Short-term efficacy of potassium-competitive acid blocker following gastric endoscopic submucosal dissection: a propensity score analysis

Background: Endoscopic submucosal dissection (ESD) is a promising method for the resection of superficial gastric neoplasms. Vonoprazan is a novel potassium-competitive acid blocker (P-CAB) that is currently considered as a potential alternative to proton pump inhibitors (PPIs) for the treatment of acid-related diseases. However, the utility of vonoprazan in ESD-related ulcers is unclear. Therefore, we compared the short-term efficacies of vonoprazan and the PPI lansoprazole in ESD-related ulcer healing during the first two weeks following intervention.

Methods: This study included 115 superficial gastric neoplasms that were treated by ESD at Hiraka General Hospital between April 2015 and January 2017. Patients treated with P-CAB (20?mg vonoprazan, n?=?62) or PPI (30?mg lansoprazole, n?=?53) were compared using propensity-score matching analysis. Primary outcome was rate of ulcer reduction at two weeks after ESD. Secondary outcomes were coverage ratio of ulcer base by granulation tissue and incidence of postoperative bleeding.

Results: The rate of ulcer reduction was significantly higher (median [range], 80.6% [67.6%–94.5%] vs. 62.7% [33.4%–85.2%]; p?P?Conclusions: P-CAB achieved rapid artificial ulcer healing with promotion of granulation tissue formation. However, conventional PPI with initial intravenous infusion might be sufficient for prevention of postoperative bleeding following gastric ESD.     

Intensive In-Hospital Rehabilitation After Hip Fracture Surgery and Activities of Daily Living in Patients With Dementia: Retrospective Analysis of a Nationwide Inpatient Database

ObjectivesTo examine the effects of earlier, more frequent, and larger daily amounts of postoperative rehabilitation on activities of daily living (ADL) after hip fracture surgery in patients with dementia.DesignRetrospective cohort study.SettingA total of 1053 acute-care hospitals.ParticipantsPatients aged ≥65 years with dementia at admission underwent hip fracture surgery and received postoperative rehabilitation from April 1, 2014 to March 31, 2016 (N=43,206).InterventionsThree rehabilitation variables as key independent variables: (1) the interval from surgery to starting rehabilitation (days); (2) the frequency of postoperative rehabilitation (days per week); and (3) the average daily units of postoperative rehabilitation (minutes per daily rehabilitation).Main Outcome MeasureADLs based on the Barthel Index (BI) at discharge from acute-care hospitals.ResultsIn the multivariable linear regression analysis, delayed rehabilitation was significantly associated with a lower BI at discharge (for each day of the interval increase, BI at discharge was 0.38 lower; 95% confidence interval [CI], 0.21-0.54), and a significant increase in the BI at discharge was observed in patients who underwent more frequent rehabilitation (BI [95% CI] was 2.62 [0.99-4.25], 5.83 [4.28-7.38], 7.56 [5.95-9.16], and 9.16 [7.34-10.97] higher for frequencies of 3.1-4.0, 4.1-5.0, 5.1-6.0, and >6.0 days per week, respectively) and larger daily amounts of rehabilitation (4.37 [3.69-5.06] and 6.60 [5.63-7.57] higher for 40-59 and ≥60 minutes per day, respectively).ConclusionsThese results suggest that earlier, more frequent, and larger daily amounts of postoperative rehabilitation in acute-care hospitals are independently associated with better recovery in ADL at discharge from acute-care hospitals after hip fracture surgery in patients with dementia.     

Morphological, genetic, and chemical polymorphism of Curcuma kwangsiensis

Previously, Chinese Gajutsu available in Japan was identified, from the chloroplast trnK gene sequence, to be the rhizomes of Curcuma phaeocaulis and two genotypes of C. kwangsiensis. Although we defined the two genotypes, the pl and gl types, on the basis of the nucleotide difference, their external features did not correspond to the two phenotypes described in the literature. In this paper, to investigate the relationship between genotype and phenotype of C. kwangsiensis, a field investigation was carried out in its main cultivation areas of Guangxi Zhuangzu Autonomous Region and Guangdong Province, China, and sequence analysis of the trnK gene and single-nucleotide polymorphism (SNP) analysis of the nuclear 18S rRNA gene were performed on the collected specimens. Four genotypes of C. kwangsiensis were recognized from the combined 18S rRNA gene–trnK gene sequences: homozygote-K(gl)Wtk type, homozygote-K(pl)Ztk type, heterozygote-K(gl)Wtk type, and heterozygote-Ltk type. Among the four genotypes, C. kwangsiensis in a field used for cultivation of Gajutsu was of heterozygote-K(gl)Wtk type. Formation of a heterozygote in the 18S rRNA gene might be a result of crossbreeding of C. kwangsiensis with several Curcuma species which had cytosine at nucleotide position 234. GC analysis of the rhizomes revealed that C. kwangsiensis was characterized by camphor and β-elemene, and by detecting additional components such as curdione and curcumenol Curcuma species involved in the formation of the heterozygote might be speculated upon.     

