scholarly journals The Comparison of the Dietary Intake Loss Between Elderly and Non-Elderly Patients After Gastrectomy for Gastric Cancer

2022 ◽  
Author(s):  
Masato Nakazono ◽  
Toru Aoyama ◽  
Keisuke Komori ◽  
Hayato Watanabe ◽  
Kazuki Kano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Observational Study ◽  
Elderly Patients ◽  
Dietary Intake ◽  
Prospective Observational Study ◽  
The Elderly ◽  
Elderly Group ◽  
Nutritional Intake ◽  
Curative Gastrectomy ◽  
Major Nutrients

Abstract Background/Aim The present study quantified the changes in the dietary and nutritional intake after gastrectomy between elderly and non-elderly patients. Patients and Methods This prospective observational study enrolled patients who underwent curative gastrectomy for gastric cancer. Results Twenty-three patients ≥ 75 years old were classified into the elderly group, and 127 patients < 75 years old were classified into the non-elderly group. The respective median % dietary intake losses at 1 and 3 months postoperatively were −12.4% and −5.3% in the elderly group and −8.3% and −2.8% in the non-elderly group (p = 0.075 and 0.080). On comparing the intake loss of three major nutrients, the respective median % lipid intake losses at 1 and 3 months postoperatively were −13.5% and −5.8% in the elderly group and −7.3% and 0% in the non-elderly group (p = 0.029 and 0.045). Conclusion Our results suggested that elderly patients experienced more serious lipid intake loss after gastrectomy than non-elderly patients.

The Comparison of the Dietary Intake Loss Between Elderly and Non-elderly Patients after Gastrectomy for Gastric Cancer

2021 ◽  
Author(s):  
Masato Nakazono ◽  
toru aoyama ◽  
Keisuke Komori ◽  
Hayato Watanabe ◽  
kazuki kano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Observational Study ◽  
Elderly Patients ◽  
Dietary Intake ◽  
Prospective Observational Study ◽  
The Elderly ◽  
Elderly Group ◽  
Nutritional Intake ◽  
Curative Gastrectomy ◽  
Major Nutrients

Abstract Background/Aim: The present study quantified the changes in the dietary and nutritional intake after gastrectomy between elderly and non-elderly patients. Patients and Methods: This prospective observational study enrolled patients who underwent curative gastrectomy for gastric cancer. Results: 23 patients ≥75 years old were classified into the elderly group, and127 patients <75 years old were classified into the non-elderly group. The respective median % dietary intake losses at one and three months postoperatively were -12.4% and -5.3% in the elderly group and -8.3% and -2.8% in the non-elderly group (p=0.075 and 0.080). On comparing the intake loss of three major nutrients, the respective median % lipid intake losses at 1 and 3 months postoperatively were -13.5% and -5.8% in the elderly group and -7.3% and 0% in the non-elderly group (p=0.029 and 0.045). Conclusion: Our results suggested that elderly patients experienced more serious lipid intake loss after gastrectomy than non-elderly patients.

scholarly journals Safety of High-Dose Dabigatran in Elderly and Younger Patients with a Low Bleeding Risk: A Prospective Observational Study

Cardiology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Aharon Erez ◽  
Gregory Golovchiner ◽  
Robert Klempfner ◽  
Ehud Kadmon ◽  
Gustavo Ruben Goldenberg ◽  
...  
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Bleeding Risk ◽  
The Elderly ◽  
High Dose ◽  
World Population ◽  
Younger Patients ◽  
End Point

<b><i>Introduction:</i></b> In patients with atrial fibrillation (AF) at risk for stroke, dabigatran 150 mg twice a day (DE150) is superior to warfarin for stroke prevention. However, there is paucity of data with respect to bleeding risk at this dose in elderly patients (≥75 years). We aimed to evaluate the safety of DE150 in comparison to warfarin in a real-world population with AF and low bleeding risk (HAS-BLED score ≤2). <b><i>Methods:</i></b> In this prospective observational study, 754 consecutive patients with AF and HAS-BLED score ≤2 were included. We compared outcome of elderly patients (age ≥75 tears) to younger patients (age &#x3c;75 years). The primary end point was the combined incidence of all-cause mortality, stroke, systemic emboli, and major bleeding event during a mean follow-up of 1 year. <b><i>Results:</i></b> There were 230 (30%) elderly patients, 151 patients were treated with warfarin, and 79 were treated with DE150. Fifty-two patients experienced the primary endpoint during the 1-year follow-up. Among the elderly, at 1-year of follow-up, the cumulative event rate of the combined endpoint in the DE150 and warfarin was 8.9 and 15.9% respectively (<i>p</i> = 0.14). After adjustment for age and gender, patients who were treated with DE150 had a nonsignificant difference in the risk for the combined end point as patients treated with warfarin both among the elderly and among the younger population (HR 0.58, 95% C.I = 0.25–1.39 and HR = 1.12, 95% C.I 0.62–2.00, respectively [<i>p</i> for age-group-by-treatment interaction = 0.83). <b><i>Conclusions:</i></b> Our results suggest that Dabigatran 150 mg twice a day can be safely used among elderly AF patients with low bleeding risk.

