Long-term efficacy and safety of tofacitinib in patients with ulcerative colitis: 3-year results from a real-world study

Background/Aims The efficacy and safety of tofacitinib for the treatment of refractory ulcerative colitis (UC) has been demonstrated in clinical trials. Although, a series of reports with real-world evidence of its short-term efficacy and safety profiles have already been published, reports of long-term real-world data have been limited. We aimed to show our 3-year evidence on the clinical use of tofacitinib for the treatment of UC, focusing on its efficacy and safety profiles. Methods A retrospective observational study was conducted on patients who started tofacitinib for active refractory UC at our hospital. The primary outcome was the retention rate until 156 weeks after initiating tofacitinib. The secondary outcomes were short-term efficacy at 4, 8, and 12 weeks; long-term efficacy at 52, 104, and 156 weeks; prognostic factors related to the cumulative retention rate; loss of response; and safety profile, including adverse events. Results Forty-six patients who were able to be monitored for up to 156 weeks after tofacitinib initiation, were enrolled in this study. Continuation of tofacitinib was possible until 156 weeks in 54.3%, with > 50% response rates and > 40% remission rates. Among patients in whom response or remission was achieved and tofacitinib was deescalated after 8 weeks of induction treatment, 54.3% experienced relapse but were successfully rescued by and retained on reinduction treatment, except for 1 patient. No serious AEs were observed in the study. Conclusions Tofacitinib is effective and safe as long-term treatment in a refractory cohort of UC patients in real-world clinical practice

Impact of frailty on long-term mortality in older patients receiving intensive care via the emergency department

The aim of this study was to evaluate whether frailty was associated with 6-month mortality in older adults who were admitted to the intensive care unit (ICU) with an illness requiring emergency care. The investigation was a prospective, multi-center, observational study conducted among the ICUs of 17 participating hospitals. Patients >= 65 years of age who were admitted to the ICU directly from an emergency department visit were assessed to determine their baseline Clinical Frailty Scale (CFS) scores before the illness and were surveyed 6 months after admission. Among 650 patients included in the study, the median age was 79 years old, and overall mortality at 6 months was as low as 21%, ranging from 6.2% in patients with CFS 1 to 42.9% in patients with CFS >= 7. When adjusted for potential confounders, CFS score was an independent prognostic factor for mortality (one-point increase in CFS, adjusted risk ratio with 95% confidence interval 1.19 [1.09-1.30]). Quality of life 6 months after admission worsened as baseline CFS score increased. However, there was no association between total hospitalization cost and baseline CFS. CFS is an important predictor of long-term outcomes among critically ill older patients requiring emergent admission

The effect of a prostaglandin E-1 derivative on the symptoms and quality of life of patients with lumbar spinal stenosis

Quality of life (QOL) is a concern for patients with lumbar spinal stenosis (LSS). In this study, QOL was examined using the 5-item EuroQol (EQ-5D). QOL and activities of daily living (ADL) were surveyed for 91 patients who visited 18 medical institutions in our prefecture and were diagnosed with LSS-associated intermittent claudication. A second survey was performed after a parts per thousand yen6 weeks for 79 of the subjects to evaluate therapy with limaprost (an oral prostaglandin E1 derivative) or etodolac (an NSAID). Symptoms, maximum walking time, QOL, ADL items, and relationships among these variables were investigated for all 91 patients. Leg pain, leg numbness, and low back pain while walking were surveyed by use of VAS scores (0-100). Leg pain, leg numbness, and low back pain while walking (VAS a parts per thousand yen25) were present in 83.5, 62.6, and 54.9 % of the patients in the first survey, and approximately half of the patients had a maximum walking time 30 min, showing that maximum walking time affected health-related QOL. Of the 79 patients who completed the second survey, 56 had taken limaprost and 23 (control group) had received etodolac. Limaprost improved possible walking time, reduced ADL interference, and significantly increased the EQ-5D utility score, whereas no significant changes occurred in the control group. Maximum walking time was prolonged by a parts per thousand yen10 min and the EQ-5D utility value was improved by a parts per thousand yen0.1 points in significantly more patients in the limaprost group than in the control group. According to the findings of this survey, at an average of 8 weeks after administration limaprost improved symptoms, QOL, and ADL in LSS patients whereas treatment with an NSAID reduced pain but did not have any other effects.ArticleJOURNAL OF ORTHOPAEDIC SCIENCE. 18(2):208-215 (2013)journal articl

