ObjectivesTo investigate the efficacy of vibegron on nocturia in patients with overactive bladder.MethodsAmong the Japanese overactive bladder patients enrolled in the placebo‐controlled, multicenter, randomized, double‐blind phase 3 study of vibegron, a total of 669 patients with nocturia (≥1 nocturnal void) were included. Changes from baseline in micturition parameters were compared for vibegron treatment (50 and 100 mg/day) versus placebo. Correlations of hours of undisturbed sleep with the frequency of nocturnal voiding and the volume of the first nocturnal voiding were examined. Demographics and baseline characteristics contributing to reduction in the frequency of nocturnal voiding were also analyzed.ResultsAt week 12, the frequency of nocturnal voiding was reduced from baseline by 0.74 and 0.78, respectively, for the vibegron 50 and 100 mg groups; the reductions were significant when compared with the placebo group (P < 0.05 and P < 0.001, respectively). The mean volume of nocturnal voids and the volume of the first nocturnal voiding were significantly greater in the vibegron groups than in the placebo group. The vibegron groups showed significant correlations of hours of undisturbed sleep with the changes in the frequency of nocturnal voiding and in the volume of the first nocturnal voiding. Vibegron treatment, no previous treatment with anticholinergics, ≥12 voids per day and hours of undisturbed sleep <180 min significantly contributed to a reduction in the frequency of nocturnal voiding.ConclusionsVibegron is a useful therapeutic option for improving nocturia in patients with overactive bladder.
Fracture of the anterior arch of the atlas is a rare complication of foramen magnum decompression(FMD)for Chiari malformation. We report a case of a fracture of the anterior arch of the atlas after FMD. A 42-year-old woman was referred to our hospital from a nearby clinic where Chiari malformation and syringomyelia were incidentally detected during head magnetic resonance imaging (MRI)examination for headache. We performed FMD and tonsillectomy for the Chiari malformation. The patient had an uneventful postoperative course and was in good condition when discharged. She developed neck pain without any preceding incident approximately 7 months after surgery. Subsequently, she experienced neck pain during flexion, extension, and sneezing. Neck computed tomography(CT)performed at a nearby clinic revealed a fracture of the anterior arch of the atlas, and she was referred to our hospital once again. Although neck radiography did not confirm an instability of the craniocervical junction, the neck pain progressed;thus, posterior atlantoaxial fusion was performed. Due to the thinning of the C2 vertebral pedicles, part of the C2 vertebral arch was removed during FMD, and pars screws were inserted into the C2 vertebra with lateral mass screws inserted into the C1 vertebra. The subsequent postoperative course was uneventful. Three cases have been reported in the literature, and the mechanism of injury(e.g., trauma)was not confirmed in all of them. Posterior fusion was used in 2 cases, external immobilization with a halo vest was used in 1 case, and fracture healing was achieved with a good prognosis in all three cases. When neck pain develops a few months after FMD, fracture of the anterior arch of the atlas should be suspected and preferably confirmed using CT.
In recent years, the usage of various alternative energies is considered from a viewpoint of CO2 emission reduction. Toyota Motor Corporation considers that Plug-in Hybrid Electric Vehicles (PHEVs) is the best practical solution, and has launched Prius Plug-in Hybrid in January 2012.Prior to this, in December 2009, Toyota sold 650 PHEVs through lease programs for validation testing in Europe, the U.S. and Japan. As a result, not only the fuel reduction effect in case of real market usage was confirmed, but also the relationship between frequency of charging and fuel reduction effect.This paper discusses the analysis of the validation test results.
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