Hypohidrosis Plays a Crucial Role in the Vicious Circle of Bathing Suit Ichthyosis: A Case with Summer Exacerbation

Although percutaneous coronary intervention (PCI) is a highly effective modality for the management of acute coronary syndromes, it can potentiate the existing prothrombotic state around lesion areas and lead to ischaemic complications. Adjunctive pharmacologic treatment with heparin reduces the risk of ischaemic events, but the utility of heparin is limited by its unpredictable pharmacodynamic effects and its inability to modulate fibrin-bound thrombin. Additionally, a potential risk of heparin-induced thrombocytopenia is associated with heparin use. Direct thrombin inhibitors (DTIs) have emerged as potential alternatives to heparin in patients undergoing PCI. Bivalirudin is a DTI indicated for use in PCI. Results from various studies have suggested clinical benefit associated with the use of bivalirudin, driven primarily by the reduction in bleeding risks compared with the standard treatment regimens. Of concern, however, is a significant increase in acute stent thrombosis with bivalirudin monotherapy compared with heparin plus GPIIb/IIIa inhibitors following primary PCI for ST-segment elevation myocardial infarction (STEMI). Desirudin is a highly potent DTI with greater binding affinity than bivalirudin for thrombin. This report provides a comparative overview of the pharmacology and clinical utility of desirudin and bivalirudin in the setting of PCI

Solar urticaria: clinical characteristics, treatment effectiveness, long-term prognosis, and QOL status in 29 patients

IntroductionSolar urticaria (SU), a relatively rare skin inflammatory and photosensitivity disease, is often resistant to standard urticaria treatment. Quality of life (QOL) among SU patients has not been extensively explored. This study was performed to clarify the clinical features and effectiveness of therapies (e.g., hardening therapy) for SU and to determine QOL among SU patients.MethodsThe authors examined the characteristics, treatments, and QOL statuses of 29 Japanese SU patients using medical records and a questionnaire approach.ResultsAmong 29 patients, H1 antihistamine therapy (H1) was effective in 22 (75.8%) patients. H2 antihistamine therapy (H2) was effective in three of seven (42.9%) patients. Ultraviolet radiation A (UVA) hardening therapy was effective in eight of nine (88.9%) patients. Visible light (VL) hardening therapy was ineffective in three of three patients. In one patient who underwent both UVA and VL hardening therapy, only UVA hardening therapy was effective. In the questionnaire, 18 patients (90%) reported some improvement compared with disease onset (four had complete remission, six had completed treatment although mild symptoms persisted, and eight were receiving treatment with moderate symptoms), whereas two patients reported exacerbation. Patients in complete remission had a mean disease duration of 4 years, whereas patients not in remission had a mean disease duration of 8.8 years. The mean Dermatology Life Quality Index (DLQI) score for the current status was 7.4. There was a correlation between DLQI and symptom/treatment status. However, neither DLQI and action spectra nor DLQI and treatments exhibited significant differences.DiscussionThe questionnaire revealed current QOL status and long-term prognosis in SU patients. Compared with disease onset, most patients showed improvement when assessed for this study. Both H1 and H2 should be attempted for all SU patients. UVA hardening therapy may be an option for SU patients with an action spectrum that includes UVA

Risk factors for severity of colonic diverticular hemorrhage

Background/AimsColonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH.MethodsAmong patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort.ResultsAmong the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors.ConclusionsSevere DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH

Efficacy of switching to bilastine, a histamine H1 receptor antagonist, in patients with chronic spontaneous urticaria (H1-SWITCH): study protocol for a randomized controlled trial

Background Chronic spontaneous urticaria (CSU) is characterized by the spontaneous appearance of wheals, angioedema, or both for > 6 weeks. Continuous treatment with H1-antihistamines is used as a first-line treatment for CSU. However, H1-antihistamine treatment leads to absence of symptoms in less than 50% of patients with CSU. Although Japanese guidelines for the diagnosis and treatment of urticaria recommend an increase in the H1-antihistamine dose or a switch to other H1-antihistamines, there is no evidence supporting a switch to other H1-antihistamines in patients with refractory CSU who are unresponsive to H1-antihistamines at the licensed dose. Methods We will conduct a multicenter, open-label, non-inferiority, randomized, parallel, comparison study to determine if the efficacy of bilastine 20 mg is not inferior to that of a twofold H1-antihistamine dose increase in patients with refractory CSU who are unresponsive to H1-antihistamines at the licensed dose. This study will be performed at 15 academic hospitals in Japan, and the administration period (increasing the H1-antihistamine dose twofold vs. switching to bilastine 20 mg) will be 7 days. Participants (n = 150) will be randomized to either an increased H1-antihistamine dose or a switch to bilastine 20 mg at a 1:1 ratio. The primary endpoint, mean of the total symptom score of 5-7 days after the intervention, will be evaluated. The secondary objective is to determine if the safety of bilastine 20 mg regarding somnolence is superior to that of a twofold dose increase of H1-antihistamines. This will be measured by a change in the Japanese version of the Epworth Sleepiness Scale from baseline to 7 days after starting the intervention. Discussion This multicenter, open-label, non-inferiority, randomized, parallel, comparison study will be, to our knowledge, the first well-designed clinical study to evaluate the efficacy of a switch to other H1-antihistamines in patients with refractory CSU who are unresponsive to H1-antihistamines at the licensed doses. This trial will provide evidence of the efficacy and safety of bilastine when treatment is switched in patients with refractory CSU who are unresponsive to H1-antihistamines at the licensed dose

