Kameda Medical Center

Rice endosperm protein hydrolysate B (REPH-B) is produced by enzymatic degradation of rice endosperm protein. REPH-B contains the following peptides: QAFEPIRSV, pEAFEPIRSV, and TNPWHSPRQGSF. A previous study reported that REPH-B has the ability to induce plasma acylated ghrelin secretion and increase food intake in animal models. In this study, we investigated the effect of REPH-B on appetite in healthy adults aged over 40 y who had a relatively low visual analogue scale (VAS) score for hunger. Forty-six healthy subjects who were aware that their appetite had decreased were enrolled. Subjects were randomly allocated to one of two groups. The influence of REPH-B on appetite was evaluated by VAS under two conditions: repeated intake over 2 wk (Study 1) and single intake (Study 2). Though a single intake of REPH-B had no influence on any of the parameters evaluated, repeated intake of REPH-B significantly improved the VAS score for hunger. In conclusion, repeated intake of REPH-B might increase hunger in healthy adults who suffer from a lack of appetite. This study was registered with UMIN Clinical Trials Registry as UMIN000049108.

We thank Gong and Luo for their correspondence [1] regarding our trial [2]. With respect to the lack of difference in acute pain intensity and opioid consumption, we agree that this may challenge conventional models linking early nociceptive input with the development of persistent postsurgical pain. However, in our study, acute postoperative pain was well controlled in both groups, most likely due to the routine use of comprehensive multimodal analgesia. As a result, early pain intensity at 2 h and 24 h was low overall, which may have limited the ability to detect additional analgesic effects attributable to the block strategy. A dissociation between acute and chronic pain outcomes has been reported previously in breast surgery. Fujii et al. showed a significant reduction in chronic pain at 6 months following mastectomy with a pectoral type-2 block compared with serratus plane block alone, despite no significant difference in 24-h postoperative pain scores between groups [3]. These findings, together with ours, suggest that the development of chronic postmastectomy pain is multifactorial and not determined solely by early postoperative pain intensity scores. Potential contributors may include modulation of subclinical neural injury, inflammatory responses and longer-term pain trajectories [4, 5]. We agree that the precise mechanisms linking regional anaesthesia techniques and chronic pain prevention remain incompletely understood and warrant further investigation. Regarding the divergence between intention-to-treat and per-protocol analyses, we acknowledge that the exclusion of three protocol deviations attenuated the statistical significance of the primary outcome. We agree that the proximity of the p value to the conventional threshold suggests that the finding may be fragile and warrants cautious interpretation. For this reason, we identified this as a limitation [2]. Confirmation in larger, adequately powered multicentre studies will be essential. We agree that the clinical impact of reducing the incidence of any pain at 6 months must be interpreted in context. Although fewer patients in the intervention group reported pain, absolute pain intensity was low in both groups, median numeric rating pain scores were 0 and no patient required ongoing analgesics. Persistent pain was defined as any pain at rest, an approach adopted increasingly in postsurgical pain research, including breast surgery trials [6], as even mild persistent pain may reflect ongoing sensory disturbance. That said, we agree that future trials should prioritise patient-centred outcomes such as functional impairment, quality of life, pain interference and moderate-to-severe pain phenotypes to better capture clinically meaningful benefits. In addition, analytical approaches that account for longitudinal pain trajectories, such as mixed-effects models, may provide greater sensitivity to detect clinically relevant differences over time and better characterise the dynamic nature of postsurgical pain. We also acknowledge that differences in pain experience and reporting across racial and ethnic groups may have influenced our observed outcomes.

Abstract Background Janus kinase inhibitors (JAKis) are effective treatment for autoimmune diseases but are known to increase the risk of herpes zoster (HZ). Recombinant zoster vaccine (RZV) is effective in preventing HZ; nonetheless, its uptake remains suboptimal in real-world practice. This study aimed to investigate the RZV vaccination rate among patients treated with JAKis and to clarify pharmacist interventions and related factors associated with RZV uptake. Methods This single-center retrospective observational study included patients who received JAKis at our hospital between March 2020 and August 2024. Pharmacist interventions related to RZV were categorized as passive or active. In the passive intervention, physicians provided usual care independently and pharmacists became involved only upon the physicians’ request (physician group). In the active intervention, pharmacists in pharmacist-led clinics provided information on RZV at JAKi initiation and, in collaboration with physicians, recommended RZV vaccination (pharmacist-led clinic group). The primary outcome was RZV vaccination status (vaccinated vs unvaccinated) among patients treated with JAKis, whilst secondary analyses explored factors associated with RZV uptake using multivariable logistic regression. Results A total of 404 eligible patients were treated with JAKis at our institution. Following the exclusion of five patients who received zoster vaccination at other institutions, 399 patients were ultimately included in the analysis. Overall, 64 (16.0%) patients were vaccinated with RZV. Multivariate logistic regression analysis revealed that shared decision-making in pharmacist-led clinics was significantly associated with RZV vaccination. Conclusion This study suggests that effective prevention of HZ in patients treated with JAKis requires not only information provision and recommendations from healthcare professionals but also pharmacist-led shared decision-making that enables patients to understand and actively choose RZV vaccination. Establishing such systems may both reduce HZ risk and advance patient-centered care in this high-risk population.