Effect of yeast cell wall supplementation on production performances and blood biochemical indices of dairy cows in different lactation periods

Aim: This experiment was conducted to determine the effect of yeast cell wall (YCW) supplementation on production performances and blood biochemical indices such as liver enzyme activities, energy metabolites, and electrolyte concentrations of dairy cows in different lactation periods (LP). Materials and Methods: Thirty-two lactating Holstein cows were assigned into 2×2 factorial arrangement, in which the factors were the treatment (TM) (control [n=16] vs. YCW [n=16]) and the LP (early lactation [n=14] vs. mid-lactation [n=18]). The cows with day in milk (DIM) 120 (179±5 DIM) were assumed as mid-lactating cows. The YCW (SafMannan; Phileo, Lesaffre Animal Care, France) was used as the dietary supplement (10 g/cow/day) in this experiment. The statistical analysis of the data was performed by the two-way analysis of variance using the general linear model procedure to determine the main effects (TM and LP) and their interaction (TM×LP) on production performances and blood biochemical parameters of experimental cows. Results: No significant effects (p>0.05) of YCW supplementation on production performances and blood biochemical indices of cows in TM groups (control vs. YCW) were observed; however, some obvious effects were detected in LP (early- and mid-lactation). Milk and milk component yield of cows in early lactation were significantly higher (p0.05) with the YCW supplementation. The higher level (p<0.05) of serum albumin was found in mid-lactating cows after YCW supplementation. Before the experiment, the higher (p<0.05) non-esterified fatty acid (NEFA) and NEFA/total cholesterol (T-Cho) ratio, and the lower (p<0.05) calcium (Ca) concentration were observed in early lactating cows comparison with mid-lactating cows; however, there were not different after YCW supplementation. Conclusion: The positive effects of YCW supplementation on milk and milk component yields, energy metabolite, especially NEFA and NEFA/T-Cho ratio and Ca concentration were observed in early lactating cows rather than mid-lactating cows

Effect of yeast cell wall supplementation on production performances and blood biochemical indices of dairy cows in different lactation periods

Aim: This experiment was conducted to determine the effect of yeast cell wall (YCW) supplementation on production performances and blood biochemical indices such as liver enzyme activities, energy metabolites, and electrolyte concentrations of dairy cows in different lactation periods (LP). Materials and Methods: Thirty-two lactating Holstein cows were assigned into 2×2 factorial arrangement, in which the factors were the treatment (TM) (control [n=16] vs. YCW [n=16]) and the LP (early lactation [n=14] vs. mid-lactation [n=18]). The cows with day in milk (DIM) 120 (179±5 DIM) were assumed as mid-lactating cows. The YCW (SafMannan; Phileo, Lesaffre Animal Care, France) was used as the dietary supplement (10 g/cow/day) in this experiment. The statistical analysis of the data was performed by the two-way analysis of variance using the general linear model procedure to determine the main effects (TM and LP) and their interaction (TM×LP) on production performances and blood biochemical parameters of experimental cows. Results: No significant effects (p>0.05) of YCW supplementation on production performances and blood biochemical indices of cows in TM groups (control vs. YCW) were observed; however, some obvious effects were detected in LP (early- and mid-lactation). Milk and milk component yield of cows in early lactation were significantly higher (p0.05) with the YCW supplementation. The higher level (p<0.05) of serum albumin was found in mid-lactating cows after YCW supplementation. Before the experiment, the higher (p<0.05) non-esterified fatty acid (NEFA) and NEFA/total cholesterol (T-Cho) ratio, and the lower (p<0.05) calcium (Ca) concentration were observed in early lactating cows comparison with mid-lactating cows; however, there were not different after YCW supplementation. Conclusion: The positive effects of YCW supplementation on milk and milk component yields, energy metabolite, especially NEFA and NEFA/T-Cho ratio and Ca concentration were observed in early lactating cows rather than mid-lactating cows

Field trial of primary and booster dose of inactivated vaccine against bovine respiratory bacteria in young Holstein calves

The objective of this research was to evaluate the antibody response to multiple doses of an inactivated mixed vaccine against Histophilus somni, Pasteurella multocida, and Mannheimia haemolytica, and to investigate the influence of age at time of vaccination in the field