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Introduction: To evaluate patient–physician communication and patients’ understanding of treatment goals in rheumatoid arthritis (RA). Methods: A cross-sectional online survey of patients with RA and physicians treating RA was conducted between 16 and 30 June 2021. Participants were asked to rate the importance of 17 goals on a 6-point Likert scale, and mean scores were compared between patients and physicians by the Wilcoxon rank sum test. Patients’ satisfaction with physician communication and their understanding of treatment goals were also assessed. Results: The responses of 502 patients and 216 physicians were analyzed. The most common patient age group was 50–59 years (28.5%), and the mean disease duration was 10.3 years. Physicians had a mean of 19.2 years of treatment experience and were treating a mean of 44.3 patients. Among the 17 goals assessed, patients placed significantly more importance on drug tapering or discontinuation as short-term goals (3–6 months) and on performing basic activities of daily living, being able to engage in daily tasks, achieving and maintaining remission, maintaining better laboratory values, and drug tapering or discontinuation as long-term goals (5–10 years; all adjusted p< 0.05). Patient treatment satisfaction was significantly associated with disease activity, a feeling of treatment effectiveness, satisfaction with physician communication, and agreement with physician goals. Conclusion: Differences exist among patients with RA and physicians treating RA regarding the importance of short- and long-term treatment goals. Good patient–physician communication appears to be important for improving patient satisfaction. Trial registration: University Hospital Medical Information Network identifier: UMIN000044463.

ABSTRACTHalophytes are salt-tolerant plant that grows naturally in saline areas where almost all conventional crops die due to NaCl toxicity. The common ice plant, Mesembryanthemum crystallinumL., an annual halophyte native to South Africa, tolerates high salinity levels and accumulates NaCl in a shoot at a high level. To check the availability of the ice plant for desalinization of soils, we cultured the ice plant in soils collected from 16 sites located along coastal regions in the prefectures of Miyagi and Iwate, where were attacked by the tsunami disaster in the wake of the 2011 earthquake off the Pacific coast of Tohoku on 11 March 2011. In the soils obtained from some tsunami affected areas, the growth was better than that in the non-contaminated soil. The factors associated with growth inhibition were suggested to be water ratio (an index of water content) and soil water permeability. The ice plant’s estimated biological yield ranged from 0.33 to 14.6 kg m−2, equivalent to 2.3 to 101.7 t ha−1. The sum of Na+and Cl−was about 9.5 g in the shoot (31.8% on a dry weight basis), and the estimated total amount of these ions removed from salinized soil was 2.38 t ha−1. These results indicated that the common ice plant could be used as a crop under salinity and a tool for ameliorating NaCl from salinized soils.

Osteosarcopenia is defined as osteoporosis with sarcopenia. The impacts of osteosarcopenia on falls and fractures in rheumatoid arthritis (RA) patients were investigated using 4 years of data from a longitudinal study (CHIKARA study).

Sarcopenia is relatively common in rheumatoid arthritis (RA) patients. Thicknesses of the quadriceps muscle and fat are easily measured by ultrasound (US) and are known to be related to skeletal muscle mass and fat mass, respectively.

We have developed an advanced LTPS TFT technology in which top‐gate oxide TFTs are used in each pixel and CMOS LTPS TFTs are used in gate drivers and multiplexers in the peripheral circuits. Oxide TFTs have excellent Ids–Vgscharacteristics with a small Vthshift under negative bias temperature illumination stress (NBTIS).

We propose an advanced LTPS TFT‐LCD technology in which top‐gate oxide TFTs are used in each pixel, whereas LTPS TFTs are used in the drivers and multiplexer in the frame areas. With this technology, we successfully developed a 538‐ppi TFT‐LCD prototype with 15‐Hz frame‐rate driving, a 0.5‐mm width side border, and lower gate driving voltages of +8.6/−8.0 V. Even after conducting a 500‐h driving test at 70 °C, no degradation was observed.