BackgroundAlthough inhaled nitric oxide (iNO) is used as a rescue therapy in patients with acute respiratory distress syndrome (ARDS), its impact on patient-centered outcomes remains uncertain. To address this gap, we conducted a systematic review of randomized controlled trials (RCTs) to test the hypothesis that the addition of iNO to standard care improves survival in adult patients with ARDS.MethodsWe searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and WHO ICTRP for RCTs evaluating iNO in adult patients with ARDS through October 28, 2025. The primary outcome was mortality at the longest follow-up. Secondary outcomes included acute kidney injury (AKI), receipt of renal replacement therapy (RRT), duration of mechanical ventilation, length of intensive care unit stay, length of hospital stay, receipt of extracorporeal membrane oxygenation (ECMO), mean pulmonary artery pressure, partial pressure of arterial oxygen/fraction of inspiratory oxygen (PaO2/FiO2) ratio, elevated methemoglobin concentrations (> 5%), elevated nitrogen dioxide concentrations (> 3 ppm), extubation, and reintubation. We pooled data using a random-effects model, assessed the risk of bias with the Cochrane RoB 2 tool, and graded certainty with the GRADE approach.ResultsWe included 11 RCTs comprising 1302 patients. Only one study was of low risk of bias. iNO therapy may result in no difference in mortality at the longest follow-up (relative risk [RR], 1.07; 95% confidence interval [CI], 0.93–1.23; I2 = 0%; low certainty). iNO may improve PaO₂/FiO₂ ratio slightly (mean difference, 15.03 mmHg; 95% CI, 6.19–23.86; I2 = 0%; low certainty). The evidence is very uncertain about the effect on ECMO use (RR, 0.45; 95% CI, 0.10–2.17; I2 = 45%; very low certainty). iNO may increase the need for RRT (RR, 1.56; 95% CI, 1.17–2.08; I2 = 0%; low certainty). No clear differences were observed in other secondary outcomes. No study reported data on reintubation.ConclusionsAlthough iNO may improve oxygenation slightly, it may not confer survival or other patient-centered benefits and may increase the need for RRT. High-quality randomized evidence is needed to guide the optimal patient selection for this therapeutic option.Trial registrationPROSPERO (registration number: CRD42024573383).Supplementary InformationThe online version contains supplementary material available at 10.1186/s40560-025-00845-4.

The cause of perimesencephalic subarachnoid hemorrhage (pmSAH) is unclear but has historically been attributed to a venous source. The authors hypothesized that high-resolution cone-beam CT (CBCT) during angiography could better identify pmSAH etiology. All patients with pmSAH treated at the authors' institution between January 2023 and December 2024 were retrospectively analyzed. Patients were excluded if CBCT was not performed as part of the digital subtraction angiography (DSA), if CBCT source data were not available for review, or if the images were deemed to be low quality. All images were reviewed by 2 neuroangiographers with extensive neurovascular imaging experience and discussed until consensus agreement. Data were recorded as counts and percentages. Among 152 patients who presented with spontaneous SAH in 2023-2024, 22 had a pmSAH defined according to the Rinkel criteria. These 22 patients had a catheter angiogram performed on 1 of 2 biplane machines. Thirteen of those patients had high-quality CBCT data available for review, 8 (61%) of whom were found to harbor a basilar perforator focal outpouching consistent with a site of rupture. All patients with pmSAH, including the 8 found to have a basilar perforator aneurysm, achieved an excellent neurological recovery with resolution of the basilar perforator finding on follow-up DSA with CBCT and without experiencing a re-rupture event or clinically significant vasospasm. In the setting of pmSAH, high-resolution CBCT acquired as part of catheter angiography frequently identifies a basilar perforator pseudoaneurysm. Conservative management was associated with excellent outcomes in this series. The authors propose that in the setting of pmSAH, a high suspicion of an arterial etiology should be considered until proven otherwise.

Introduction: The addition of corticosteroids to selective nerve root block (SNRB) is widely practiced for lumbar radiculopathy, yet robust evidence regarding its efficacy for functional outcomes remains limited. We evaluated whether adding corticosteroids to local anesthetic in SNRB relieves functional disability and improves quality of life in patients with lumbar radiculopathy.