Conventional versus Rapid Glucocorticoid Tapering in Severe Systemic Lupus Erythematosus Patients: A Non-Blind, Randomized Controlled Trial

Glucocorticoids (GCs) have long played a central role in the treatment of systemic lupus erythematosus (SLE), but these drugs have many adverse effects. We will determine whether rapid weekly GC tapering is non-inferior to conventional biweekly tapering in patients with severe SLE. This is a randomized, open-label, multicenter controlled trial. The primary outcome is the relapse-free survival rate at 52 weeks. The main secondary outcome is the prevalence of the Lupus Low Disease Activity State at 52 weeks. The trial will determine the optimal method of tapering GCs in patients with severe SLE

Conventional-dose Versus Half-dose Sulfamethoxazole-trimethoprim for the Prophylaxis of Pneumocystis Pneumonia in Patients with Systemic Rheumatic Disease: A Non-blind, Randomized Controlled Trial

Pneumocystis pneumonia (PCP) due to Pneumocystis jirovecii infection is the leading cause of fatal opportunistic infections in immunocompromised patients. We will determine whether a daily sulfamethoxazole-trimethoprim (SMX/TMP) dose of 200/40 mg was non-inferior to 400/80 mg for PCP prevention in patients with systemic rheumatic disease under immunosuppressive therapy. This is a randomized, open-label, multicenter controlled trial. The primary outcome is the rate of PCP prevention at 52 weeks. The secondary outcome is the discontinuation rate of SMX/TMP. The trial will evaluate the optimal dose of SMX/TMP for PCP prevention in patients with systemic rheumatic disease under immunosuppressive therapy

Adherence and Persistence with Once-Daily Teriparatide in Japan: A Retrospective, Prescription Database, Cohort Study

Adherence and persistence with osteoporosis treatments are essential for reducing fracture risk. Once-daily teriparatide is available in Japan for treating osteoporosis in patients with a high risk of fracture. The study objective was to describe real-world adherence and persistence with once-daily teriparatide 20 μg during the first year of treatment for patients who started treatment during the first eight months of availability in Japan. This prescription database study involved patients with an index date (first claim) between October 2010 and May 2011, a preindex period ≥6 months, and a postindex period ≥12 months and who were aged >45 years. Adherence (medication possession ratio (MPR)) and persistence (time from the start of treatment to discontinuation; a 60-day gap in supply) were calculated. A total of 287 patients started treatment during the specified time period; 123 (42.9%) were eligible for inclusion. Overall mean (standard deviation) adherence was 0.702 (0.366), with 61.0% of patients having high adherence (MPR > 0.8). The percentage of patients remaining on treatment was 65.9% at 180 days and 61.0% at 365 days. Our findings suggest that real-world adherence and persistence with once-daily teriparatide in Japan are similar to that with once-daily teriparatide in other countries and with other osteoporosis medications

Interpreting changes in measles genotype: the contribution of chance, migration and vaccine coverage

<p>Abstract</p> <p>Background</p> <p>In some populations, complete shifts in the genotype of the strain of measles circulating in the population have been observed, with given genotypes being replaced by new genotypes. Studies have postulated that such shifts may be attributable to differences between the fitness of the new and the old genotypes.</p> <p>Methods</p> <p>We developed a stochastic model of the transmission dynamics of measles, simulating the effects of different levels of migration, vaccination coverage and importation of new genotypes on patterns in the persistence and replacement of indigenous genotypes.</p> <p>Results</p> <p>The analyses illustrate that complete replacement in the genotype of the strain circulating in populations may occur because of chance. This occurred in >50% of model simulations, for levels of vaccination coverage and numbers of imported cases per year which are compatible with those observed in several Western European populations (>80% and >3 per million per year respectively) and for the given assumptions in the model.</p> <p>Conclusion</p> <p>The interpretation of genotypic data, which are increasingly being collected in surveillance programmes, needs to take account of the underlying vaccination coverage and the level of the importation rate of measles cases into the population.</p