Behavioral restrictions and staying at home during the COVID-19 pandemic have affected lifestyles. It was hypothesized that patients with rheumatoid arthritis (RA) decreased their activities of daily living (ADL) and exercise during the pandemic. The aim of this study is to investigate the changes in lifestyle and body composition.

A cross-sectional study.

Background: The dietary inflammatory index (DII®), a quantitative measure of the inflammatory potential of daily food and nutrient intake, and associations between a variety of health outcomes have been reported. However, the association between DII score and disease activity of rheumatoid arthritis (RA) is unclear. Therefore, this study was designed to test whether higher DII score contributes to disease activity and as a corollary, whether reducing DII score helps to achieve or maintain low disease activity or remission in patients with RA. Methods: We performed a cross-sectional and longitudinal analysis using 6 years of data (from 2011 to 2017) in TOMORROW, a cohort study consisting of 208 RA patients and 205 gender- and age-matched controls started in 2010. Disease activity of RA patients was assessed annually using DAS28-ESR (disease activity score 28 joints and the erythrocyte sedimentation rate) as a composite measure based on arthritic symptoms in 28 joints plus global health assessment and ESR. Dietary data were collected in 2011 and 2017 using the brief-type self-administered diet history questionnaire (BDHQ). Energy-adjusted DII (E-DII™) score was calculated using 26 nutrients derived from the BDHQ. Data were analyzed with two-group comparisons, correlation analysis, and multivariable logistic regression analysis. Results: One hundred and seventy-seven RA patients and 183 controls, for whom clinical and dietary survey data were available, were analyzed. RA patients had significantly higher E-DII (pro-inflammatory) score compared to controls both in 2011 and 2017 (p< 0.05). In RA patients, E-DII score was not a factor associated with significant change in disease activity. However, anti-inflammatory change in E-DII score was associated maintaining low disease activity (DAS28-ESR ≤ 3.2) or less for 6 years (OR 3.46, 95% CI 0.33–8.98, p= 0.011). Conclusions: The diets of RA patients had a higher inflammatory potential than controls. Although E-DII score was not a factor associated with significant disease activity change, anti-inflammatory change in E-DII score appeared to be associated with maintaining low disease activity in patients with RA. Trial registration: UMIN Clinical Trials Registry, UMIN000003876. Registered 7 Aug 2010—retrospectively registered.

To increase the options for agents for gastric cancer chemotherapy, we performed a phase II clinical trial on the use of a 3-h infusion of paclitaxel to confirm its efficacy and the feasibility of its use in patients with advanced gastric cancer. Thirty-two (32) patients with measurable metastatic gastric cancer were enrolled in this study. Seventeen patients (53%) had received prior chemotherapy for metastatic disease, 4 patients (13%) had adjuvant chemotherapy alone, and 11 patients (34%) were chemotherapy-naive. Paclitaxel was intravenously infused for 3 h, at a dose of 210 mg/m2, once every 3 weeks. To prevent hypersensitivity reactions, standard premedication was administered to all patients. Nine (28%; 9/32 ) objective partial responses (PRs) were observed (95% confidence interval [CI], 14%–47%), and the remaining 23 patients showed stable (12 patients; 37.5%) and progressive disease (11 patients; 34.4%). The median time to response was 20 days (range, 14–38 days). The median response duration was 87 days (range, 50–103 days). The median survival of all patients was 234 days (range, 13–646+ days). The major adverse reactions were myelosuppression (grade 3/4 leukopenia and neutropenia were observed in 59% and 88% of the patients, respectively), alopecia, and peripheral neuropathy. Peripheral neuropathy was observed in 19 patients, however, most of the patients recovered after the completion of treatment. A 3-h infusion of paclitaxel is an effective therapy for advanced gastric cancer and is clinically well tolerated by the patients.

Jumbo biopsy techniques have now developed into a therapy called endoscopic mucosal resection (EMR) which can achieve the complete cure of a well-differentiated mucosal adenocarcinoma not more than 2 cm. There is still a possibility to apply EMR to a wider range of early gastric cancer.

