Oida Hospital

5-Aminolevulinic acid (5-ALA) reportedly improves overactive bladder (OAB) symptoms by reducing reactive oxygen species derived from vascular endothelial cells to protect vascular function and enhance bladder blood flow and by inhibiting bladder C-fiber activity. This double-blind, randomized controlled trial aimed to evaluate the efficacy and safety of 5-ALA in participants with OAB. This randomized, prospective study classified the participants into the 5-ALA and placebo groups. The 5-ALA group received oral 5-ALA phosphate at 150mg/day for 12weeks. The efficacy of 5-ALA was determined by assessing the changes in the Overactive Bladder Symptom Score (OABSS) and the Overactive Bladder Questionnaire Short Form from baseline to weeks 4 and 12 after treatment initiation, as well as the post-void residual urine volume. Regarding safety, we evaluated participants' blood pressure and adverse events. This study enrolled and randomized 49 participants, with 23 in the 5-ALA group and 26 in the placebo group. Ultimately, 47 participants completed the study (21 and 26 in the 5-ALA and placebo groups, respectively). From baseline to week 12, OABSS significantly decreased from 8.81 to 6.52 (- 2.29) in the 5-ALA group and from 8.54 to 6.35 (- 2.35) in the placebo group (both: p = 0.008). However, no significant difference was noted between the two groups at week 12 (p = 0.956). Using a mixed model for repeated measures with a random intercept, the model-adjusted between-group difference in the change from baseline to week 12 in the OABSS between the 5-ALA and placebo groups was 0.06 points (95% confidence interval, - 1.63 to 1.75; p = 0.944). This study found no significant improvement in OAB symptoms with 5-ALA administration. Nevertheless, given that no previous double-blind, randomized controlled trial has assessed 5-ALA's efficacy in patients with OAB, this study holds important value as a pilot study. This study was prospectively registered in the Japan Registry of Clinical Trials (jRCT); registration number: jRCTs061220050; registration date: [August 29, 2022].

ABSTRACTBackgroundThe long‐term prognosis of patients with heart failure (HF) remains poor. Most patients with HF are older, and multiple factors involved in geriatric syndromes are associated with worse long‐term prognosis. Sarcopenia is a major component of geriatric syndrome. Early diagnosis and therapeutic intervention for sarcopenia are clinically important in patients with HF; however, the prevalence and long‐term prognostic impact of sarcopenia in patients with stage B HF remain unclear. This study aimed to determine the prevalence of sarcopenia in older patients with stage B HF and its impact on the long‐term prognosis.MethodsThe PAPRIKA‐HF study was a multicenter, prospective study that enrolled outpatients ≥ 65 years who were diagnosed with stage B HF. Sarcopenia was assessed based on the Asian Working Group for Sarcopenia 2019 diagnostic criteria. The primary endpoint was a composite endpoint (all‐cause mortality, incident myocardial infarction, or hospitalization for heart failure) of > 2 years.ResultsAmong 312 patients (mean age: 78.2 ± 6.5 years, 45% female), 17.7% (56 of 312 patients) had sarcopenia. The rate of the composite endpoint over 2 years was significantly higher in patients with sarcopenia than in those without (25.0% vs. 2.7%, log‐rank test, p < 0.0001). Multivariate analysis using the Cox proportional hazards model showed that sarcopenia was an independent predictor of long‐term prognosis (hazard ratio: 5.78, 95% confidence interval: 2.16–15.43, p < 0.001).ConclusionsSarcopenia was associated with a worse long‐term prognosis in older patients with stage B HF, highlighting the importance of early diagnosis of sarcopenia.

Homozygosity for the PNPLA3 risk allele is linked to liver fat accumulation. In phase 1 trials, JNJ-75220795, a hepatocyte-targeted GalNAc-conjugated PNPLA3 siRNA, reduced liver fat in PNPLA3 I148M homozygous patients with metabolic dysfunction–associated fatty liver disease.

pois a Psicanálise não se ocupa de dados quantitativos.

