ObjectivesThis is the first clinical trial of this type in Japan, designed to analyze two important aspects of Alzheimer’s disease (AD) management using medium-chain triglycerides. Axona was administered for 3 months (40 g of powder containing 20 g of caprylic triglycerides). We used an indurating, four-step dose-titration method (from 10 to 40 g per day) for 7 days before the trial, and examined the tolerance and adverse effects of this intervention. We also investigated its effect on cognitive function in mild-to-moderate AD patients.Patients and methodsThis was a clinical intervention in 22 Japanese patients with sporadic AD at a mild-to-moderate stage (ten females, 12 males), mean age (± standard deviation) 63.9 (±8.5) years, Mini-Mental State Examination (MMSE) score, 10–25, seven patients were ApoE4-positive. During Axona administration, we examined changes in cognitive function by obtaining MMSE and AD assessment-scale scores. Intolerance and serum ketone concentrations were also examined.ResultsThe tolerance of Axona was good, without severe gastrointestinal adverse effects. Axona did not improve cognitive function in our sample of AD patients, even in those patients without the ApoE4 allele. However, some ApoE4-negative patients with baseline MMSE score ≥14 showed improvement in their cognitive functions.ConclusionThe modified dose-titration method, starting with a low dose of Axona, decreased gastrointestinal adverse effects in Japanese patients. Axona might be effective for some relatively mildly affected patients with AD (with cognitive function MMSE score of ≥14 and lacking the ApoE4 allele).

The results, specifically that lower serum IGF-I was associated with cognitive impairment, suggest that metabolism of IGF-I may be involved in the pathogenesis of cognitive deficits in Alzheimer's disease.

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OBJECTIVES: Emergence agitation (EA) is a common and troublesome problem in pediatric patients recovering from general anesthesia. The incidence of EA is reportedly higher after general anesthesia maintained with sevoflurane, a popular inhalational anesthetic agent for pediatric patients. We conducted this prospective, randomized, double-blind study to test the effect of an intravenous ultra-short–acting barbiturate, thiamylal, administered during induction of general anesthesia on the incidence and severity of EA in pediatric patients recovering from Sevoflurane anesthesia. METHODS: Fifty-four pediatric patients (1 to 6 years of age) undergoing subumbilical surgeries were randomized into 2 groups. Patients received either intravenous thiamylal 5mg/kg (Group T) or inhalational Sevoflurane 5% (Group S) as an anesthetic induction agent. Following induction, general anesthesia was maintained with Sevoflurane and nitrous oxide (N2O) in both groups. To control the intra- and post-operative pain, caudal block or ilioinguinal/iliohypogastric block was performed. The incidence and severity of EA were evaluated by using the Modified Objective Pain Scale (MOPS: 0 to 6) at 15 and 30 min after arrival in the post-anesthesia care unit (PACU). RESULTS: Fifteen minutes after arrival in the PACU, the incidence of EA in Group T (28%) was significantly lower than in Group S (64%; p = 0.023) and the MOPS in Group T (median 0, range 0 to 6) was significantly lower than in Group S (median 4, range 0 to 6; p = 0.005). The interval from discontinuation of Sevoflurane to emergence from anesthesia was not significantly different between the 2 groups. CONCLUSIONS: Thiamylal induction reduced the incidence and severity of EA in pediatric patients immediately after Sevoflurane anesthesia.

Background Treatment with adalimumab (ADA) has been reported to improve work productivity and reduce indirect cost due to work impairment in patients with rheumatoid arthritis (RA). The impact of disease duration at the time of treatment initiation on work impairment is less well understood. Objectives To assess the impact of disease duration before starting treatment with ADA on work productivity and economic benefit in Japanese patients with RA. Methods Data were taken from the first 24 weeks of a 48-week, multicenter, prospective, single-cohort study of self-reported work productivity and activity impairment in 897 Japanese patients with RA receiving ADA.1 Patients were divided by quartiles (Q) based on disease duration at the time of ADA initiation. Work-related outcomes (absenteeism, presenteeism, overall work impairment [OWI], and activity impairment [AI]) were measured using the Work Productivity and Activity Impairment questionnaire for rheumatoid arthritis (WPAI/RA). Disease activity score based on 28 joint counts (DAS28) and the Health Assessment Questionnaire Disability Index (HAQ-DI) were used to assess clinical and functional response, respectively. For the comparison of changes in clinical response and WPAI domain scores by quartiles of disease duration, contrast test (linear trend) was performed with adjustments for baseline factors. Life saved productivity loss was estimated using OWI score and basic wages in Japanese workers 2012 by Ministry of Health Labor and Welfare. Results At week 24, disease activity measures and WPAI/RA domain scores were significantly improved across quartiles. There were statistically significant decreasing trends in the percentage of patients achieving DAS28-ESR and HAQ-DI remission after 24 weeks of treatment with longer disease duration. Similarly, there were statistically significant decreasing trends in changes of OWI and AI (activity impairment) from baseline to week 24 with increasing disease duration (table). The estimated life saved productivity losses due to OWI for paid workers in this analysis were €88,292 for Q1, €61,541 for Q2, €55,677 for Q3 and €36,177 for Q4 (€1 = $1.40). Conclusions Shorter disease duration before starting ADA treatment leads to better clinical response and work related outcomes in Japanese patients with RA. Earlier ADA treatment has an economic impact on lifetime benefit in Japanese RA patients. References Y. Tanaka, et al. ACR2013, Poster #2366 Acknowledgements This study was sponsored by AbbVie and Eisai Co., Ltd. AbbVie contributed to the study design, research, and interpretation of data, writing, reviewing, and approving the publication. Disclosure of Interest T. Takeuchi Grant/research support: AbbVie GK., Astellas Pharma, Bristol-Myers K.K., Chugai Pharmaceutical Co, Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Nippon Shinyaku Co., Ltd., Pfizer Japan Inc., Sanofi-Aventis K.K., Santen Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and...