Variously oxidized 12 natural abietanes, 6,7-dehydroferruginol methyl ether (3), ferruginol (5), 11-hydroxy-12-oxo-7,9(11),13-abietatriene (7), royleanone (9), demethyl cryptojaponol (12), salvinolone (14), sugiol methyl ether (16), sugiol (17), 5,6-dehydrosugiol methyl ether (19), 5,6-dehydrosugiol (20), 6β-hydroxyferruginol (23), and taxodione (25) were synthesized. Antimicrobial activities of synthesized phenolic diterpenes and their related compounds against MRSA and VRE were evaluated. Phenols (12-hydroxyabieta-8,11,13-trien-6-one 22and 23), catechols (12and 14) and taxodione 25showed potent activity with 4–10μg/mL of MIC against MRSA and 4–16μg/mL of MIC against VRE. (−)-Ferruginol showed more potent activity than natural type (+)-ferruginol. Quinone methide 7showed the most potent activity with 0.5–1μg/mL of MIC against both MRSA and VRE.

A seroepidemiologic, nested case-control studywas conducted to evaluate the risk for atrophicgastritis associated with Helicobacter pylori infection.Atrophic gastritis was diagnosed on the basis of serum pepsinogen levels: pepsinogen I level≤70 ng/ml and pepsinogen I/pepsinogen II ratio≤3.0. Cases were 23 men and 39 women who were notdiagnosed with atrophic gastritis in 1987, but who were diagnosed with the condition in 1992. Controlswere the 120 men and 282 women who did not meet theserologic criteria for atrophic gastritis in either timeperiod. Neither cases nor controls had a history of upper gastrointestinal operations.Helicobacter pylori infection at the initial survey wasassociated with a significantly increased risk ofatrophic gastritis incidence for both sexes combined(odds ratio = 3.72; 95% confidence interval,1.78-7.79; P = 0.0005). Cigarette smoking andconsumption of alcohol and green-yellow vegetables werenot associated with incidence of atrophicgastritis.

Gastric and duodenal ulcer healing and scarring were evaluated with a highly magnifying endoscope. The appearance of scar was classified into three types. Sa, with a depression at the center; Sb, with a pattern of regenerated mucosa reaching the center; and Sc, with a uniform pattern throughout. The relationship between regenerative mucosal patterns and histologic findings of biopsy specimens was investigated in 58 patients with gastric ulcer. Mucosal regeneration was sufficient in 26.7 of patients with Sa pattern, 79.2 of patients with Sb pattern, and 100 with Sc pattern. From prospective endoscopic follow-up observations, the relationship between endoscopic findings of ulcer scars and ulcer relapses was investigated in 80 patients with gastric ulcer and 56 patients with duodenal ulcer. As a result, patients who completed the cycle of ulcer healing from Sa pattern through Sb to Sc patterns had rarely relapse. In contrast, patients with a Sa pattern of mucosal scar showed a high rate of recurrence: 88.8 for gastric ulcer, and 88.0 for duodenal ulcer. Our method of evaluation of gastric and duodenal ulcer healing with a highly magnifying endoscope may have important prognostic and therapeutic implications. It may indicate a population of patients (with Sa scarring pattern) with a high risk of ulcer recurrence and therefore requiring prolonged prophylactic treatment.

o-Quinone methides were generated by a photosensitized cleavage of sulfides under neutral conditions using visible light provided by a 100 Watt spot light and methylene blue as a sensitizer. The key step in the oxidative cleavage is the transfer of one electron form the sulfide to the electronically excited visible dye. The resulting phenylthio radical cation undergoes frangmentation, and the correspondign o-quinone methides are generated and trapped by varied alkenes to yield chromans.

Summary: Thirty cases of ulcerative colitis were examined endoscopically by means of magnifying colonoscope with dye spraying method (the combined method), and their minute mucosal structures were classified into four categories endoscopically, which correlated well with the histological findings. By this procedure, it was easy to detect the subsidence of inflammation of the mucosa in the quiescent phase or to reveal the active inflammatory involvement of the bowel. Moreover, inspecting the minute changes of the colonie mucosa detected by the combined method, remission was more correctly decided and rigid control is contributing to the decrease in the recent rate of recurrence of ulcerative colitis.