Coronary artery calcification detected by a mobile helical computed tomography unit and future cardiovascular death: 4-year follow-up of 6120 asymptomatic Japanese

In the present study, we performed a prospective follow-up study in a population which underwent chest computed tomography (CT) screening. A total of 6120 participants underwent a chest CT medical examination for lung cancer and tuberculosis in Nagano Prefecture, Japan, between 1996 and 1997. Computed tomography scanning was performed from the apex of the lung to the diaphragm at a tube voltage of 120kV and a tube current of 50mA. We measured the CT density of the coronary arteries in 5–7 slices where coronary arteries were detected. The CT density threshold for determining coronary artery calcification (CAC) was above +110 HU. In 2000, we investigated the number of deaths due to cardiac and noncardiac disease among the participants. Of the 6120 participants, 14 died of cardiac disease (9, myocardial infarction; 4, heart failure; and 1, angina pectoris) and 64 died of other diseases. Coronary artery calcification was detected in 10 of the patients who died of cardiac disease, and in 31 of those who died of other diseases. The prevalence of CAC was higher in the former than in the latter (71.4% vs 48.4%, P = 0.084). The relative risk of CAC for cardiac death was 2.66 (95% confidence interval: 0.76, 9.37). The findings of this study suggested that CAC detected in a mass chest CT screening by a mobile helical CT unit was predictive of future cardiovascular death.     

Sarcoidosis with high serum levels of vascular endothelial growth factor (VEGF), showing RS3PE-like symptoms in extremities

We report a patient with sarcoidosis who showed edema in the distal portion of all extremities, particularly the legs, as seen in remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Magnetic resonance imaging demonstrated diffuse abnormal intensity in subcutaneous tissues of both legs, and skin biopsy led to a diagnosis of sarcoidosis. Vascular endothelial growth factor (VEGF) showed a high serum level, which decreased soon after starting oral prednisolone, in parallel with an improvement in the limb edema. In this patient VEGF as well as infiltration by sarcoid granuloma in the skin might have played an important role in the pathogenesis of RS3PE-like symptoms in the extremities. When painful pitting edema is seen predominantly in the distal portion of all extremities, sarcoidosis as well as RS3PE should be considered as a possible diagnosis.Abbreviations ACE Angiotensin converting enzyme - RS3PE Remitting seronegative symmetrical synovitis with pitting edema - VEGF Vascular endothelial growth factor     

Low testosterone levels in diabetic men and animals: a possible role in testicular impotence

Poorly controlled NOD spontaneously diabetic mice were proven to have significantly less plasma and testicular testosterone than well-controlled diabetic mice (489 +/- 15 ng/dl and 3.89 +/- 0.79 micrograms/100 g tissue, vs. 176 +/- 24 and 9.00 +/- 1.24, respectively), and these in turn had significantly less than NOD non-diabetic control mice. These data were consistent with our previous observation of a decrease in total plasma and testicular testosterone levels in streptozotocin diabetic rats. A greater difference between total plasma testosterone levels and free testosterone levels was found in streptozotocin diabetic rats (17 +/- 4 ng/dl vs. 91 +/- 7 ng/dl) than in control rats (660 +/- 141 vs. 352 +/- 77). Fat droplets, depicting blocked testosterone synthesis, were found in the testicular Leydig cells of streptozotocin diabetic rats and disappeared with insulin treatment. No difference was found among plasma total testosterone concentrations in people in different stages of diabetes, as had been previously reported. However, human diabetic males, free of complications but poorly controlled, had less free testosterone than those without complications but well controlled (18.0 +/- 2.0 pg/ml vs. 22.8 +/- 1.3), who in turn had significantly less than age-matched controls (25.3 +/- 1.1 pg/ml). These data suggest gonadal dysfunction in diabetes mellitus.