Exercise oxygen desaturation is a predictor of cardiopulmonary complications after lung resection

Background To investigate whether oxygen desaturation during low technology tests was associated with complications after lung resection.Methods A retrospective cohort study was conducted on 1097 candidates for pulmonary resection; seven metabolic equivalents in the Master’s double two-step test were loaded. The predicted postoperative (PPO) forced expiratory volume in 1 s and PPO diffusing capacity of the lung for carbon monoxide were estimated. The patients were divided into three groups: those with both values ≥60% (≥60% group (n=298)), either value &lt;30% (&lt;30% group (n=112)) and others (30%–60% group (n=687)). The relationships between postoperative cardiopulmonary complications and exercise stress test based on availability, symptoms and percutaneous oxygen saturation values were investigated in each group.Results Τhe cardiopulmonary morbidity rates in the ≥60%, 30%–60%, and &lt;30% groups were 7.7%, 14.6%, and 47.3%, respectively. Multivariate analyses revealed that predictors of complications were age (OR 0.96; p&lt;0.001), male sex (OR 1.74; p=0.016) and exercise oxygen desaturation (EOD) &gt;4% (OR 2.39; p=0.001) in the 30%–60% group, and male sex (OR 3.76; p=0.042) and EOD &gt;4% (OR 2.28; p=0.030) in the &lt;30% group.The two-flight test (TFT) was performed in 181 patients (22.8%); desaturation &gt;4% in the TFT was also a predictor of complications.Conclusions A low technology test is also valuable for high-risk patients. EOD &gt;4% is a predictor of postoperative complications.Clinical registration This study is a non-interventional observational study and has not been registered in a public database. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines.This study was approved by the Ethics Committee of the Juntendo University School of Medicine (no. 2016085)

Effects of COVID-19 on Japanese medical students' knowledge and attitudes toward e-learning in relation to performance on achievement tests.

The COVID-19 pandemic forced many educational institutions to turn to electronic learning to allow education to continue under the stay-at-home orders/requests that were commonly instituted in early 2020. In this cross-sectional study, we evaluated the effects of the COVID-19 pandemic on medical education in terms of students' attitudes toward online classes and their online accessibility; additionally, we examined the impacts of any disruption caused by the pandemic on achievement test performance based on the test results. The participants were 674 students (412 in pre-clinical, 262 in clinical) at Juntendo University Faculty of Medicine; descriptive analysis was used to examine the respondents' characteristics and responses. The majority of respondents (54.2%) preferred asynchronous classes. Mann-Whitney U tests revealed that while pre-clinical students preferred asynchronous classes significantly more than clinical students (39.6%, p < .001), students who preferred face-to-face classes had significantly higher total achievement test scores (U = 1082, p = .021, r = .22). To examine the impacts of pandemic-induced changes in learning, we conducted Kruskal-Wallis tests and found that the 2020 and 2021 scores were significantly higher than those over the last three years. These results suggest that while medical students may have experienced challenges adapting to electronic learning, the impact of this means of study on their performance on achievement tests was relatively low. Our study found that if possible, face-to-face classes are preferable in an electronic learning environment. However, the benefit of asynchronous classes, such as those that allow multiple viewings, should continue to be recognized even after the pandemic

Novel characteristics of the temporal transition to maximum tongue pressure in Parkinson’s disease: A pilot study