Gastric tissue specimens from 20 patients with chronic atrophic gastritis, one of whom also had an early gastric carcinoma, were studied for evidence of Epstein–Barr virus (EBV) infection by Southern blot analysis, DNA and RNA in situhybridization, and immunohistochemistry for the presence of the EBV‐determined nuclear antigen 1 (EBNA‐1) and the latent membrane protein 1 (LMP‐1). EBV DNA was detected in two cases with chronic atrophic gastritis and in the case with early gastric carcinoma by Southern blot hybridization. DNA in situhybridization showed EBV genomes in the epithelial cells of two other cases with chronic atrophic gastritis and in non‐carcinomatous and carcinomatous epithelial cells of the early gastric carcinoma case. EBNA‐1 was detected in all cases. LMP‐1 was detected in areas of intestinal metaplasia in eight patients with chronic atrophic gastritis. EBV‐encoded small RNA 1 (EBER‐1) expression was limited to carcinoma cells. These results show that gastric epithelium is frequently infected with EBV and suggest that prolonged EBV persistence may contribute to the development of gastric carcinoma. © 1997 John Wiley & Sons, Ltd.

Treatment of 2,4-dimethyl-3-furoic acid in THF with LDA gave a dianion (A). Alkylation of Awith methyl iodide, cyclohexanone, 2-methyl-2-cyclohexenone or 3-methoxy-2-cyclohexenone yielded the corresponding alkylated derivatives (2, 3, 4or 5) respectively. The methyl ester (6) was treated with LiMe2Cu to give 4,6-dioxo-14-norfuranoeudesmane (7), a key intermediate for the synthesis of some eudesmanolides and elemanolides.

A 60 year-old man with primary amyloidosis confined to the small intestine was reported. Multiple polyps of the small intestine were found by an upper GI series and enteroscopic polypectomy revealed massive deposition of amyloid in the lamina propria and the submucosa. No predisposing disorder or other sites of deposition were found, and the diagnosis of primary amyloidosis of the small intestine was confirmed.

Gastric tissue specimens from 20 patients with chronic atrophic gastritis, one of whom also had an early gastric carcinoma, were studied for evidence of Epstein–Barr virus (EBV) infection by Southern blot analysis, DNA and RNA in situ hybridization, and immunohistochemistry for the presence of the EBV-determined nuclear antigen 1 (EBNA-1) and the latent membrane protein 1 (LMP-1). EBV DNA was detected in two cases with chronic atrophic gastritis and in the case with early gastric carcinoma by Southern blot hybridization. DNA in situ hybridization showed EBV genomes in the epithelial cells of two other cases with chronic atrophic gastritis and in non-carcinomatous and carcinomatous epithelial cells of the early gastric carcinoma case. EBNA-1 was detected in all cases. LMP-1 was detected in areas of intestinal metaplasia in eight patients with chronic atrophic gastritis. EBV-encoded small RNA 1 (EBER-1) expression was limited to carcinoma cells. These results show that gastric epithelium is frequently infected with EBV and suggest that prolonged EBV persistence may contribute to the development of gastric carcinoma. © 1997 John Wiley & Sons, Ltd.

The Epstein‐Barr virus (EBV) has been reported to be detectable in about 10% of gastric carcinomas. We performed a comparative study of endosonographic findings of EBV‐positive and ‐negative early gastric carcinomas. Epstein‐Barr virus was detected in 11.8% (four of 34) of endosonographically observed early gastric carcinoma lesions. Endoscopic ultrasonography (EUS) revealed a hypoechoic mass in the third layer, which reflected submucosal nodules, in 75% (three of four) of EBV‐associated lesions. Endoscopically, in 66.7% (two of three) of EBV‐associated carcinomas, the depressed lesion was surrounded by a raised margin covered with normal mucosa and was similar to a submucosal tumour (P< 0.05). Histologically, all three cases of EBV‐associated lesions with submucosai tumour invasion had submucosal nodules of carcinoma with lymphoid stroma and 75% (three of four) were located in the gastric body. The ratio of maximal thickness to width of EBV‐associated lesions was significantly larger than that of EBV‐negative lesions, and this tendency was marked in lesions with submucosal rumour invasion (P< 0.05). This study indicated that EUS and endoscopy are of great use for the determination of EBV association with early gastric carcinoma.

