京都女子大学

Prevention of hypertension (HT), a risk factor for cardiovascular diseases, and blood pressure (BP) control are important. For the prevention and management of high BP, increased physical activity (PA) is recommended as a lifestyle intervention. Although various PA assessment methods exist, their associations with clinical BP have been inconsistent. This study aimed to compare self-reported and accelerometer-measured PA in relation to home HT prevalence based on home BP, which has better reproducibility than office BP. We conducted this cross-sectional study of 5895 participants (mean age: 57.5 years, 70.4% women) in the Tohoku Medical Megabank Project Cohort Study. Total PA was assessed using two methods: self-reported activities (leisure, occupational/household) and accelerometer-measured values. Home HT was defined as morning home BP ≥ 135/85 mmHg or under HT treatment. Modified Poisson regression analysis showed no statistically significant association between self-reported total PA and the prevalence of home HT. In contrast, higher levels of accelerometer-measured total PA were associated with lower prevalence of home HT (P for trend <0.05). Regarding other accelerometer-measured components, higher light PA and more steps were also significantly associated with lower prevalence of home HT. These associations were largely mediated by body mass index. In conclusion, accelerometer-measured PA, unlike self-reported PA, was associated with home HT, suggesting that PA assessed by accelerometers is useful for understanding the relationship between PA and HT, preventing HT, and managing high BP.

OBJECTIVE:To investigate the long-term safety and efficacy of tocilizumab, an IL-6 receptor inhibitor, in patients with adult-onset Still's disease. METHODS:Patients who completed the precedent phase III trial of tocilizumab for adult-onset Still's disease were enrolled in a long-term extension (LTE) study. Patients received i.v. tocilizumab (8 mg/kg every 2 weeks) until its approval in Japan. The primary end point was safety and tolerability, and secondary endpoints included the ACR coreset response, glucocorticoid doses, tocilizumab dosing interval, remission defined as achieving ACR50 without fever and other laboratory parameters. Efficacy was assessed every 12 weeks. RESULTS:All 22 patients who had completed the precedent phase III trial participated in the LTE study. Sixteen (72.7%) completed the LTE study, with the mean observation period of 168.9 ± 10.8 weeks. Whereas three (13.6%) patients experienced serious adverse events, resulting in two patients withdrawn from the trial, no new safety signal was detected. Treatment efficacy was maintained through the LTE study, with the ACR70 response rate of 68.2% and 95.2% reduction in glucocorticoid doses from the start of the phase III trial and glucocorticoid-free remission of 40.9% at the last visit. Laboratory markers such as CRP and ferritin remained well controlled. The dosing interval was successfully extended in 63.6% of patients, with the overall mean tocilizumab interval at the final visit of 3.4 weeks. CONCLUSIONS:During the observation period, no new safety findings were observed with the long-term use of tocilizumab. Response to tocilizumab was sustained even with an extended dosing interval, with substantial glucocorticoid dose reduction or discontinuation. CLINICAL TRIAL REGISTRATION:UMIN000018414.

BackgroundAlthough the distal end of palisade vessels (DEPV) has recently been proposed as an anatomically appropriate endoscopic landmark for defining the gastroesophageal junction (GEJ), its evidence under sedation remains limited. This study aimed to evaluate DEPV visualization under sedation, including its detectability and related factors.MethodsThis was a multicenter prospective cohort study conducted at 15 institutions across Japan. Patients underwent real-time endoscopic GEJ observation under sedation in three views: forward view on insertion, retroflex view, and forward view on withdrawal. The primary endpoint was the DEPV identification rate. The secondary endpoints included the DEPV identification rates across three sedation levels and factors associated with unsuccessful DEPV identification.ResultsA total of 638 patients were enrolled. The DEPV identification rate was highest in the forward view on insertion (77.0%). When the retroflex view and/or the forward view on withdrawal were additionally considered, the overall identification rate increased to 85.3%. The identification rate declined with deeper sedation, while combining all three views yielded identification rates ranging from 80.1% under deep sedation to 100% under minimal sedation. In multivariate analysis, risk factors for unsuccessful DEPV identification were deep sedation (odds ratio [OR], 3.83), reflux esophagitis (OR, 2.24-16.37), and incomplete GEJ distention (OR, 8.87), whereas hiatus hernia was protective (OR, 0.52).ConclusionsThis largest multicenter prospective study demonstrated that early DEPV identification during insertion is most effective, whereas deep sedation adversely affects visualization, supporting a standardized approach for routine GEJ assessment.

OBJECTIVES:This study examined longitudinal changes in episodic memory performance in SuperAgers (SAs) and typical older adults (TOAs), focusing on whether SAs avoid age-related decline or show a slower rate of decline. METHODS:Data were drawn from the Yakumo Study. Participants who completed episodic memory assessments on at least two occasions between ages 60 and 85 were classified as SAs or TOAs based on Logical Memory Test performance. Age-related changes were analyzed using regression models including age, group, and their interaction. RESULTS:SAs performed significantly better than TOAs across the observed age range. A significant Age × Group interaction was found, indicating different rates of decline between groups (F(1, 678) = 7.26, p = .007). Although memory performance declined significantly in both groups, the decline was less pronounced in SAs (β =  -0.164) than in TOAs (β =  -0.316). Analyses of standardized scores further showed that SAs maintained their relative cognitive standing more effectively than TOAs. CONCLUSIONS:SAs are not immune to age-related decline but exhibit a significantly attenuated rate of decline. These findings suggest that super-aging reflects both superior baseline memory performance and greater preservation over time, consistent with Brain Maintenance and Cognitive Reserve frameworks.

To evaluate the intermediate treatment targets for Still's disease proposed by EULAR/PReS recently, we conducted this post-hoc analysis of the Phase III trial of tocilizumab and its long-term extension to assess the achievement probability of these targets with tocilizumab. Additionally, we assessed the associations of the intermediate treatment targets with long-term outcomes, including glucocorticoid-free clinically inactive disease (CID) and recurrence. Given the predefined glucocorticoid tapering schedule, we also evaluated the achievement of CID irrespective of glucocorticoid dosage when assessing treatment targets at Months 3 and 6. Twenty-one patients were followed for a median of 39.8 months. The week 4 target was achieved in 57.1%, while 47.6% and 38.1% achieved CID at months 3 and 6, respectively. At the final visit, 57.1% and 28.6% achieved CID and glucocorticoid-free CID, respectively. Achievement of the week 4 target and CID at month 6 was associated with subsequent glucocorticoid-free CID (50% vs. 0%, p = 0.01; 62.5% vs. 7.7%, p = 0.01). Month 6 CID achievers had higher baseline swollen joint counts and lower interferon-γ levels. In conclusion, achievement of intermediate treatment targets was associated with long-term CID, suggesting that these targets may also be useful in treatment with tocilizumab. CLINICAL TRIAL REGISTRATION:UMIN000012987, UMIN000018414.