scholarly journals Characteristics and prognostic outcome factors in elderly peritoneal dialysis patients:a prospective observational study

2020 ◽  
Author(s):  
Xiaoying Ma ◽  
HaiPing Xu ◽  
FuYun Sun
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Diabetic Nephropathy ◽  
Heart Disease ◽  
Peritoneal Dialysis ◽  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Elderly Group ◽  
Dialysis Patients

Abstract Background: This study aimed to analyze the characteristics, outcomes and prognosis factors of survival in elderly peritoneal dialysis patients, so as to better understand the status of elderly peritoneal dialysis patients and improve their quality of life.Methods: This study was a prospective, observational study that included peritoneal dialysis (PD)patients.Categorizing by age, elderly group aged ≥ 65, younger group aged < 65. Clinical characteristics, survival and transferring to hemodialysis were compared between two groups.Meanwhile, risk factors for death in elderly PD patients were explored.Results: A total of 202 PD patients were enrolled, including 61 in elderly group and 141 in younger group. Among elderly individuals,serum albumin and normalized protein catabolic rate(nPCR) decreased, the incidence of previous cardiovascular, cerebrovascular diseases and Charlson Comorbidity Index(CCI) were higher.The major primary disease in elderly patients was diabetic nephropathy, significant differences were found between elderly and younger group(P < 0.01). The mortality in elderly group was substantially higher, 27 patients (44.3%) died in elderly group and 21 patients(14.3%) died in younger group .The 1-year,2-year,3-year,4-year survival rate were 81.97%, 70.49%, 60.66%, 55.74% respectively. Cardiovascular disease was the main cause of death in elderly PD patients. Higher BMI, CCI, and previous ischemic heart disease were risk factors for long-term survival of elderly PD patients. Compared with the younger group, elderly patients were less likely to transfer to hemodialysis: 2 cases (3.3%) in elderly group and 23 cases (16.3%) in younger group. Peritonitis was the primary reason for converting to hemodialysis(HD) in both two groups.Conclusions: Poor nutrition, more complications and diabetic nephropathy were characteristics of elderly PD patients. High BMI, CCI and previous ischemic heart disease were independent predictors of death in elderly PD patients. Cardiovascular disease was the main cause of death in elderly PD patients，while the chief reason of transferring to hemodialysis was peritonitis.

scholarly journals Characteristics and prognostic outcome factors in elderly peritoneal dialysis patients:a prospective observational study

2020 ◽  
Author(s):  
Xiaoying Ma ◽  
HaiPing Xu ◽  
FuYun Sun
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Diabetic Nephropathy ◽  
Peritoneal Dialysis ◽  
Observational Study ◽  
Elderly Patients ◽  
Cause Of Death ◽  
Prospective Observational Study ◽  
Elderly Group ◽  
Dialysis Patients

Abstract Background This study aimed to analyze the characteristics, outcomes and prognosis factors of survival in elderly peritoneal dialysis patients, so as to better understand the status of elderly peritoneal dialysis patients and improve their quality of life.Methods This study was a prospective, observational study that included peritoneal dialysis (PD)patients.Categorizing by age, elderly group is aged ≥ 65, younger group is aged < 65. Clinical characteristics, survival and transferring to hemodialysis were compared between two groups.Meanwhile, risk factors of death in elderly PD patients were explored.Results A total of 202 PD patients were enrolled, including 61 in elderly group and 141 in younger group. The comparison of baseline data between two groups: in elderly group serum albumin and normalized protein catabolic rate(nPCR) decreased, the incidence of previous cardiovascular and cerebrovascular diseases and Charlson Comorbidity Index(CCI) were higher, the major primary disease in elderly patients was diabetic nephropathy, significant differences were found between elderly and younger group(P < 0.01). The mortality in elderly group was substantially higher, 27 patients (44.3%) died in elderly group and 21 patients(14.3%) died in younger group .The 1-year,2-year,3-year,4-year survival rate were 81.97%, 70.49%, 60.66%, 55.74%,respectively. Cardiovascular disease was the main cause of death in elderly PD patients. Higher BMI 、CCI, and previous ischemic heart disease(IHD)were risk factors for long-term survival of elderly PD patients. Compared with the younger group, elderly patients were less likely to transfer to hemodialysis: 2 cases (3.3%) in elderly group and 23 cases (16.3%) in younger group. Peritonitis was primary reason for converting to hemodialysis(HD) in both two group.Conclusions Poor nutrition, more complications and diabetic nephropathy were characteristics of elderly PD patients. High BMI, CCI and previous IHD were independent predictors of death in elderly PD patients. Cardiovascular disease was the main cause of death in elderly PD patients,while the chief reason of transferring to hemodialysis was peritonitis.

