em> status is recommended for all patients with HER2-negative metastatic breast cancer (MBC) to identify candidates for poly(ADP-ribose) polymerase (PARP) inhibitor therapy, which is not always possible in clinical practice due to limited testing resources. In this study, we investigate the cross-sectional prevalence of g<em>BRCA1/2</em> pathogenic variant (PV) carriers in unselected Korean patients with HER2-negative MBC.</div></div><div><h3>Methods</h3><div>Patients diagnosed with HER2-negative metastatic BC receiving palliative systemic treatment were eligible for inclusion in the study. Peripheral blood was prospectively drawn from each patient and g<em>BRCA1/2</em> status was assessed by next-generation sequencing using an NGeneBio BRCAaccuTest.</div></div><div><h3>Findings</h3><div>A total of 586 patients were enrolled between October 2019 and March 2022, and the prevalence of g<em>BRCA1/2</em> PV was analyzed in 570 patients. The median age at enrollment was 54 years (interquartile range, 48–61) and 567 patients were female. Among the 570 patients with g<em>BRCA1/2</em> analysis, 481 had hormone receptor–positive/HER2-negative breast cancer (BC) and 89 had triple-negative breast cancer (TNBC). The overall prevalence of g<em>BRCA1/2</em> PV carriers was 7.4% (42/570, 95% confidence interval (CI) 5.4%–9.8%) in unselected patients with HER2-negative MBC [g<em>BRCA1</em>, 1.8% (95% CI 0.8%–3.2%), 10/570; g<em>BRCA2</em>, 5.6%(95% CI % - 7.8%), 32/570]. The overall prevalence of g<em>BRCA1/2</em> PV carriers in Korean patients with HER2-negative MBC and a low risk of hereditary breast ovarian cancer syndrome (HBOC) was 5.7% [19/332, 95% confidence interval 3.5%–8.8%; TNBC 10.5% (95% CI 1.3%–33.1%), <em>2/19; HR-positive/HER2-negative</em> 5.4%(95% CI 3.2%–8.6%), 17/313].</div></div><div><h3>Interpretation</h3><div>Our study measured the size of the current underestimation of g<em>BRCA1/2</em> PV carriers in unselected Korean patients with HER2-negative MBC, particularly in patients without high risk factors for HBOC. An active screening strategy for unselected HER2-negative MBC should be pursued to avoid missing potential candidates for systemic treatment with PARP inhibitors.</div></div><div><h3>Funding</h3><div>Pfizer.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101622"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort study","authors":"Dong-Seon Kang ,&nbsp;Pil-Sung Yang ,&nbsp;Jinseob Kim ,&nbsp;Daehoon Kim ,&nbsp;Eunsun Jang ,&nbsp;Hee Tae Yu ,&nbsp;Tae-Hoon Kim ,&nbsp;Jung Hoon Sung ,&nbsp;Hui-Nam Pak ,&nbsp;Gregory Y.H. Lip ,&nbsp;Boyoung Joung","doi":"10.1016/j.lanwpc.2025.101619","DOIUrl":"10.1016/j.lanwpc.2025.101619","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies from Western populations have reported changing temporal trends in ischemic stroke (IS) incidence in females with atrial fibrillation (AF) when compared with males. Nationwide data on such temporal trends in AF-related IS incidence by sex are limited in Asian populations.</div></div><div><h3>Methods</h3><div>This population-based retrospective cohort study included patients with incident AF diagnosed between 2005 and 2016 from the Korean National Health Insurance Service. Patients with valvular heart disease, prior IS, or anticoagulant use were excluded. Incidence rates (IRs) per 100 person-years and hazard ratios (HRs) for IS were calculated by Fine and Gray competing risk regression.</div></div><div><h3>Findings</h3><div>After exclusions, 290,081 females (mean age: 64.4 years, SD 16.3) and 338,100 males (mean age: 60.1 years, SD 14.9) were included. The mean follow-up duration was 5.7 (SD 4.1) years. At baseline, the CHA₂DS₂-VA scores were higher in females than in males (2.0 vs. 1.6, <em>P</em> &lt; 0.0001). IRs for IS declined over time in both sexes (<em>P for trend</em> &lt; 0.0001). The IS incidence in females compared to males was significantly higher in 2005–2006 (1.55 vs. 1.40; HR_unadj: 1.12, 95% confidence interval: 1.06–1.19); however, it was no longer significant in 2015–2016 (1.20 vs. 1.17; HR_unadj: 1.03, 95% confidence interval: 0.99–1.08). The reduction in relative risk primarily originated from the subgroup with CHA₂DS₂-VA scores 0–1. Females with CHA₂DS₂-VA scores ≥3 consistently showed higher IRs for IS compared to males regardless of adjustment.