Introduction: The reason why maximum tongue pressure (MTP) decreases in patients with Parkinson’s disease (PD) remains unclear. Repeated measurements of isometric force and MTP may be useful for analyzing muscle wasting and force generation. The purpose of this pilot study was to evaluate the clinical characteristics and temporal transition of MTP in PD and normal control (NC) groups. Methods: There were 18 participants in this study: 10 with PD and 8 NCs. The MTP was measured 20 times at regular intervals. The area under the curve of MTP temporal transitions, time to reach MTP, and total transition time of the tongue pressure (time to return to baseline) were compared between the groups. Results: MTP decreased from baseline in PD subjects. Unlike NCs, PD subjects showed diverse and inconsistent temporal transitions. The decrease in MTP and delays in time to reach MTP and time to return to baseline were significantly greater in PD subjects (p < 0.05), while there was no group difference in area under the curve values. According to repeated-measures ANOVA, MTP was not different over time between PD subjects and NCs. Conclusion: In this study, muscle fatigue did not affect the decrease in MTP seen in PD subjects, or the diversity and inconsistency of the temporal transition in MTP in that group. These findings indicate that the motor control needed for the repeated, identical movements associated with MTP generation may be impaired in PD patients

The impact of cardiac rehabilitation for older adults with heart failure who underwent invasive cardiac treatment eligible for long‐term care needs certification: A retrospective cohort study

Abstract Background This study aimed to assess the usefulness of cardiac rehabilitation (CR) for older adults with heart failure (HF) who need nursing care and investigate the effect of CR on cognitive function (CF) and basic activities of daily living (BADL). Methods This was a retrospective cohort study. The study included older adults with HF eligible for long‐term care insurance in fiscal year 2014 (FY2014) as the baseline and followed them up until March 2018. Patients were divided into two groups, CR (+) and CR (−), and the changes in their CF and BADL scores over time for 3 years were investigated. Results Of the 765 patients included in the study, 36.5% performed CR. BADL scores in the CR (+) and CR (−) groups (mean (SE)) were 5.81 (0.26) vs. 5.87 (0.20) in FY2014, 5.6 (0.28) vs. 5.92 (0.21) in FY2015, 5.72 (0.31) vs. 6.15 (0.22) in FY2016, and 5.64 (0.33) vs. 6.40 (0.25) in FY2017, respectively. BADL scores worsened over time in the CR (−) group but had a trend to inhibit decline in the CR (+) group, and a significant difference was observed between both groups (p = 0.04). Multivariate analysis showed a significant difference in CR as a factor suppressing ADL decline after 1 year (adjusted odds ratios: 0.54, 95% confidence intervals: 0.36–0.82; p = 0.004). However, no significant difference in the CF scores was observed. Conclusion CR for older adults with HF eligible for long‐term care needs certification does not affect CF and may suppress ADL decline

Risk Factors for Concussion in Under 18, Under 22 and Professional Men's Rugby Union: A Video Analysis of 14,809 Tackles

Abstract Objective This study aimed to identify the risk factors for tackle-related concussion observed in matches involving under (U) 18, U 22 and professional men’s Rugby Union players through video analysis. Study Design Descriptive epidemiology study. Methods Twenty Rugby Union matches each for high school (U18), university/college (U22) and professional (Elite) were randomly selected from 202 matches in the 2018/2019 season. Both one-on-one and tackles involving multiple tacklers were analyzed for the 60 matches. The 28 categorical and continuous variables (e.g., tackle characteristics and duration before the tackle) were applied as risk factors to a least absolute shrinkage and selection operator (Lasso) regression analysis. To identify high-risk situations, a simulation model with coefficients obtained from the Lasso regression was used. Statistical analysis was conducted according to tackle direction. Results A total of 14,809 tackles and 41 concussions involving 1800 players were included in the analyses. The incidence rate of concussions (injuries/1000 tackles) was greater in Elite players (4.0) compared with U18 (1.9) and U22 (2.4) players. The factors most highly associated with concussions were head-in-front tackles (where the tackler’s head is placed forward, impeding a ball carrier’s forward movements, 11.26/1000 tackles), and were more often observed among U18 players. A simulation model predicted that the highest risk tackle situation in Elite players was a head-in-front, side-on tackle below the hip of the ball carrier (predicted incidence rate 18.07/1000 tackles). Conclusion The risk factors associated with concussion need to be assessed cautiously. Avoiding head-in-front, side-on tackles to the lower extremities of a ball carrier should be considered to reduce injury risks