Second-line chemotherapy with paclitaxel for elderly patients with advanced gastric cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 108-108 ◽  
Author(s):  
Akihiro Ohba ◽  
Atsuo Takashima ◽  
Takamasa Nishiuchi ◽  
Yoshitaka Honma ◽  
Satoru Iwasa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adverse Events ◽  
Elderly Patients ◽  
Advanced Gastric Cancer ◽  
Progression Free Survival ◽  
The Elderly ◽  
Elderly Group ◽  
Second Line ◽  
Second Line Chemotherapy ◽  
Line Chemotherapy

108 Background: Survival benefits of second-line chemotherapy such as weekly paclitaxel (wPTX) for patients with advanced gastric cancer (AGC) were shown in several phase 3 trials. However, these trials included a small proportion of elderly patients, and few elderly patients receive second-line therapy in clinical practice. The aim of this study was to compare the efficacy and safety of second-line chemotherapy with wPTX between elderly and non-elderly patients. Methods: The subjects of this retrospective study were AGC patients who received wPTX as second-line chemotherapy between January 2002 and August 2014, fulfilling the following selection criteria; 1) pathologically proven metastatic or recurrent gastric adenocarcinoma, 2) receipt of wPTX after platinum or fluoropyrimidine containing chemotherapy. Patients were divided into two groups by age: ≥ 75 years old (elderly group) and < 75 years old (non-elderly group). Response rate (RR) in patients with measurable lesions, overall survival (OS), progression-free survival (PFS), post-progression survival (PPS) and adverse events were evaluated. Hazard ratios of survival were adjusted by prognostic factors using Cox proportional hazard model. Results: A total of 272 patients, 31 elderly and 241 non-elderly, were selected in this study. RRs were 6.2% (1/16) in the elderly group and 12.7% (15/118) in the non-elderly group (p = 0.69). While PFS was similar between two groups (median 2.4 vs. 3.6 months, adjusted hazard ratio [HR] 1.18, p = 0.46), the elderly group showed shorter OS than the non-elderly group (median 5.1 vs. 6.1 months, adjusted HR 1.49, p = 0.06), associated with relatively shorter PPS (median 2.2 vs. 2.6 months, adjusted HR 1.40, p = 0.11). There were no remarkable differences in the incidences of grade 3 or higher adverse events between the two groups (hematologic 38.7 vs. 41.1%; non-hematologic 25.8 vs. 23.7%). No treatment related deaths were observed in either group. Third-line chemotherapy was administered in 19.4% of elderly group and 35.3% of non-elderly group (p = 0.11). Conclusions: It is suggested that second-line chemotherapy with wPTX for AGC may be tolerable and have some clinical benefits for elderly patients as well as for non-elderly patients.

scholarly journals Efficacy of endoscopic retrograde cholangiopancreato-graphy in elderly patients

2016 ◽  
Vol 45 (1) ◽  
pp. 44-46
Author(s):  
Chittaranjan Das ◽  
Ashis Saha ◽  
Faruk Hossain ◽  
Md Mokhlesur Rahman ◽  
Rakibul Hasan ◽  
...  
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Biliary Tract ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Prospective Observational Study ◽  
The Elderly ◽  
Therapeutic Use ◽  
Data Sheet ◽  
Endoscopic Retrograde ◽  
Therapeutic Ercp

The incidence of biliary tract pathologies increases as the population ages leading to an increase in the demand of therapeutic use of endoscopic retrograde cholangiopancreatography (ERCP). This study was carried out to assess the effectiveness of therapeutic ERCP in elderly patients. It was a prospective observational study. Patients aged 65 years or more referred for therapeutic ERCP from July 2007 to June 2008 were reviewed by a preformed data sheet which included all the relevant details of the procedure. It was collected at the time of ERCP & before discharge. Of 67 patients audited, successful therapeutic ERCP was performed in 91.04% cases. Our study showed that ERCP was effective in the elderly patients.Bangladesh Med J. 2016 Jan; 45 (1): 44-46

scholarly journals Prospective observational study in elderly patients with non-valvular atrial fibrillation: Rationale and design of the All Nippon AF In the Elderly (ANAFIE) Registry