</div></div><div><h3>Interpretation</h3><div>Sex differences in IS incidence decreased over calendar-year intervals, mainly in low-risk patients with AF. The persistently high IS incidence in high-risk females with AF suggests that sex still remains an important risk modifier.</div></div><div><h3>Funding</h3><div><span>Patient-Centered Clinical Research Coordinating Center</span>, Republic of Korea.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101619"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thymic central tolerance takes centre stage in autoimmune disease","authors":"Smaila Mulic-Al Bunni,&nbsp;Adam E. Handel","doi":"10.1016/j.lanwpc.2025.101638","DOIUrl":"10.1016/j.lanwpc.2025.101638","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101638"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a deep learning-based imaging diagnostic framework, PVDNet, for differentiating pulmonary artery sarcoma and pulmonary thromboembolism: a multi-center observational study","authors":"Linfeng Xi ,&nbsp;Anqi Liu ,&nbsp;Han Kang ,&nbsp;Yifei Ni ,&nbsp;Jianping Wang ,&nbsp;Hongyi Wang ,&nbsp;Xiaoyan Li ,&nbsp;Xiaojuan Guo ,&nbsp;Minjie Lu ,&nbsp;Hui Liu ,&nbsp;Yinzhu Chen ,&nbsp;Heng Ma ,&nbsp;Yinsu Zhu ,&nbsp;Yu Deng ,&nbsp;Liqing Peng ,&nbsp;Fajiu Li ,&nbsp;Ziyang Zhu ,&nbsp;Lihua Wang ,&nbsp;Xin Chen ,&nbsp;Hong Yu ,&nbsp;Min Liu","doi":"10.1016/j.lanwpc.2025.101625","DOIUrl":"10.1016/j.lanwpc.2025.101625","url":null,"abstract":"<div><h3>Background</h3><div>Differentiating pulmonary artery sarcoma (PAS) from pulmonary thromboembolism (PTE) based on CT pulmonary angiography (CTPA) is a big challenge, necessitating the incorporation of other methods, such as deep learning (DL). This study aimed to develop and validate a DL-based model, PVDNet, for differentiating PAS and PTE on CTPA.</div></div><div><h3>Methods</h3><div>This study retrospectively analyzed CTPA image datasets from the prospective CHinese pulmOnary embolism multimodality Imaging artifiCial intelligencE (CHOICE) study to develop and validate a DL model for differentiating PAS from PTE. CTPA image datasets of 952 patients (470 acute PTE [APE], 363 chronic PTE [CPE], and 119 PAS) from 15 hospitals were included. The training set comprised CTPA images from 590 patients, and the internal test set comprised those from 186 patients, all obtained from the same three centers. CTPA images of 176 patients from 12 centers were used for external validation. A DL framework, PVDNet, was employed to perform fine-grained classification. Meanwhile, CTPA images in the external validation set were independently assessed by four radiologists with different levels of expertise. The main outcome measures were area under the curve (AUC) and the consistency test.</div></div><div><h3>Findings</h3><div>In the internal test set, PVDNet achieved an AUC of 0.972, 0.902, and 0.900 for PAS (95% CI: [0.945, 0.994]), APE (95% CI: [0.855, 0.944]), and CPE (95% CI: [0.852, 0.946]), respectively. Furthermore, PVDNet model demonstrated effective differentiation between PAS and PTE, showing comparable AUC values to a senior radiologist specialized in pulmonary vascular diseases (SRPV) in the external validation set (0.973 vs. 0.943, p = 0.308). The model achieved moderate agreement with SRPV (kappa = 0.651, p &lt; 0.001), which was the highest among four readers.</div></div><div><h3>Interpretation</h3><div>PVDNet model could differentiate PAS from PTE, with performance approaching the proficiency level of a senior radiologist specializing in pulmonary vascular diseases. PVDNet's performance in distinguishing APE from CPE requires further optimization.</div></div><div><h3>Funding</h3><div><span>National Natural Science Foundation of China</span> (No. <span><span>82272081</span></span>), <span>Medical and Health Science and Technology Innovation Project of Chinese Academy of Medical Science</span> (No. <span><span>2021-I2M-1-049</span></span>), and the <span>National Key Research and Development Program of China</span> (No. <span><span>2023YFC2507200</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101625"},"PeriodicalIF":8.