We report the case of a 76-year-old man who developed type IA endoleak through the fenestration after 1-debranch TEVAR using a Najuta endograft. The patient was admitted with expansion of the aneurysm after TEVAR, for additional therapy. Type IA endoleak through a fenestration has remained a significant clinical concern and its treatment is challenging. We performed Zone 0 TEVAR using the “Squid-Capture” technique assisted in situ stent-graft fenestration. Cerebral vessels were perfused by a percutaneous cardiopulmonary support system during in situ stent-graft fenestration, and the cerebral branch was clamped at the proximal site. It is difficult to operate the catheter inside the endoskeleton structure of a Najuta endograft, but several innovations were effective. Test dilation of the balloon catheter was performed to ensure that the wire did not interfere with the endoskeleton. Avoiding interference with the endoskeleton is important. The Squid-Capture technique allows safe and secure puncture of the graft. The operation was completed successfully. After this procedure, the endoleak disappeared. It is considered to be a useful method for treatment of endoleak through the fenestration.

Background/Aims: Gastric acid secretion is suspected to be a pivotal contributor to the pathogenesis of functional dyspepsia. The present study investigates the potential association of the gastric acid secretion estimated by measuring serum pepsinogen with therapeutic responsiveness to the prokinetic drug acotiamide. Methods: Dyspeptic patients consulting participating clinics from October 2017 to March 2019 were prospectively enrolled in the study. The dyspeptic symptoms were classified into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Gastric acid secretion levels were estimated by the Helicobacter pylori infection status and serum pepsinogen using established criteria and classified into hypo-, normo-, and hyper-secretion. Each patient was then administered 100 mg acotiamide thrice daily for 4 weeks, and the response rate to the treatment was evaluated using the overall treatment efficacy scale. Results: Of the 86 enrolled patients, 56 (65.1%) and 26 (30.2%) were classified into PDS and EPS, respectively. The estimated gastric acid secretion was not significantly different between PDS and EPS. The response rates were 66.0% for PDS and 73.1% for EPS, showing no significant difference. While the response rates were stable, ranging from 61.0% to 75.0% regardless of the estimated gastric acid secretion level among subjects with PDF, the rates were significantly lower in hyper-secretors than in non-hyper-secretors among subjects with EPS (42.0% vs 83.0%, P = 0.046). Conclusion Although acotiamide is effective for treating EPS as well as PDS overall, the efficacy is somewhat limited in EPS with gastric acid hypersecretion, with gastric acid suppressants, such as proton pump inhibitors, being more suitable.

Background/Aims: The safety and effectiveness of adalimumab was demonstrated in a phase 3 trial in Japanese patients with intestinal Behçet’s disease. The aim of this study was to evaluate the long-term safety and effectiveness of adalimumab in Japanese patients with intestinal Behçet’s disease. Methods: This prospective, all-case, post-marketing study was conducted at 254 centers in Japanese patients with intestinal Behçet’s disease receiving adalimumab. The primary endpoint was incidence of adverse drug reactions. Effectiveness endpoints included global improvement rating and change in C-reactive protein levels. Results: Of the 473 registered patients, 462 and 383 included in the safety and effectiveness populations were administered adalimumab for a mean of 515.3 and 579.5 days, respectively. Overall, 395 patients (85.5%) received adalimumab at the recommended dose. Adverse drug reactions and serious adverse drug reactions were reported in 120 (25.97%) and 51 (11.04%) patients, respectively. The incidence of adverse drug reactions was significantly higher in patients with comorbidities (P< 0.0001), patients taking concomitant oral corticosteroids (P< 0.0001), and those not self-administering adalimumab (P= 0.0257). At study end, global improvement rating was “effective” (n = 156, 40.7%) or “markedly effective” (n = 168, 43.9%) in 324 patients (overall effective, 84.6%). Mean C-reactive protein levels (mg/dL) decreased from 1.96 at baseline (n = 324) to 0.58 at week 24 (n = 208) and 0.25 at week 156 (n = 37). Conclusions This large real-world study confirmed the long-term safety and effectiveness of adalimumab in patients with intestinal Behçet’s disease. No new safety concerns were identified. (Clinical trial registration number: NCT01960790)