Endoscopic ultrasound (EUS) was designed for the evaluation of malignancies; however, its utility has been extended to the assessment of benign disorders, which include inflammatory bowel diseases. Topics discussed in this article include instruments and methods, EUS images in various inflammatory diseases, clinical severity and EUS typing, endoscopic grading of inflammation and EUS typing, extent of disease involvement and EUS typing, response to therapy and EUS typing, changes in EUS findings by treatment, Crohn’s disease, radiation proctitis, ischemic colitis, tuberculosis, and mucosal prolapse syndrome.

Diels-Alder reaction of dienes and in situgenerated quinones was accelerated on a PTFE-fiber in an electrolytic lithium perchlorate / nitromethane system. In the presence of PTFE-fiber on a glassy carbon electrode, unstable quinones were efficiently generated by electrooxidation and trapped by dienes maintained on the poly-fluorinated fiber to give the desired cycloadducts stereoselectively in excellent yields.

New insertion technique in colonoscopy with a middle length colonoscope which is easy to be handled and without guidance of fluoroscopy was reported. Forming a small N-loop at the sigmoid colon, it was easy to pass the sigmoid colon where is one of the most difficult points to pass through. Further, using a stiffening cord, the sigmoid colon and the transverse colon were easily straightened and no more loop was seen. With this technique, ileocecal area was observed in 26 of 30 cases (86.7%), and its average time for the insertion required only 17.4 minutes.

α-1,4-Polygalactosamine (PGA) and N-acetylated α-1,4-polygalactosamine (NAPGA) are chitosan- and chitin-like biodegradable α-1,4-linked polysaccharides, respectively. Radioactivity of 14C-50% N-acetylated PGA injected into hepatomized mice, was found to accumulate more in the liver, kidney, ileum and hepatoma tumor tissues, compared with other organs. To provide a lysosomotropic macromolecular prodrug of doxorubicin (DXR) targeted to hepatoma tumor tissue, DXR was immobilized on water-soluble 6-O-carboxymethyl(CM)-NAPGA by Gly-Phe-Leu-Glyspacer groups (CM-NAPGA/Gly-Phe-Leu-Gly/DXR conjugate). The conjugate showed cathepsin B susceptible DXR release behavior and exhibited remarkable survival effects in mice bearing MH134Y hepatoma implanted by subcutaneous (s.c.) implantation/intravenous (i.v.) injection, compared with free DXR and CM-NAPGA-immobilized DXRs with pentamethylene spacer groups (CM-NAPGA/C5/DXR conjugate).

Endoscopic variceal ligation (EVL) using ‘O’ rings is widely accepted as a treatment of oesophageal varices that is at least as effective as endoscopic injection sclerotherapy but which produces fewer complications. Endoscopic variceal ligation using detachable snares has attracted attention as a safe and easy method of endoscopic treatment for gastric varices. Nineteen patients with acute bleeding from oesophageal or gastric varices were treated in the present study. Of these, 14 patients were treated with EVL using ‘O’ rings and five patients were treated with EVL using detachable snares and the treatment results were evaluated. Haemostasis was achieved in all patients. No serious complications of the procedures were observed. However, recurrences and rebleeding were observed in some patients during the maximum follow‐up period of 24 months. Endoscopic variceal ligation using ‘O’ rings and detachable snares is useful for achieving haemostasis in cases of acute bleeding from oesophageal or gastric varices. However, additional endoscopic sclerotherapy may be needed to eliminate the variceal feeding vessels to further improve the long‐term prognosis of these patients.