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pembrolizumab monotherapy for previously treated metastatic HER2-negative breast cancer with germline APOBEC3B deletion: results of the phase II AUROR study","authors":"Gwo Fuang Ho ,&nbsp;Soo Chin Lee ,&nbsp;Anita Zarina Bustam ,&nbsp;Adlinda Alip ,&nbsp;Nur Fadhlina Abdul Satar ,&nbsp;Marniza Saad ,&nbsp;Rozita Abdul Malik ,&nbsp;Siew Eng Lim ,&nbsp;Samuel G.W. Ow ,&nbsp;Andrea Wong ,&nbsp;Wan-Qin Chong ,&nbsp;Yvonne L.E. Ang ,&nbsp;Audrey Weng Yan Lee ,&nbsp;Siti Norhidayu Hasan ,&nbsp;Nabilah Tuan Zaid ,&nbsp;Kian Boon Law ,&nbsp;Yok Yong Toh ,&nbsp;Hooi Chiao Tan ,&nbsp;Bawani Selvam ,&nbsp;Joanna Lim ,&nbsp;Soo Hwang Teo","doi":"10.1016/j.lanwpc.2025.101637","DOIUrl":"10.1016/j.lanwpc.2025.101637","url":null,"abstract":"<div><h3>Background</h3><div>A common germline deletion polymorphism in the <em>APOBEC3B</em> gene increases the rate of somatic hypermutation in breast cancer, which in turn is associated with greater neoantigen burden and immune activation. This phase II study evaluated the impact of the <em>APOBEC3B</em> deletion polymorphism on the response to pembrolizumab monotherapy in metastatic HER2-negative breast cancer patients.</div></div><div><h3>Methods</h3><div>Eligible patients had a confirmed diagnosis of metastatic HER2-negative breast cancer, 1–3 prior lines of therapy, and documented homozygous or heterozygous germline deletion of <em>APOBEC3B</em>. Patients received 200 mg of pembrolizumab intravenously every 3 weeks for up to 2 years. The primary endpoint was objective response rate. Secondary endpoints were disease control rate, progression-free survival, and overall survival. <strong>Clinical trial registration:</strong> <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT03989089</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>All enrolled patients (N = 44) were women, 30% (12/40) had PD-L1-positive tumours, and 64% (28/44) had received ≥2 previous lines of therapy for metastatic disease. Objective response rate (ORR) was 20% (9/44) (95% CI, 9.8–35.3) in the total and 25% (3/12) (95% CI, 5.5–57.2) in the PD-L1-positive population. Disease control rate (DCR) for the study was 52% (23/44) (95% CI, 36.7–67.5). Median progression-free survival (PFS) was 3.1 months (95% CI, 2.1–4.3), and 6-month PFS rate was 27% (12/44) (95% CI, 16.8–44.2). Median overall survival (OS) was 15.5 months (95% CI, 13.0–26.5), and 12-month OS rate was 66% (29/44) (95% CI, 53.3–82.5). Treatment-related adverse events (AEs) occurred in 30 (68%) patients, including 1 (2%) with a grade 3 AE. There were no deaths due to AEs.</div></div><div><h3>Interpretation</h3><div>Pembrolizumab monotherapy demonstrated anti-tumour activity in a subset of previously treated metastatic HER2-breast cancer patients with germline <em>APOBEC3B</em> deletion.</div></div><div><h3>Funding</h3><div>This study was sponsored by <span>Cancer Research Malaysia</span>, a non-profit cancer research organization. Merck Sharp &amp; Dohme (MSD) provided free access to the trial drug through the Merck Investigator Studies Program.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101637"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational study","authors":"Haoxiao Chang ,&nbsp;Junqiang Yan ,&nbsp;Anxin Wang ,&nbsp;Ningning Wang ,&nbsp;Peng Liu ,&nbsp;Yemin Shi ,&nbsp;Xin Zhao ,&nbsp;Jinqiao Zhu ,&nbsp;Yuan Cai ,&nbsp;Xue Xia ,&nbsp;Yunyi Hao ,&nbsp;Shiyi Yin ,&nbsp;Jing Wang ,&nbsp;Xinli Wang ,&nbsp;Lina Sun ,&nbsp;Jia Ma ,&nbsp;Xiaoyu Huang ,&nbsp;Haonan Guan ,&nbsp;De-Cai Tian ,&nbsp;Kaibin Shi ,&nbsp;Wei-Na Jin","doi":"10.1016/j.lanwpc.2025.101615","DOIUrl":"10.1016/j.lanwpc.2025.101615","url":null,"abstract":"<div><h3>Background</h3><div>Autoimmune diseases comprise a spectrum of illnesses stemming from a common etiology: the loss of self-tolerance. The organ crucial for the establishment and maintenance of central and peripheral tolerance, namely the thymus, has rarely been explored across these diseases.</div></div><div><h3>Methods</h3><div>In a multicentre radiological case–control study, we characterized the thymus in 16 prevalent autoimmune diseases using chest computed tomography (CT) images from patients and age- and sex-1:1 matched healthy controls. Participants underwent a routine CT examination, and baseline information on demographic, clinical, and potential risk factors was gathered at the time of enrollment. A semi-automatic algorithm was developed and employed for the analysis of thymic radiological characteristics, encompassing structural features and density. Thymic fatty replacement was evaluated using a four-point visual scoring scale (0–3). This study is registered with the Chinese Clinical Trial Registry (ChiCTR2300078417).