A case of atopic dermatitis with hypohidrosis improved after dupilumab treatment

LETTER TO THE EDITO

Maintaining Agricultural Production by Building Local Distribution Systems in the Northern Area of Japan

In the field of vegetable farming, it has become a common approach for farmers to advance into the secondary and tertiary industries to increase their income, an initiative known as the sixth industrialization. Under these circumstances, a growing trend is to outsource a part of the sixth industrialization activities in order to improve consumer satisfaction, strengthen market competitiveness, and avoid investment risks. However, owing to a mismatch between farmers and processors, there are few cases that result in collaboration. Under such circumstances, a new distribution channel called local distribution systems have been born, and its importance is increasing in Japan. This paper demonstrates how a local distribution system for farmers living in rural areas could address this distortion. The concept of local distribution systems has been used since the 1990s, and yet, its significance and importance are still increasing in relevancy in today’s Japanese agriculture. In this study, the subject is an intermediary (Company A) that originated from farmers, so it was able to understand the behavioral principles of farmers and to identify businesses that could not be covered by the management resources of farmers themselves. Through the entrustment of the business, company A could support the production and sales activities of the farmers. The following conclusions were drawn: (1) the company does not directly involve members in the decision-making of sales methods but instead provides a number of options for decision-making, and (2) the needs on the production side will match those on the consumer side and play the role of communication. By building such a collaboration system, the company succeeded in establishing a local distribution system. In the distribution of vegetables, which is characterized as perishable items, it is essential to pursue efficiency and rationality through a wholesale market system to distribute the products from producers to a large number of consumers. However, constraints in the wholes system limit the extent to which this local distribution functions. This paper demonstrates how a local distribution system for farmers living in rural areas could address this distortion. The concept of local distribution systems has been used since the 1990s, yet its significance and importance are still increasing in relevancy in today’s Japanese agriculture

Maintaining Agricultural Production by Building Local Distribution Systems in the Northern Area of Japan

In the field of vegetable farming, it has become a common approach for farmers to advance into the secondary and tertiary industries to increase their income, an initiative known as the sixth industrialization. Under these circumstances, a growing trend is to outsource a part of the sixth industrialization activities in order to improve consumer satisfaction, strengthen market competitiveness, and avoid investment risks. However, owing to a mismatch between farmers and processors, there are few cases that result in collaboration. Under such circumstances, a new distribution channel called local distribution systems have been born, and its importance is increasing in Japan. This paper demonstrates how a local distribution system for farmers living in rural areas could address this distortion. The concept of local distribution systems has been used since the 1990s, and yet, its significance and importance are still increasing in relevancy in today’s Japanese agriculture. In this study, the subject is an intermediary (Company A) that originated from farmers, so it was able to understand the behavioral principles of farmers and to identify businesses that could not be covered by the management resources of farmers themselves. Through the entrustment of the business, company A could support the production and sales activities of the farmers. The following conclusions were drawn: (1) the company does not directly involve members in the decision-making of sales methods but instead provides a number of options for decision-making, and (2) the needs on the production side will match those on the consumer side and play the role of communication. By building such a collaboration system, the company succeeded in establishing a local distribution system. In the distribution of vegetables, which is characterized as perishable items, it is essential to pursue efficiency and rationality through a wholesale market system to distribute the products from producers to a large number of consumers. However, constraints in the wholes system limit the extent to which this local distribution functions. This paper demonstrates how a local distribution system for farmers living in rural areas could address this distortion. The concept of local distribution systems has been used since the 1990s, yet its significance and importance are still increasing in relevancy in today’s Japanese agriculture

A Case of Lichen Planus Pemphigoides Successfully Treated with a Combination of Cyclosporine A and Prednisolone

Lichen planus pemphigoides (LPP) is a rare clinical variant of bullous pemphigoid (BP). A 35-year-old female patient presented to our hospital complaining of pruritic violaceous-colored plaques or papules on the extremities. Tense vesicles were also seen on the soles. Skin biopsies from the papules and vesicles demonstrated lichen planus and BP, respectively. Direct immunofluorescence demonstrated linear IgG and C3 deposition on the basement membrane zone. Indirect immunofluorescence on 1 M NaCl split skin detected IgG reactivity with the epidermal side. Enzyme-linked immunosorbent assay also detected anti-BP180 antibodies. After treatment with oral prednisolone alone had failed, low-dose cyclosporine A (CyA) was added. The clinical symptoms immediately improved and the titer of the anti-BP180 antibodies decreased. Although there is little information about the treatment of recalcitrant LPP, additional CyA appeared to be beneficial