Studies on a Medicinal Parasitic Plant: Lignans from the Stems of Cynomorium songaricum

Eight phenolic compounds including two new lignan glucopyranosides together with a known alkaloid were isolated from the stems of Cynomorium songaricum RUPR. (Cynomoriaceae). Their chemical structures were elucidated on the basis of spectral and chemical evidence. The chemotaxonomic significance of these metabolites is discussed

慢性関節リウマチ患者におけるWHO／QOLとその関連要因

慢性関節リウマチ患者58名を対象に世界保健機構開発のQOL調査票（WHO／QOL-26）を用いて，QOLとその関連要因について検討し，以下の結果を得た．　（1）今回の対象者の属性は，日本における慢性関節リウマチ患者のそれに類似するものであった．　（2）WHO／QOL-26はその下位次元の一つである社会関係と関連を示さなかった．　（3）WHO／QOL-26と有意に関連を示したのは，身体機能，痛み，手術経験の有無，同居者の有無の4要因であった．　以上より，社会関係は他の下位次元との交互作用を介してWHO／QOL-26に関連していると考えられる．また，身体面で痛みの軽減・寛解によって機能改善を図ること，及び生活面で同居者への気兼ねからむしろ同居者無しの方がQOLを高めることが示唆された．Rheumatoid arthritis has total or partial influence on the life situation of patients. A variety of outcome measures are used in evaluating disease activity, therapeutic efficacy, and the quality of life (QOL) in rheumatoid arthritis studies. This study was designed to explore QOL in patients with rheumatoid arthritis in Japan. Fifty-eight rheumatoid arthritis patients (9 male and 49 female, mean age 57.2±14.1) participated as subjects in this study and were interviewed using the World Health Organization\u27s QOL assessment instrument (WHO/QOL-26) by a single interviewer. In addition, simultaneous surveys were made using the Modified Health Assessment Questionnaire (MHAQ) for functional disability, the Visual Analogue Scale for pain (VAS), assessment of patients\u27 understanding of rheumatic disease, and appropriate questionnaires concerning social activities, social support, suffering in life, and demographic characteristics (i.e., age, sex, duration from onset, marital status, presence of other person(s)in household, other illness, having undergone arthritis-related operation(s), holding of physically disabled person\u27s certificate, having hobby(ies), engaged in occupation). Social relationship was the only dimension found not to be correlated with the WHO/QOL-26. Predictors of the overall WHO/QOL-26 were studied by means of multiple regression analysis, with 17 explanatory variables. The factors that had a direct impact on WHO/QOL-26 were MHAQ, VAS, presence of other person(s) in household, and having undergone arthritis-related operation(s). These four factors explained 29.3% of the total variance in WHO/QOL-26 scores. It was suggested by the results that the QOL in rheumatoid arthritis patients is affected especially by pain and by the presence of other person(s) in the household

Computed Tomography Perfusion Parameters Predictive of Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy in Patients With Cerebral Large Vessel Occlusion

Background Hemorrhagic transformation after recanalization is a severe complication in patients with a large ischemic core due to cerebral large vessel occlusion. Risk assessment using perfusion imaging to predict hemorrhagic infarction has not been established. Thus, we aimed to investigate the association between perfusion imaging findings and hemorrhagic transformation in patients with acute cerebral large vessel occlusion who had undergone preoperative perfusion imaging evaluation and mechanical thrombectomy. Methods We enrolled consecutive patients who received mechanical thrombectomy after undergoing perfusion imaging for anterior large vessel occlusion from May 2019 to March 2022. The patients in whom recanalization were not achieved and who experienced procedure‐related bleeding were excluded. We investigated the predictors of symptomatic intracranial hemorrhage (sICH) by exploring preoperative perfusion imaging parameters (relative cerebral blood flow, relative cerebral blood volume, time of maximum concentration, and hypoperfusion index ratio). Results Among the 167 patients (median age 79 years, 47% female) enrolled, 63 (38%) and 14 (8%) patients had any intracranial hemorrhage and sICH (sICH group), respectively. The sICH group had a shorter puncture‐recanalization time than the non‐sICH group (median [interquartile range (IQR)]; 43 [34–55] versus 61 [37–88]; P=0.046), whereas the modified Rankin scale at 90 days showed a worse prognosis (median [IQR]; 5 [5–6] versus 3 [1–4]; P<0.01). All perfusion imaging parameters were significantly predicting the sICH group in multiple logistic regression analysis. The value of relative cerebral blood volume was the parameter most strongly associated with sICH in receiver operating characteristic curve analysis (area under the curve=0.90, 95% CI [0.83–0.98]; cutoff 43 mL; sensitivity, 86 %; specificity, 87%). Conclusion Among perfusion computed tomography parameters, relative cerebral blood volume is highly associated with sICH after mechanical thrombectomy for cerebral large vessel occlusion. In patients with low relative cerebral blood volume regions, the indication of mechanical thrombectomy should be carefully considered for postoperative intracranial hemorrhage

Long-term safety and efficacy of alogliptin, a DPP-4 inhibitor, in patients with type 2 diabetes: a 3-year prospective, controlled, observational study (J-BRAND Registry)

Introduction Given an increasing use of dipeptidyl peptidase-4 (DPP-4) inhibitors to treat patients with type 2 diabetes mellitus in the real-world setting, we conducted a prospective observational study (Japan-based Clinical Research Network for Diabetes Registry: J-BRAND Registry) to elucidate the safety and efficacy profile of long-term usage of alogliptin.Research design and methods We registered 5969 patients from April 2012 through September 2014, who started receiving alogliptin (group A) or other classes of oral hypoglycemic agents (OHAs; group B), and were followed for 3 years at 239 sites nationwide. Safety was the primary outcome. Symptomatic hypoglycemia, pancreatitis, skin disorders of non-extrinsic origin, severe infections, and cancer were collected as major adverse events (AEs). Efficacy assessment was the secondary outcome and included changes in hemoglobin A1c (HbA1c), fasting blood glucose, fasting insulin and urinary albumin.Results Of the registered, 5150 (group A: 3395 and group B: 1755) and 5096 (3358 and 1738) were included for safety and efficacy analysis, respectively. Group A patients mostly (&gt;90%) continued to use alogliptin. In group B, biguanides were the primary agents, while DPP-4 inhibitors were added in up to ~36% of patients. The overall incidence of AEs was similar between the two groups (42.7% vs 42.2%). Kaplan-Meier analysis revealed the incidence of cancer was significantly higher in group A than in group B (7.4% vs 4.8%, p=0.040), while no significant incidence difference was observed in the individual cancer. Multivariate Cox regression analysis revealed that the imbalanced patient distribution (more elderly patients in group A than in group B), but not alogliptin usage per se, contributed to cancer development. The incidence of other major AE categories was with no between-group difference. Between-group difference was not detected, either, in the incidence of microvascular and macrovascular complications. HbA1c and fasting glucose decreased significantly at the 0.5-year visit and nearly plateaued thereafter in both groups.Conclusions Alogliptin as a representative of DPP-4 inhibitors was safe and durably efficacious when used alone or with other OHAs for patients with type 2 diabetes in the real world setting

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era