Background/Aims: Despite the advent of advanced therapies, cases of so-called “difficult-to-treat” (D2T) ulcerative colitis (UC) persist. This study aims to clarify the epidemiological and clinical characteristics of patients with D2T UC. Methods: We conducted a nested case-control study using the Medical Data Vision Claims Database in patients with UC who began an advanced therapy (biologics, advanced small molecules, calcineurin inhibitors) from January 2018 through April 2023. D2T UC patients were defined as having 2 or more switches of advanced therapies, or as undergoing surgery for UC, within 2 years after the first advanced therapy. Results: Four hundred and one (16.7%) and 1,996 patients (83.3%) met the definitions of patients with D2T UC and non-D2T UC, respectively. After 1:1 matching by index year, 355 patients per group were included in the analysis. Multivariate logistic regression analyses, including sensitivity analyses based on follow-up period after the first advanced therapy, showed that a prescribed corticosteroid dose of ≥ 30 mg/day during the 6-month baseline period was associated with D2T UC. In D2T UC patients, median duration of the first advanced therapy was 99 days, and median number of advanced therapies per year was 1.7. The first advanced therapy was continued for 2 years in 78% of patients with non-D2T UC. Conclusions The proportion of D2T UC patients among UC patients starting advanced therapy was 16.7%. The factor most associated with D2T UC was the need for a corticosteroid dose ≥ 30 mg/day during the 6 months before initiation of advanced therapy.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.

The purpose of the present investigation was to examine the relationships between the exercise history and the bone mineral density (BMD) and bone mineral content (BMC) in female Japanese young adults using dual X-ray absorptiometry (DXA). One-hundred twenty females, aged between 18 to 28 years, participated in the present investigation. The BMD at the lumbar spine (L-BMD), whole body BMD and BMC (WB-BMD and WB-BMC), lean body mass (LBM) and fat mass (FM) were measured by DXA. Using a self-administrered questionnaire, the exercise habits during preschool (4-6 years), primary school (7-12 years), junior high school (13-15 years), high school (16-18 years), and the current habits (>18 years) were eveluated. The L-BMD, WB-BMD and WB-BMC were significantly higher in the subjects with exercise habits during both the period of <18 years and >18 years compared with those in the subjects without an exercise history during all periods (p<0.05). In a separate analysis with the data stratified by the school age, the subjects with an exercise history during primary school, junior high school, or high school had significantly higher BMD and BMC values compared with the non-exercisers (each, p<0.05). In contrast, the BMD and BMC did not differ significantly according to either the exercise history during pre-school nor the current exercise status. A multiple stepwise regression analysis revealed that the body weight, LBM, FM, age of menarche, and exercise habits during high school were significant determinants of the L-BMD, WB-BMD and WB-BMC (p<0.001). The results of the present investigation show that both the exercise history during school age and the current exercise habits affect the BMD and BMC in young adults. In particular, high school females should be encouraged to participate in the regular exercise to increase their bone health. Future studies will be needed to confirm the targeted age-group(s) for participation in sports/exercise for the improvement of bone health, including an analysis of the type and intensity of exercise/sports.

The purpose of this study was to verify the concept of Kampo medicine epidemiologically and demonstrate the objective bases of the Kampo treatment. For this purpose, a population based survey of subjective symptoms based on Kampo medicine was conducted among 1,486 residents of Hase village, Nagano prefecture, ages 20 and older. The completion rate was 80.7% and 1,199 residents provided favorable responses. An investigation of gender differences showed a higher rate of blood deficiency among female residents, while spleen and qi deficiency were more common in males. Considering age differences, symptoms related to blood deficiency and water-dampness affected younger females, symptoms related to qi deficiency primarily affected younger males, and symptoms of liver afflictions were common in younger both genders. Among the elderly residents, symptoms of kidney deficiency were overwhelmingly predominant in both genders. Though younger people with subjective sense of health had few diseases in western medicine, most of the elderly with perceived health actually had some kind of diseases for medical treatment. Physical symptoms in the chest area such as shortness of breath correlated positively with the perception not to be healthy, and these may be regarded as both the manifestation and factors contributing to ill health. Approximately 1 out of 12 residents reported currently receiving the treatment of oriental medicine or demonstrated the potential to benefit from such intervention. These results may clinically be useful as the objective bases to perform the Kampo treatment.