Association between comprehensive workstation and neck and upper-limb pain among office worker

Objectives: Our study aimed to investigate the association between comprehensive workstations and neck and upper-limb pain (NUP) among office workers. Methods: This cross-sectional study included 307 office workers (median age, 39 years; 88% men). Workstations (presence of armrest, armrest position, number of monitors used, mouse position, mouse usage, keyboard usage, and keyboard position) were investigated in terms of 17 items and judged as "adequate" or "inadequate." NUP was assessed using a numerical rating scale. NUP locations included the neck, shoulder, elbow, and wrist. In the statistical analysis, outcome variables were the presence of pain in each part, while explanatory variables were the number of inadequate workstations. Logistic regression analyses were conducted with adjustment for age, gender, working duration, and exercise habit. Results: The prevalence of neck pain was 47% (n = 143), shoulder pain was 50% (n = 153), elbow pain was 7.2% (n = 22), and wrist pain was 13% (n = 40). In the adjusted model, the number of inadequate workstations had significant positive associations with elbow pain (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.06.1.81) and wrist pain (OR, 1.80; 95% CI, 1.17.2.26). However, the number of inadequate workstations was not significantly associated with neck pain or shoulder pain. Conclusions: Workstation-related factors (presence of armrest, armrest position, mouse usage, and keyboard usage) were significantly associated with elbow and wrist pain. Our findings suggest that workstations can contribute to elbow and wrist pain in office workers

A Case of Isolated Thoracic Aortic Aneurysm as a Manifestation of Undiscovered Giant Cell Arteritis

73-year-old woman was referred to our hospital to investigate dilatation of an　aortic arch which had been detected by a chest roentgenogram and severe aortic valve regurgitation detected by echocardiography. On admission, a computed tomography scan of the chest showed a large fusiform ascending aortic aneurysm. She had not shown any symptoms such as headache or polymyalgia rheumatica and had no significant coronary atherosclerosis. She underwent aneurysmectomy and reconstruction of the ascending aorta using cardiopulmonary bypass without aortic valve replacement, and pathological examination of the aneurismal wall revealed giant cell arteritis (GCA). Preoperatively, she did not have any temporal pain, and no signs of inflammation were detected serologically. Postoperatively, aortic valve regurgitation improved and she did well. However, three months after the surgery, she died suddenly due to the rupture or dissection of aorta. In the Japanese population, GCA is reportedly a rare cause of aortic aneurysm. However, retrospective studies show that GCA affects the aorta and that thoracic aortic aneurysm is a possible complication of GCA. In cases of the thoracic aortic aneurysms with unknown etiology, there is a possibility that GCA is the cause of the aortic aneurysm.胸部エックス線写真での大動脈弓拡大と心臓超音波検査での大動脈弁閉鎖不全にて受診した73歳女性. 胸部CT検査にて, 上行大動脈に径7cmの大動脈瘤があることが明らかとなった. 術前の各種検査において, 全身の動脈硬化病変は冠動脈含めてほとんど認められていなかった. 心臓外科にて人工心肺下で上行大動脈瘤切除・人工血管置換術を施行され(大動脈弁置換術は施行せず), その際に切除した上行大動脈瘤の組織所見から巨細胞性肉芽腫が認められ, 巨細胞性動脈炎が基礎疾患であることが明らかとなった. 術前には頭痛やリウマチ性多発筋炎の症状・血沈充進・CRP陽性がなく, またそれらを含めて側頭動脈炎を示唆する所見がなく動脈生検を行っていなかったため, 予測は困難であった. 術後は大動脈弁閉鎖不全も改善し, 術後経過良好で退院となった(しかし, 術後3ケ月目に吻合部破裂によるものと思われる突然死となった). 日本においては, 大動脈瘤の原因として巨細胞性動脈炎の報告例は非常に少ない. しかし, これまでの海外での報告例や剖検例での検討では, 巨細胞性動脈炎は大動脈瘤を引き起こすことはまれではない. 胸部大動脈瘤の患者において, 動脈硬化が軽度など原因が特定できない場合には巨細胞性動脈炎によるものの可能性がある

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 (>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