A rare case of carcinoma of the ileocecal valve is reported, which is endoscopically confirmed by the colonofiberscope (Olympus CF-LB type apparatus) and a biopsy examination. The characteristic endoscopical findings of this tumor reveals an irregularly shaped tumor with superficial depression circumscribed at the ileocecal valve and the lack of peristalsis. Colonofiberscopy is of value in the differential diagnosis of the ileocecal lesions when carried out in the combination with roentgenographic studies and histological examination using biopsy specimens.

Since intussusception is a common complication of the Peutz-Jeghers polyps, laparotomy should be recommended to remove them. However, all of them will not be palpable or discernible during laparotomy. Operative endoscopy was employed for removing polyps of the small intestine of a 22-year-old female who was previously diagnosed as Peutz-Jeghers syndrome. Using a newly designed enteroscope with two channels (SIF-2C, Olympus), four large polyps over 1 cm in size were removed from the ileum and jejunum with safety.

Although ischemic colitis is not rare in the elderly with episodes of ischemia involving the heart and brain, clinical features of mild cases (transient type) have seldom been reported. Whereas the diagnostic findings of ischemice colitis are said to be longitudinal ulcers and stricture, longitudinal ulcers were noted only in 38% of the transient type in our series. For the correct diagnosis of the transient type, it was necessary to observe slight mucosal changes such as edema, congestion and petechiae by colonoscopy. It is emphasized that for the diagnosis of the mild transient type of ischemic colitis emergency colonoscopy must be performed as soon as possible after the onset of abdominal pain or rectal bleeding.

Background:Although the presence of Epstein-Barr virus has been documented in approximately 7% of patients with gastric carcinoma, the clinical features of Epstein-Barr virus–associated carcinoma have not been well documented. We studied the histologic and endoscopic characteristics of Epstein-Barr virus–associated gastric carcinoma. Methods:We tested 124 gastric carcinomas from 117 patients using in situ hybridization for Epstein-Barr virus encoded small RNA1. The histologic and endoscopic findings in the Epstein-Barr virus–associated groups and the negative control groups were analyzed and compared. Results:Twelve tumors (9.7%) were identified as Epstein-Barr virus associated. These lesions were located mainly in the upper part of the stomach (p< .05) and had a diffuse-type histology (p< .05) compared with those in the control group. Six of seven (85.7%) early Epstein-Barr virus–associated lesions were type 0 IIc (superficial depressed) or a combined type, and 42.9% were accompanied by submucosal nodules of carcinoma with lymphoid stroma. Four of five (80%) advanced Epstein-Barr virus–associated tumors were type 3 (ulcerated without definite limits), thought to be the advanced shape of superficial depressed lesions. Conclusions:Epstein-Barr virus–associated gastric carcinomas often appear as superficial depressed or ulcerated lesions in the upper part of the stomach and have a diffuse-type histology with lymphoid infiltration. (Gastrointest Endosc 1997;45:236-42.)

Steroidal diones and trione, bicyclic diones (7and 8) and a tricyclic dione were adsorbed on silica gel and reduced with BH3.NMe3. The carbonyl groups at C-3 of the steroids, at C-4 of 7and at C-3 of 8were reduced regioselectively. The FT-IR spectra of 5α- and 5β-androstane-3,17-dione adsorbed on silica gel were measured.

Two eudesmanolides having opposite stereochemistry of lactone ring each other, (±)-isoalantolactone and (±)-dihydrocallitrisin were synthesized stereoselectively by a route involving alkylation of 2-methyl-3-furoic acid and oxidation of furan ring.

NMR and CD spectroscopic evidence showed that cis-decalin types of sesquiterpenic ketones, isoligularone (2) and fukinone (3), predominantly adopt “steroid-like” conformations in solution in contrast with ligularone (1) which prefers the “non-steroid-like” one. 13C NMR signal assignments and anomalies in the CD of the furanoketones are also reported.

Two new antimicrobial compounds against Gram-positive bacteria, chinesin I and II, were isolated from the flowers of Hypericum chinenseL. The structures of chinesin I and II were elucidated on the basis of spectral and chemical evidences. Chinesin I is relatively active in the cytotoxicity test with Hela.