Background:In recent years, sodium-glucose cotransporter 2 (sGLT2) inhibitors, a new treatment for diabetes mellitus (DM), are associated with an increased risk of urinary tract infections, particularly in older patients and women[1]. While 20% of patients with rheumatoid arthritis (RA) also require DM treatment[2], the impact of infection risk concerns on their treatment choices, especially in the context of risk, including glucocorticoids (GCs) and immunosuppressive drugs, remains unclear.Objectives:To analyze the transition in DM treatment among Japanese patients with RA complicated since the launch of sGLT2 inhibitors, utilizing an administrative claims database.Methods:Our study had a cross-sectional design and used data from the Medical Data Vision (MDV) hospital database (2015–2023). Patients were included if they had: 1) one or more claims for RA (ICD-10 code M05, 06) with prescribed disease-modifying anti-rheumatic drugs (DMARDs); 2) one or more claims for DM (ICD-10 code E11, 12, 13, 14 and N18) with prescribed anti-diabetic agents. Patients treated with insulin or diagnosed with type 1 DM were excluded. Data from January through March of each year (2015-2023) was used to assess annual patient characteristics (age, sex) and medication usage for RA and DM.Results:Of the 534,189 patients with one or more claims for RA, 5766 patients met inclusion criteria in 2023. In 2023, the median age of the enrolled patients in 2023 was 74 years (interquartile range [IQR], 67-80), with 59% (3394 patients) being female. The most commonly used antidiabetic agents were dipeptidyl peptidase 4 (DPP4) inhibitors (37%), biguanide (21%), and sGLT2 inhibitors (20%). The use of sGLT2 inhibitors increased (from 0.3% in 2015 to 20% in 2023), while the use of DPP4 inhibitors and sulfonylureas decreased (DPP4 inhibitors from 41% in 2015 to 37% in 2023; sulfonylurea from 16% in 2015 to 5% over the same period) (Figure 1).DDP4 inhibitors was used more frequently in patients with glucocorticoids (GCs) compared to those without (40% in the patients with GCs and 34% in those without), while sGLT2 inhibitors was used less frequently (19% in the patients with GCs and 21% in those without) (Figure 2).Conclusion:The increasing use of sGLT2 inhibitors in RA patients with DM highlights a need for further evaluation of their safety.REFERENCES:[1] Lin Y-H, Lin C-H, Huang Y-Y, et al. Risk factors of first and recurrent genitourinary tract infection in patients with type 2 diabetes treated with SGLT2 inhibitors: A retrospective cohort study. Diabetes Res Clin Pract 2022;186:109816.[2] Albrecht K, Luque Ramos A, Hoffmann F, et al. High prevalence of diabetes in patients with rheumatoid arthritis: results from a questionnaire survey linked to claims data. Rheumatology 2018;57:329–36.Figure 1.Figure 2.Acknowledgements:NIL.Disclosure of Interests:None declared.

We report a rare case of a patient experiencing pain and dysfunction attributable to bone fragments from a trauma sustained over two decades prior. A 43-year-old Japanese woman presented with persistent left shoulder pain. Initial radiographs revealed glenohumeral joint osteoarthritis, an unusual finding for her age. Her medical history included a previously overlooked traumatic dislocation of the left acromioclavicular joint over 20 years ago. Computed tomography scans later uncovered bone fragments below the coracoid process without signs of scapular or tuberosity fractures. The fragments were arthroscopically removed, resulting in significant pain relief. The patient's Shoulder Pain and Disability Index score improved from 60 to 9 at the six-month postoperative follow-up. This case underscores the importance of considering historical trauma in patients presenting with atypical shoulder pain and highlights the potential diagnostic value of revisiting a patient's medical history when unusual lesions are discovered.