</div></div><div><h3>Findings</h3><div>After matching, 2441 participants in each group were included in case–control study. As individuals age, the thymus undergoes involution, leading to marked changes in thymic features over time, yet the degree of thymic feature alterations varies among groups. Compared to healthy controls, multiple characteristics of the thymus were distinct in the autoimmune disease patients, featuring higher trapezoidal proportions (68.21% vs 46.29%; p &lt; 0.0001), larger bilobed size, and reduced density (−9.50; 95% CI, −10.95 to −8.04; p &lt; 0.0001). In addition, the autoimmune disease patients displayed a greater proportion of fatty replacement (score 0, score 1, and score 2, 94.23% vs 87.83%, p &lt; 0.0001). This consistent trend of thymic characteristic alternations, was observed across the 16 diseases (albeit varying in degree) and in newly diagnosed as early-stage patients. Notably, the subgroup for female patients of childbearing age (≤49 years) exhibited an especially prominent difference in thymic density (−16.23; 95% CI, −19.19 to −13.26; p &lt; 0.0001 in all comparisons) and in the proportion of fatty replacement (85.37% vs 71.68%; p &lt; 0.0001).</div></div><div><h3>Interpretation</h3><div>Radiological assessments reveal a consistent pattern of exacerbated age-dependent thymic involution across 16 autoimmune diseases, suggesting a common underlying mechanism in the development of these diseases. This mechanism may involve the compromise of self-tolerance due to thymic involution.</div></div><div><h3>Funding</h3><div>The <span>National Key R&amp;D Program of China</span>, the <span>National Science Foundation of China</span>, and the <span>Tianjin Key Medical Discipline (Specialty) Construction Project</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101615"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of onset of persistent critical illness in Japan: a nationwide registry study","authors":"Hiroyuki Ohbe ,&nbsp;Daisuke Kudo ,&nbsp;Naoya Kobayashi ,&nbsp;Kasumi Shirasaki ,&nbsp;Kensuke Nakamura ,&nbsp;Theodore J. Iwashyna ,&nbsp;Shigeki Kushimoto","doi":"10.1016/j.lanwpc.2025.101632","DOIUrl":"10.1016/j.lanwpc.2025.101632","url":null,"abstract":"<div><h3>Background</h3><div>Persistent critical illness (PerCI) occurs in patients whose ongoing ICU stay is no longer primarily driven by their presenting illness, but rather by new clinical instability. Studies in Western countries have found PerCI onset at 5–11 days, but timing in Japan or other Asian countries is unknown.</div></div><div><h3>Methods</h3><div>Using the Japanese Intensive Care Patient Database (JIPAD), PerCI onset was assessed by comparing the predictive ability of antecedent characteristics components (demographics, comorbidities) and acute illness components (physiological status at ICU admission) for in-hospital mortality, analyzed through multivariable logistic regression models among patients still in ICU from day 1 to day 28. The day when the Area Under the Receiver Operating Characteristic curve (AUROC) of antecedent characteristics exceeded that of acute illness was defined as the onset of PerCI.</div></div><div><h3>Findings</h3><div>We studied 285,567 patients from 101 ICUs in Japan between April 2015 and March 2023. Overall in-hospital mortality was 8.2%. The AUROCs of antecedent characteristics and acute illness components for in-hospital mortality was 0.752 and 0.920 on day 1, 0.669 and 0.779 on day 7, 0.668 and 0.743 on day 14 and 0.667 and 0.700 on day 28, respectively. Through day 28, the AUROC of acute illness component remained consistently higher than that of antecedent characteristics component, with no observed onset of PerCI.</div></div><div><h3>Interpretation</h3><div>Unlike findings from Western countries, PerCI onset was not observed in ICU in Japan. This suggests that variation in end-of-life decision making and the critical care delivery system may influence the onset of PerCI.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101632"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An equitable, safe, and reliable blood supply in the Western Pacific","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2025.101647","DOIUrl":"10.1016/j.lanwpc.2025.101647","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101647"},"PeriodicalIF":8.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}