ペルーアマゾン中部第二都市近辺の集落における薬用植物の利用と現代医療の影響：統合的アプローチ

筑波大学 (University of Tsukuba)201

Assessing medicinal plants as the linkage between healthcare, livelihood and biodiversity: a case study from native villages surrounding a second-tier city in the central Peruvian Amazon

Medicinal plants are still used for healthcare and as medicaments especially in developing countries and some rural areas. The potential and high expectation of medicinal plants for local healthcare and livelihood and as biodiversity management is prevalent globally. This study assesses the extent to which medicinal plants bring benefits in biodiversity management and improve livelihood and healthcare in indigenous villages near a small city, a second tier city in the central Peruvian Amazon, taking into consideration the course of urbanization. A total of 81 people living in two villages were interviewed. The results show that unlike areas surrounding large cities in the Amazon, areas around the second tier city do not have the conditions to commercialize medicinal plants to support livelihood. Therefore, the local utilization of medicinal plants does not deteriorate the forest resources, thus medicinal plants would not be expected to be a driver for biodiversity management. Although medicinal plants still support healthcare of the locals, the reliance on modern medicine is aparent. The distance to the urbanized city and modern facilities influences the use of medicinal plants. While close proximity facilitates the use of modern medicine, it is found that mal-accessibility to modern medicine does not increase the variety of medicinal plant use

Conditions of marine protected areas (MPAs) in the Philippines observed through the MEAT database and a reality of evaluation system and the community based management in two MPA cases

It is well recognized that the marine resources of the Philippines are increasingly and severely damaged by climate change and human interventions, including overfishing and destructive fishing. To manage its marine resources, the government has implemented marine protected area (MPA) systems, expecting the involvement of local communities in its management. Although over 1,600 MPAs had been established by 2014, it is reported that they are not effectively managed. The purpose of the study is to determine the current conditions of MPAs in the Philippines using the MPA Management Effectiveness Assessment Tool (MEAT) developed in 2010, and to identify how MEAT reflects reality through interviews at two MPAs. The MEAT data analysis shows that MEAT has not yet been fully utilized and its information is not representative of all the MPAs in the country. So far, as based on the information provided by MEAT, less than half of the MPAs are effectively managed and management effectiveness is not related to the age of the MPA or evenly distributed across regions. The field study, although limited by the fact that it is based on only two MPAs, raises the question as to whether or not local evaluation has been conducted as intended. Unlike the high expectations of communities as effective MPA management entities, local people in the two cases rely more on local government. The results suggest the necessity of further studies on monitoring the MEAT evaluation process and the importance of field studies regarding the effectiveness of community-based MPA management

High pericoronary adipose tissue attenuation on computed tomography angiography predicts cardiovascular events in patients with type 2 diabetes mellitus: post-hoc analysis from a prospective cohort study

Background Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTA) is a non-invasive biomarker for pericoronary inflammation. We aimed to investigate the prognostic value of PCAT attenuation in patients with type 2 diabetes mellitus (T2DM). Methods We included 333 T2DM patients (mean age, 66 years; male patients, 211; mean body mass index, 25 kg/m(2)) who underwent clinically indicated coronary CTA and examined their CT findings, coronary artery calcium score, pericardial fat volume, stenosis (> 50% luminal narrowing), high-risk plaque features of low-attenuation plaque and/or positive remodelling and/or spotty calcification, and PCAT attenuation. We assessed PCAT attenuation in Hounsfield units (HU) of proximal 40-mm segments of the left anterior descending artery (LAD) and right coronary artery (RCA). Cardiovascular events were defined as cardiac death, hospitalisation for acute coronary syndrome, late coronary revascularisation, and hospitalisation for heart failure. Results During a median follow-up of 4.0 years, we observed 31 cardiovascular events. LAD-PCAT attenuation was significantly higher in patients with cardiovascular events than in those without (- 68.5 +/- 6.5 HU vs - 70.8 +/- 6.1 HU, p = 0.045), whereas RCA-PCAT attenuation was not (p = 0.089). High LAD-PCAT attenuation (> - 70.7 HU; median value) was significantly associated with cardiovascular events in a model that included adverse CTA findings, such as significant stenosis and/or high-risk plaque (hazard ratio; 2.69, 95% confidence interval; 1.17-0.20, p = 0.020). After adding LAD-PCAT attenuation to the adverse CTA findings, the C-statistic and global chi-square values increased significantly from 0.65 to 0.70 (p = 0.037) and 10.9-15.0 (p = 0.043), respectively. Conclusions In T2DM patients undergoing clinically indicated coronary CTA, high LAD-PCAT attenuation could significantly predict cardiovascular events. This suggests that assessing LAD-PCAT attenuation can help physicians identify high-risk T2DM patients

Incremental prognostic value of non-alcoholic fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease

Aims　This study aimed to investigate additional risk stratification benefits of hepatic steatosis (HS) concurrently assessed during coronary computed tomography angiography (CTA) in a large patient cohort with suspected stable coronary artery disease (CAD). Methods and results　In this prospective study, 1148 Japanese outpatients without a history of CAD who underwent coronary CTA for suspected stable CAD (mean age 64 ± 14 years) were included. HS, defined on CT as a hepatic-to-spleen attenuation ratio of Conclusion　In patients with suspected stable CAD, concurrent evaluation of HS during coronary CTA enables more accurate detection of patients at higher risk of MACE