2018 ◽  
Vol 72 (4) ◽  
pp. 300-306 ◽  
Author(s):  
Hiroshi Inoue ◽  
Takeshi Yamashita ◽  
Masaharu Akao ◽  
Hirotsugu Atarashi ◽  
Takanori Ikeda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
The Elderly

Curative Surgery for Gastric Cancer in the Elderly: Treatment Decisions, Surgical Morbidity, Mortality, Prognosis and Quality of Life

2007 ◽  
Vol 93 (5) ◽  
pp. 478-484 ◽  
Author(s):  
Adolfo Pisanu ◽  
Alessandro Montisci ◽  
Sara Piu ◽  
Alessandro Uccheddu
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Elderly Patients ◽  
Subtotal Gastrectomy ◽  
The Elderly ◽  
Tumor Stage ◽  
Curative Surgery ◽  
Curative Gastrectomy ◽  
Younger Patients

Aims and Background Surgical risk is deemed to be higher in the aged population because there are often comorbidities that may affect the postoperative result. This consideration is important for the treatment decision-making for gastric cancer in the elderly. The aim of this study was to identify factors influencing mortality, morbidity, survival and quality of life after curative surgery for gastric cancer in patients aged 75 years and older, and to plan their appropriate management. Methods and Study Design From January 1993 to December 2004, 135 patients underwent surgery at our department because of gastric cancer. Ninety-four of these patients (69.6%) underwent potentially curative gastrectomy. A cross-sectional study of 23 patients aged 75 years and older and 71 younger patients who underwent curative gastrectomy was carried out: patient characteristics, tumor characteristics, management, morbidity, mortality, survival, and quality of life were evaluated. Results Elderly patients had significantly more comorbidities and a poorer nutritional status than younger patients. The surgical procedures were similar in both groups and the overall morbidity rate was 27.9% and the overall mortality rate 8.5%. Medical mortality was significantly higher in elderly patients, and the presence of comorbidities was the only independent factor affecting mortality. The 5-year survival rate was 56.2% in the older group versus 62.1% in the younger group and tumor stage was the only prognostic factor influencing survival. Quality of life after surgery was similar in both groups. The significantly better postoperative functional outcome after subtotal gastrectomy suggested a better compliance of elderly patients with subtotal than total gastrectomy. Conclusions In the elderly, surgical strategies must be modulated on the basis of comorbidities, tumor stage and future quality of life. Since elderly patients have no worse prognosis than younger patients, age is not a contraindication to curative resection for gastric cancer. Subtotal gastrectomy should be the procedure of choice mainly in elderly patients as it offers better quality of life.

scholarly journals The association between hypoglycemia and glycemic variability in elderly patients with type 2 diabetes: a prospective observational study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Takahisa Handa ◽  
Akinobu Nakamura ◽  
Aika Miya ◽  
Hiroshi Nomoto ◽  
Hiraku Kameda ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Multivariate Logistic Regression Analysis ◽  
Glycemic Variability ◽  
Multivariate Logistic Regression

Abstract Background This study aimed to explore predictive factors of time below target glucose range (TBR) ≥ 1% among patients’ characteristics and glycemic variability (GV) indices using continuous glucose monitoring data in elderly patients with type 2 diabetes. Methods We conducted a prospective observational study on 179 (71 female) Japanese outpatients with type 2 diabetes aged ≥ 65 years. The characteristics of the participants with TBR ≥ 1% were evaluated by multivariate logistic regression analysis. Receiver-operating characteristic (ROC) curve analyses of GV indices, comprising coefficient of variation (CV), standard deviation, and mean amplitude of glycemic excursions, were performed to identify the optimal index for the identification of patients with TBR ≥ 1%. Results In the multivariate logistic regression analysis, none of the clinical characteristics, including HbA1c and C-peptide index, were independent markers for TBR ≥ 1%, while all three GV indices showed significant associations with TBR ≥ 1%. Among the three GV indices, CV showed the best performance based on the area under the curve in the ROC curve analyses. Conclusions Among elderly patients with type 2 diabetes, CV reflected TBR ≥ 1% most appropriately among the GV indices examined. Trial registration UMIN-CTR: UMIN000029993. Registered 16 November 2017