Background/Aims: The safety and effectiveness of adalimumab was demonstrated in a phase 3 trial in Japanese patients with intestinal Behçet’s disease. The aim of this study was to evaluate the long-term safety and effectiveness of adalimumab in Japanese patients with intestinal Behçet’s disease. Methods: This prospective, all-case, post-marketing study was conducted at 254 centers in Japanese patients with intestinal Behçet’s disease receiving adalimumab. The primary endpoint was incidence of adverse drug reactions. Effectiveness endpoints included global improvement rating and change in C-reactive protein levels. Results: Of the 473 registered patients, 462 and 383 included in the safety and effectiveness populations were administered adalimumab for a mean of 515.3 and 579.5 days, respectively. Overall, 395 patients (85.5%) received adalimumab at the recommended dose. Adverse drug reactions and serious adverse drug reactions were reported in 120 (25.97%) and 51 (11.04%) patients, respectively. The incidence of adverse drug reactions was significantly higher in patients with comorbidities (P< 0.0001), patients taking concomitant oral corticosteroids (P< 0.0001), and those not self-administering adalimumab (P= 0.0257). At study end, global improvement rating was “effective” (n = 156, 40.7%) or “markedly effective” (n = 168, 43.9%) in 324 patients (overall effective, 84.6%). Mean C-reactive protein levels (mg/dL) decreased from 1.96 at baseline (n = 324) to 0.58 at week 24 (n = 208) and 0.25 at week 156 (n = 37). Conclusions This large real-world study confirmed the long-term safety and effectiveness of adalimumab in patients with intestinal Behçet’s disease. No new safety concerns were identified. (Clinical trial registration number: NCT01960790)

With the cooperation of Kurobe City, we conducted a basic survey using the nine classification of constitution and an intervention survey using a constitutional guidance program. The basic survey was conducted by the Kurobe group (Kurobe River alluvial fan spring water drinker n=155, 60.6±10.4 years old) and the non-Kurobe group (normal tap water drinker n=99, 50.7±12.8 living in the Hokuriku region without Kurobe City). A total of three surveys were conducted using the constitution Questionnaire (CCMQ-J). As a result, the Gentleness type, which is usually called the healthy constitution, was clearly higher in the Kurobe group, with 44.6 % in the Kurobe group and 22.5 % in the non-Kurobe group. In the proportion of each biased constitution(Mibyo constitution), the Kurobe group had less Wet-heat type (4.5 % vs 11.8 %), Qi-depression type (5.4 % vs 10.7 %), Yin-deficiency type (7.1 % vs 12.3 %) , and Phlegm-wetness type (5.8 % vs 9.6 %) than the non-Kurobe group. After the basic survey was completed, the Kurobe group was randomly divided into two groups, an intervention group (n=65, 62.3±9.3 years old) and a non-intervention group (n=68, 62.7±9.8 years old), and compared with the non-Kurobe group (control group) (n=80, 51.9±13.6 years old). The survey design was a simple comparative study, and the primary endpoint was a comparative study of changes in constitutional scores before and after intervention. As a result, in the Yang-deficiency type, a significant difference was observed between the intervention group, the non-intervention group and the control group at the first time after the intervention (One-way ANOVA p=0.04). No change was seen in the second survey after the intervention. In the comparison of Phlegm-wetness type between the three groups, there was a tendency in the amount of change in the constitutional score (One-way ANOVA p=0.087). From the above, it was suggested that the constitutional survey can not only grasp the health and the pre-symptomatic state, but also improve the pre-symptomatic by combining the guidance methods according to the constitution.

We evaluated the effect of Coix-seed Reactive Derivatives (CRD) on cold sensitivity of female hands and feet. Ninety females were assigned randomly to 3 groups and CRD(2g/day, 4g/day or placebo) was administrated for 8weeks. Significant improvement of cold sensitivity was observed in both the 2g/day and 4g/day groups. It was speculated that a naringenin and a quercetin as active ingredients of adlay hull may play a critical role in ameliorating effect on blood flow.

To clarify the functions of Coix-seed Reactive Derivatives(CRD), we observed 2 cases of plantar keratosis (case 1. 34 years of age, female/ case 2. 29 years of age, female) successfully cured by intake of CRD for several months. Although CRD intake seemed to be effective in these cases, further studies are needed to define the optimal dose and duration.

To clarify the functions of Coix-seed Reactive Derivatives(CRD), we observed 3 cases of refractory atopic dermatitis(case 1. 25 years of age, male/ case 2. 40 years of age, female/ case 3. 5 years of age, male) successfully cured by intake of CRD. Although CRD intake seemed to be effective in all cases, further studies are needed to define the optimal dose and duration.

To clarify the functions of Coix-seed Reactive Derivatives(CRD), we observed 2 cases of plantar wart (case 1. 8 years of age, female/ case 2. 26 years of age, female) successfully cured by intake of CRD for several months. Although CRD intake seemed to be effective in these cases, further studies are needed to define the optimal dose and duration.