The purpose of this 3-year retrospective study was to determine the efficacy and economic benefit of boiogito when administered concurrently with methotrexate (MTX) in patients with rheumatoid arthritis (RA). One hundred twenty-six patients who were treated at Ohno Clinic between May 2006 and November 2011 with either the MTX-boiogito combination (n = 59) or MTX alone (n = 67) were identified for the study. Eligible patients were selected on the basis of the 1987 American College of Rheumatology (ACR) criteria and their disease activity, while their remission rates and treatment outcomes were evaluated using the Disease Activity Score 28 Erythrocyte Sedimentation Rate (DAS 28-ESR). A total of 93 patients (MTX-boiogito group,n = 45 ; MTX alone group, n = 48) were included in the statistical analysis after excluding those who prematurely withdrew from the study due to adverse events or conditions that required treatment with biological agents.
Our results showed that the MTX-boiogito group had significantly lower disease activity (p = 0.0372),higher rates of remission (p = 0.0093), and greater improvement in overall DAS 28-ESR score (p = 0.0050) when compared to the MTX alone group. With the combination therapy group, fewer patients needed to add further disease-modifying anti-rheumatic drugs (DMARDs), and the total cost of medications over the 3 years was lower (2,145,470 JPY vs 2,301,690 JPY) with a resultant savings of 156,220 JPY per person. In conclusion, the use of boiogito 7.5 g/day represents a clinically and economically important addition to MTX therapy for the treatment of RA.

We experienced a case of polymyalgia rheumatica (PMR) which responded to Kampo medicine. A 53-year-old female patient first complained of stiffness and pain in the neck. Myalgia was severe and gradually eypanded to both shoulders and both upper extremities. Body weight decreased, and the erythrocyte sedimentation rate (ESR) was greater than 100mm/hour. Because her condition tended to improve when treated with prednisolone 10mg/day, she was diagnosed as having PMR. Her condition was well controlled until the dose of prednisolone decreased. Myalgia then recurred, and the ESR increased to 83mm/hour. The patient visited our outpatient department for treatment with Kampo therapy. Two months after treatment with Sairei-to plus Yokuinin-to, all signs and symptoms disappeared other than the stiff neck. Her body weight showed a tendency to increase. Six months after she first visited us, prednisolone was decreased and then stopped. Her condition still remains well controlled with this Kampo therapy alone. She has no clinical signs and symptoms, and the ESR has improved to 16mm/hour.

In 1984 a 42-year-old female complaining of general malaise and loss of strength in the proximal muscles of the limbs came to the 2nd Department of Internal Medicine for an examination. From her high CPK value, electromyogram, muscle biopsy, etc., she was diagnosed as having polymyositis. Initially she responded well to steroids, but a year later the condition recurred. Treatment with various methods such as the immunosuppressants methotrexate and azathioprine, steroid pulse therapy and plasma replacement were tried without success. In September 1991, the patient's CPK value remained abnormal at about 800mU/ml. According to the Oriental Medical viewpoint, the condition was diagnosed as Kidney yin Deficiency. Rokumi-gan was therefore administered daily (7.5g/day) for a period of 80 days. The CPK value was brought down to the vicinity of 200mU/ml, and the feeling of general malaise and lack of strength in the proximal muscles of the limbs was improved. However, due to the persistence of edema in the lower limbs, the Kampo formula was changed from Rokumigan to Chorei-to, also administered at a dosage of 7.5g/day. This reduced the edema and normalized the CPK value to the 100mU/ml range. During this period, steroid administration was maintained with prednisolone (30mg/day). At present, with the improvement in the CPK value, steroid administration is gradually being reduced.

Twenty-two patients with chronic glomerulonephritis were treated with Sairei-to (7.5g/day), either alone or in combination with camostat mesilate (600mg/day), to determine the efficacy and adverse effects of these regimens. Although there was significant improvement in proteinuria (p<0.05) after 8 weeks of treatment with Sairei-to alone, this was not longlasting. Combination therapy resulted in sustained significant improvement (p<0.03; there were two dropouts). No adverse effects were seen with either regimen. The results suggest that combination therapy using Sairei-to and camostat mesilate may be a safe and efficacious method of treatment for patients with chronic glomerulonephritis.