In this review, we focused on four topics, namely, minimally invasive esophagectomy (MIE), robot-assisted minimally invasive esophagectomy (RAMIE), conversion and salvage surgery, and neoadjuvant and adjuvant therapy, based on notable reports published in the years 2020 and 2021. It seems that while the short-term outcomes of minimally invasive Ivor Lewis esophagectomy (MIE-IL) were better than those of open Ivor Lewis esophagectomy (OE-IL), there were no significant differences in the long-term outcomes between MIE-IL and OE-IL. Similarly, the short-term outcomes of minimally invasive McKeown esophagectomy (MIE-MK) were better than those of open McKeown esophagectomy (OE-MK), while there were no significant differences in the long-term outcomes between MIE-MK and OE-MK. Furthermore, the short-term outcomes of robot-assisted minimally invasive Ivor Lewis esophagectomy (RAMIE-IL) were superior to those of completely minimally invasive Ivor Lewis esophagectomy (CMIE-IL). On the other hand, there were advantages and disadvantages in relation to the short-term outcomes of robot-assisted minimally invasive McKeown esophagectomy (RAMIE-MK) as compared with completely minimally invasive McKeown esophagectomy (CMIE-MK). However, there were no significant differences in the long-term outcomes between RAMIE-MK and CMIE-MK. Further research is needed to evaluate of short-term and long-term outcomes of transmediastinal esophagectomy with and without robotic assistance. Both induction chemotherapy and induction chemoradiotherapy appear to be promising to secure a higher rate of conversion surgery. Neoadjuvant chemoimmunotherapy and chemoimmunoradiotherapy have shown promising results and are expected as new powerful therapies.

Table S1. Chouinard research diagnostic Criteria for supersensitivity psychosis. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

AimsThe aim of this study was to investigate clinical characteristics of frail patients based on a comprehensive frailty assessment in patients hospitalized for acute decompensated heart failure (HF) (ADHF) in super‐aged regional Japanese cohort.Methods and resultsWe established the Kochi Registry of Subjects with Acute Decompensated Heart Failure (Kochi YOSACOI) study, which was a prospective multicentre community‐based cohort study in six participating hospitals in Kochi Prefecture, Japan. We enrolled 1061 patients (median age, 81 years; 50.0% men) hospitalized for ADHF between June 2017 and December 2019 in this registry. Patients were classified into the three groups by the severity of frailty using the Kihon Checklist: we identified frailty in 510 patients (53.7%), prefrailty in 293 patients (30.9%), and non‐frailty in 146 patients (15.4%). Compared with prefrail and non‐frail patients, frail patients were older (84 years interquartile range [IQR, 77–88] vs. 79 years [IQR, 69–86] and 72 years [IQR 65–81], P < 0.001) and more often had prior HF hospitalization (29.6% vs. 21.8% and 16.4%, P < 0.05), chronic kidney disease (81.6% vs. 71.7% and 61.0%, P < 0.01), anaemia (75.3% vs. 61.4% and 50.0%, P < 0.001), cerebrovascular accident (19.0% vs. 9.9% and 4.1%, P < 0.01). The proportion of patients with three or more comorbidities was larger in the frailty group than in the other groups (78.0% vs. 67.2% and 63.0%, P < 0.01). The frequency of functional decline in all domains increased with frailty status. Approximately 70% of frail patients were identified as functional decline in physical function and socialization domains. Fifty to sixty per cent of frail patients had functional decline in instrumental activities of daily living, cognitive function, and depression domains. The percentage of worsening walking ability during hospitalization was increasing with the frailty status (frailty, 27.5%; prefrailty, 21.8%; non‐frailty, 8.9%). In multivariate logistic regression analysis, frailty was associated with age [odds ratio (OR) 1.031, 95% confidence interval (CI) 1.011–1.052, P = 0.003], prior HF hospitalization (OR 1.789, 95% CI 1.165–2.764, P = 0.008), brain natriuretic peptide level at discharge (OR 1.001, 95% CI 1.000–1.001, P = 0.020) and prior cerebrovascular accident (OR 2.549, 95% CI 1.484–4.501, P < 0.001).ConclusionsMore than half of patients with ADHF were frail and had functional decline across multiple domains, not only physical function domain. The Kihon Checklist provided useful and valuable information for easily identifying frail patients and comprehensive management of HF.