It is well known that aconitine-alkaloids is effective for treatment of rheumatoid arthritis (RA). However, the clinical use is limited in part because of its side effects. In this study we examined the therapeutic effects of newly processed “bushi” (Shujibushi) in which the contents of original forms of aconitines were reduced to aboid their undesirable effects. The effectiveness of the “Shujibushi” was recognized in 65.8% (45/67) for clinical and definite RA and in 80.7% (21/26) for probable RA. There were not any adverse side effects.
In order to obtain possible explanations for the high effectiveness of the “Shujibushi”, we analized ingredients of the “Shujibushi” in comparison with “Uzu” another type of aconitine-alkaloids medicine. The “Shujibushi” contained the significantly larger amounts of total alkaloids compared with “Uzu”. The satisfactory effectiveness of the “Shujibushi” might be brought on by the high content of total alkaloids which seem to be composed of aconitine-metabolites and its original forms.

In order to reduce the side effects of aconitine alkaloids, various types of processed Aconitine Tuber have been developed. We have been using 2 types of processed materials: the “Shujibushi” and the “Uzu” for the treatment of rheumatoid arthritis.
Original forms of aconitines (aconitine, hypaconitine and mesaconitine) and total alkaloids of these processed materials were analyzed. Hypaconitine content was 4.9 times larger in the “Uzu” than in the “Shujibushi”. In contrast, the content of total alkaloids was significantly larger in the “Shujibushi” than in the “Uzu”. Accordingly, the amount of total alkaloids eluted to the decoction was 1.3-1.8 times larger in the “Shujibushi” than in the “Uzu”.
Our data indicate that 1) The effectiveness of the processed Aconiti Tuber may depend on the contents of the total alkaloids as well as the original forms of aconitines; 2) Elution rates of total alkaloids to the decoction vary among the types of herb complex resulting in the difference of their clinical effectiveness and reduction of side effects.

A 76-year-old-woman, who had undergone endoscopic resection of a gastric polyp 2 years previously, had a cardiac tumor incidentaly pointed out on an abdominal ultrasonographic image. Echocardiography showed a solid round mass (34×25 mm in diameter), attached by a short stalk and which was floating on the right ventricular outflow tract and prolapsing over the pulmonary valve during systole. We suspected right ventricular myxoma. Urgent surgery was performed under cardiopulmonary bypass. After aortic clamping, the trunk of the pulmonary artery was opened near the right ventricule. The tumor was found under the pulmonary valve, attached to the anterior papillary muscle and chordae of the tricuspid valve. The tumor was completely excised with a piece of the papillary muscle and chordae. After right atriotomy, mild tricuspid regurgitation was seen on a water test. After we performed tricuspid annuloplasty and chordplasty with artificial chordae, a second water test did not show any tricuspid regurgitation. The postoperative course was uneventful, and she was discharged on the 13th postoperative day.

We evaluated the efficacy of evoked spinal potential (ESP) monitoring during thoracoabdominal aortic replacement to prevent intra-operative spinal ischemia. Nine patients underwent intraoperative ESP monitoring. The ESP was unchanged in 5 patients and decreased in 4 patients. However, ESP recovered in 2 of them by the following techniques: (1) perfusion of intercostal arteries, (2) elevation of distal bypass perfusion pressure, (3) slight hypothermia. Postoperative paraplegia occurred only 1 patient of the 2 whose ESP was not restored. The sensitivity and specificity of the efficacy of ESP monitoring were 100% and 87.5%, respectively. We concluded that ESP is the most useful monitoring for prevention of operative spinal ischemia during thoracoabdominal aortic replacement.

Since a skin infiltration of breast cancer may increase hemorrhage and malodorous exudates, it significantly reduces the quality of life. Local treatment is usually performed with zinc oxide starch, Mohs paste or its alternatives. However, the Mohs paste causes pain due to necrobiosis of normal tissues, while the topical therapy with zinc oxide starch ineffectively suppresses hemostasis and odor. We hereby report a case of an 86-year old woman with skin infiltration by breast cancer. The patient’s symptoms including bleeding, infection signs, odor, exudates, necrotic tissue objectively improved with Shiunko ointment, Zinc oxide starch, and Metronidazole (MNZ) combination therapy. The gauze was exchanged once a day and this treatment was simple and easy. The combination therapy with Shiunko ointment, Zinc oxide starch, and MNZ may become an effective new regimen for bleeding and odor from skin involvement in breast cancer.

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract, with increasing prevalence worldwide. IBD Ahead is an international educational program that aims to explore questions commonly raised by clinicians about various areas of IBD care and to consolidate available published evidence and expert opinion into a consensus for the optimization of IBD management. Given differences in the epidemiology, clinical and genetic characteristics, management, and prognosis of IBD between patients in Japan and the rest of the world, this statement was formulated as the result of literature reviews and discussions among Japanese experts as part of the IBD Ahead program to consolidate statements of factors for disease prognosis in IBD. Evidence levels were assigned to summary statements in the following categories: disease progression in CD and UC; surgery, hospitalization, intestinal failure, and permanent stoma in CD; acute severe UC; colectomy in UC; and colorectal carcinoma and dysplasia in IBD. The goal is that this statement can aid in the optimization of the treatment strategy for Japanese patients with IBD and help identify high-risk patients that require early intervention, to provide a better long-term prognosis in these patients.
Asian Continental Ancestry Group ; Colectomy ; Colitis, Ulcerative ; Colorectal Neoplasms ; Consensus ; Crohn Disease ; Disease Management* ; Disease Progression ; Early Intervention (Education) ; Epidemiology ; Expert Testimony ; Gastrointestinal Tract ; Hospitalization ; Humans ; Inflammatory Bowel Diseases* ; Japan* ; Prevalence ; Prognosis

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) was recently proposed as an alternative disease concept to nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the prognosis of patients with biopsy-confirmed MASLD using data from a multicenter study. Methods: This was a sub-analysis of the Clinical Outcome Nonalcoholic Fatty Liver Disease (CLIONE) study that included 1,398 patients with NAFLD. Liver biopsy specimens were pathologically diagnosed and histologically scored using the NASH Clinical Research Network system, the FLIP algorithm, and the SAF score. Patients who met at least one cardiometabolic criterion were diagnosed with MASLD. Results: Approximately 99% of cases (n=1,381) were classified as MASLD. Patients with no cardiometabolic risk (n=17) had a significantly lower BMI than patients with MASLD (20.9 kg/m2 vs. 28.0 kg/m2, P<0.001), in addition to significantly lower levels of inflammation, ballooning, NAFLD activity score, and fibrosis stage based on liver histology. These 17 patients had a median follow-up of 5.9 years, equivalent to 115 person-years, with no deaths, liver-related events, cardiovascular events, or extrahepatic cancers. The results showed that the prognosis for pure MASLD was similar to that for the original CLIONE cohort, with 47 deaths and one patient who underwent orthotopic liver transplantation. The leading cause of death was extrahepatic cancer (n=10), while the leading causes of liver-related death were liver failure (n=9), hepatocellular carcinoma (n=8), and cholangiocarcinoma (n=4). Conclusions Approximately 99% of NAFLD cases were considered MASLD based on the 2023 liver disease nomenclature. The NAFLD-only group, which is not encompassed by MASLD, had a relatively mild histopathologic severity and a favorable prognosis. Consequently, the prognosis of MASLD is similar to that previously reported for NAFLD.