It is known that the prognosis of preductal type coarctation of the aorta is poor because cardiac malformation is frequent in these cases. There have been very few reports on adult cases of the coarctation. We have recently carried out aneurysmectomy and reconstructed the descending aorta by a 30mm Veri-Soft tube graft for one adult case of descending aortic aneurysm associated with coarctation of the aorta. The patient was 49-year-old female. Segmental stenosis 5cm in length was demonstrated in the thoracic descending aorta immediately below the bifurcation of the left subclavian artery. The poststenotic dilatation was shown at the distal portion of the segmental stenosis. The postoperative clinical course was uneventful.

Background/Aims: High-grade pancreatic intraepithelial neoplasia and invasive pancreatic duc-tal adenocarcinoma ≤10 mm are targets for early detection of pancreatic cancer. However, their imaging characteristics are unknown. We aimed to identify endoscopic ultrasound findings for the detection of these lesions. Methods: Patients diagnosed with high-grade pancreatic intraepithelial neoplasia (n=29), pan-creatic ductal adenocarcinoma ≤10 mm (n=11) (who underwent surgical resection), or benignmain pancreatic duct stenosis (n=20) between January 2014 and January 2021 were retrospectively included. Six features differentiating these lesions were examined by endoscopic ultraso-nography: main pancreatic duct stenosis, upstream main pancreatic duct dilation, hypoechoic areas surrounding the main pancreatic duct irregularities (mottled areas without demarcation or round areas with demarcation), branch duct dilation, prominent lobular segmentation, and atrophy. Interobserver agreement was assessed by two independent observers. Results: Hypoechoic areas surrounding the main pancreatic duct irregularities were observedmore frequently in high-grade pancreatic intraepithelial neoplasia (82.8%) and pancreatic ductal adenocarcinoma ≤10 mm (90.9%) than in benign stenosis (15.0%) (p<0.001). High-grade pan-creatic intraepithelial neoplasia exhibited mottled hypoechoic areas more frequently (79.3% vs 18.9%, p<0.001), and round hypoechoic areas less frequently (3.4% vs 72.7%, p<0.001), than pancreatic ductal adenocarcinoma ≤10 mm. The sensitivity and specificity of hypoechoic areas for differentiating high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarci-noma ≤10 mm, and benign stenosis were both 85.0%, with moderate interobserver agreement. Conclusions The hypoechoic areas surrounding main pancreatic duct irregularities on endo-scopic ultrasound may differentiate between high-grade pancreatic intraepithelial neoplasia, pan-creatic ductal adenocarcinoma ≤10 mm, and benign stenosis (Trial Registration: UMIN Clinical Trials Registry (UMIN000044789).

An amendment to this paper has been published and can be accessed via the original article.

BACKGROUND: The living arrangement has been suggested as an important factor affecting health. Recent studies have also suggested that there was a risk among elderly persons who were not alone. This study examined whether the detailed living arrangement was associated with a future decline in functional capacity in the elderly, by gender, in a Japanese suburban city. METHODS: A 3-year longitudinal questionnaire survey (baseline: 2011; follow-up: 2014) for aged 65 years or older was conducted in Kurihara city, Japan. Of the respondents in the baseline survey, we analyzed those who scored 13 points (a perfect score which indicates the highest functional capacity; n = 2627) on the Tokyo Metropolitan Institute of Gerontology Index of Competence at the baseline. The exposure was living arrangement at baseline, divided into five categories: "with spouse only," "living alone," "with child and his/her spouse," "with child without his/her spouse," and "with other family/person." The outcome was the decline in functional capacity at the follow-up survey (score decreased to 10 points or less from 13 points). RESULTS: Of the 2627 analyzed population, 1199 (45.6%) were men. The incidence of the decline was 5.8% in men and 5.9% in women. Multivariable logistic regression analyses adjusted for age, educational attainment, and health behavior and condition revealed that in women, the odds ratio of the decline was higher in living with child and his/her spouse (2.41, 95% confidence interval; 1.10-5.28) referring to living with spouse only. When adjusting activities inside and outside the home such as housework additionally, the association was attenuated to marginal significance (2.25, 0.98-5.18). No statistical significance was observed in men. CONCLUSIONS These results suggested that living with child and spouse of a child was associated with the future decline in women's functional capacity.
Activities of Daily Living ; Aged ; Aged, 80 and over ; Female ; Geriatric Assessment ; Humans ; Independent Living ; statistics & numerical data ; Japan ; Longitudinal Studies ; Male ; Self Report