FRI0075 DECREASED RISKS OF HOSPITALIZED INFECTION UNDER TARGETED THERAPIES VS METHOTREXATE IN ELDERLY AND OLDER ELDERLY PATIENTS COMPARED TO YOUNGER PATIENTS WITH RHEUMATOID ARTHRITIS USING JAPANESE HEALTH INSURANCE DATABASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 614-615
Author(s):  
R. Sakai ◽  
E. Tanaka ◽  
M. Majima ◽  
M. Harigai
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Insurance ◽  
Elderly Patients ◽  
The Elderly ◽  
Young Group ◽  
Elderly Group ◽  
Research Support ◽  
Chugai Pharmaceutical ◽  
Insurance Database ◽  
Icd10 Code

Background:Recently, vital prognosis has been improved in patients with rheumatoid arthritis (RA)1. In elderly patients, it is difficult to establish a treatment strategy due to multi-morbidities and treatment-related risks. Since older age is a significant risk factor of serious infections, one of the primary concerns during treatment of RA, rheumatologists should always strike a balance between efficacy and safety of the immunosuppressive treatment. However, infection data under the targeted therapy (TT) in elderly patients is still limited to date.Objectives:To compare the risk of hospitalized infection (HI) under the TT among young, elderly, and older elderly patients with RA using the Japanese health insurance database.Methods:This retrospective longitudinal population-based study was conducted using claims data in Japan provided by Medical Data Vision Co., Ltd. We defined individuals as RA cases if they met all of the following: 1) having at least one ICD10 code (M05x, M06x except for M061, or M08x except for M081 and M082); 2) having at least one prescription of disease-modifying antirheumatic drugs (DMARDs) including methotrexate (MTX) and TT (biological DMARDs and Janus kinase inhibitors) between April 2008 and September 2018; and 3) 16 years old or older. We define the month patients met the above all criteria for the first time in this database as the index month. We excluded patients who were prescribed any DMARDs during the first 12 months from MTX users and those with prescription of any TT during the first 12 months from TT users (i.e., prevalent users). Among the study population, we divided patients into 3 groups according to their age at the index month; young group (16-64), elderly group (65-74), and older elderly group (>=75). The observation started from the index month and ended at 36 months later, the last month of the exposure of DMARDs, the month of loss of follow-up, or September 2019, whichever came first. HI was defined by ICD10 code with one prescription of predefined drugs for each infection during hospitalizations. Some of HIs were defined by ICD10 code alone.Results:In this study, 8269, 6454, 5745 patients with RA were included in the young, elderly, and older elderly groups, respectively. The incidence rate (IR) of HI (/100 patient-years [PY]) [95%CI] was 3.4 [3.1-3.7] in the young group, 5.8 [5.3-6.3] in the elderly group, and 12.0 [11.2-12.8] in the older elderly group. IR rate (IRR) of HI (reference: the young group) was 1.7 [1.5-1.9] in the elderly group and 3.6 [3.2-4.0] in the older elderly group. In the young group, the IRR of HI in TT users vs MTX users was significantly elevated (1.8 [1.5-2.1]), whereas, those of the elderly and the older elderly groups were significantly decreased (IRR 0.8 [0.7-0.9] for elderly; 0.6 [0.5-0.7] for older elderly). Concomitant use of immunosuppressive DMARDs or prednisolone >=10mg/day with TT became less frequent with aging.Conclusion:The elderly and older elderly patients had significantly higher risks of HI compared to the young. The risk of HI under the TT compared to MTX was decreased in the elderly patients, probably due to adjusting for treatment by attending physicians.References:[1]Arthritis Rheum 2014;66:786-93Acknowledgments:This work was supported by JSPS KAKENHI Grant Number 17K08963.Disclosure of Interests:Ryoko Sakai Grant/research support from: Tokyo Women’s Medical University (TWMU) has received unrestricted research grants forDivision of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases from Ayumi Pharmaceutical Co. Ltd., Bristol Meyers Squib, Chugai Pharmaceutical Co. Ltd., Nippon Kayaku Co. Ltd., Taisho Toyama Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp., and with which TWMU paid the salary of R.S., Eiichi Tanaka Consultant of: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Speakers bureau: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., masako majima: None declared, masayoshi harigai Grant/research support from: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., and Teijin Pharma Ltd. MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Oxford Immuotec, Pfizer Japan Inc., and Teijin Pharma Ltd. MH is a consultant for AbbVie, Boehringer-ingelheim, Kissei Pharmaceutical Co., Ltd. and Teijin Pharma.

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