Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
50 巻, 18 号
選択された号の論文の50件中1~50を表示しています
REVIEW ARTICLE
  • Gülfidan Aras
    2011 年 50 巻 18 号 p. 1869-1877
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Vasculitis is pathologically identified as specific cellular inflammation, vessel destruction, and tissue necrosis. Current classifications of vasculitis such as the Chapel Hill Classification (CHCC) and American College of Rheumatology (ACR) guidelines are not sufficiently adequate for clinicians to diagnose vasculitis. The biomarkers that are currently in clinical use such as PR3-ANCA and MPO-ANCA, only help in diagnosing small vessel vasculitis and their sensitivity and specificity are not sufficient. However, recent developments related to the pathogenesis and etiopathogenesis of vasculitis have the potential to contribute to new and improved biomarkers. The determination of diverse roles of ANCA and synergistic effects of infection, genetic, environmental factors and drugs on pathogenesis is quite important. The demonstration of a new autoantibody directed to hLAMP-2 and the resemblance to some microbial structures, in addition to the determination of the possible roles of hepatitis B and C on vasculitis are important findings. These hints may lead to new biomarker developments, providing a better method to diagnose vasculitis. The evidence on T cell immunity as circulatory and lesional will likely contribute to the development of new drugs for vasculitis.
ORIGINAL ARTICLES
  • Qiao-Ming Zhi, Li-tao Yang, Hai-chen Sun
    2011 年 50 巻 18 号 p. 1879-1887
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Objective To evaluate the possible therapeutic effect of ambroxol on pulmonary fibrosis induced by paraquat.
    Methods Adult male Sprague-Dawley rats (n=144, 200-250 g) were divided into four groups (Control, Ambroxol, Paraquat, and Paraquat+Ambroxol group) and sacrificed on day 1, 3, 5, 7, 14 and 28. Several significant oxidant stress markers (MDA, SOD and GSH-PX), MPO activity, cytokines (TNF-α, MCP-1, TGF-β1, MMP-2 and TIMP-1), total inflammatory cell count, hydroxyproline content, collagen I and III mRNA were analyzed.
    Results In Paraquat group, the MDA, MPO activity, hydroxyproline contents, the mRNA expression of TNF-α, MCP-1, TGF-β1, MMP-2, TIMP-1, collagen I, collagen III and the number of total inflammatory cells were up-regulated in lung tissue, but SOD and GSH-PX activity were down-regulated in lung tissue compared with Control group (p<0.05). In paraquat+ambroxol group, the MDA, MPO activity, hydroxyproline content, the mRNA expression of TNF-α, MCP-1, TGF-β1, MMP-2, TIMP-1 collagen I, collagen III and the number of total inflammatory cells were significantly decreased, while the SOD and GSH-PX activities in lung tissue were increased compared with Paraquat group (p<0.05). Histological examination of paraquat-treated rats showed lung injury with interstitial edema and widespread inflammatory cell infiltration in the alveolar space and septum, as well as pulmonary fibrosis. Ambroxol could markedly reduce such damage in lung tissue and prevent pulmonary fibrosis.
    Conclusion The results of this study indicated that ambroxol could reduce lung damage and prevent pulmonary fibrosis induced by paraquat.
  • Atsushi Iwata, Shin-ichiro Miura, Joji Morii, Sho-ichi Yamagishi, Keij ...
    2011 年 50 巻 18 号 p. 1889-1894
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Objective Recent evidence has strongly suggested that atherosclerosis is an angiogenic disease, and PEDF may play a significant role in determining the balance of angiogenesis/antiangiogenesis during atherogenesis. Therefore, we assessed the associations among plasma levels of pigment epithelium-derived factor (PEDF), high-sensitivity C-reactive protein (hsCRP), the lipid profile and tissue characteristics of coronary plaque as assessed by integrated backscatter intravascular ultrasound (IB-IVUS).
    Methods Fifty-two consecutive patients with stable coronary artery disease who underwent percutaneous coronary intervention were enrolled. Non-target coronary lesions with mild to moderate stenosis were measured by IB-IVUS. A total of 20 IB-IVUS images were recorded at an interval of 0.5 mm for a length of 10 mm in each plaque.
    Results Although the percentage of plaque volume (%PV, 100×total PV/total vessel volume), percentage of lipid volume (%LV, 100×LV/PV) and percentage of fibrous volume (%FV, 100×FV/PV) were not associated with plasma log[PEDF] levels in the overall patients, in the patients without statin treatment %LV and %FV were correlated with plasma log[PEDF] levels (r=0.525, p=0.021 and r=-0.498, p=0.030, respectively).
    Conclusion The plasma level of PEDF may be a useful biomarker for predicting the tissue characteristics of coronary plaque using IB-IVUS.
  • Susumu Kashine, Ken Kishida, Tohru Funahashi, Tetsuyuki Yasuda, Kohei ...
    2011 年 50 巻 18 号 p. 1895-1903
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Objective Sleep-disordered breathing (SDB) is a potential risk factor for cardiac sudden death. Recent studies have reported that patients with type 2 diabetes mellitus (T2DM) frequently suffer from SDB. Although the roles of hyperglycemia, disturbances of the autonomic nervous system and obesity have been postulated, the factors related to SDB in T2DM, especially those related to improvement of SDB remain unknown. We investigated the significance of waist circumference (WC), representing excess visceral fat, body mass index (BMI), glycemic control and other clinical parameters on SDB in T2DM.
    Methods and Subjects Forty inpatients received treatment for T2DM. Overnight cardiorespiratory monitoring and laboratory tests were conducted before and after treatment of T2DM.
    Results The apnea-hypopnea index (AHI) at admission correlated positively with BMI, neck circumference, WC, and systolic and diastolic blood pressures, but not with Log 1,5-anhydro-D-glucitol (1,5-AG) and presence or absence of diabetic neuropathy. Stepwise multiple regression analysis identified BMI and WC as significant determinants of AHI. After 2 or 3 weeks of glucose-lowering therapy, hyperglycemia was controlled and significant reductions in AHI, BMI, WC, 1,5-AG, leptin, high-sensitivity C-reactive protein (hs-CRP), and an oxidative stress marker, thiobarbituric acid reactive substances (TBARS) were observed. The fall in AHI correlated significantly with changes in WC independent of BMI, 1,5-AG, leptin, hs-CRP, and TBARS.
    Conclusion Our results demonstrated that reduction of WC correlated with improvement in SDB independent of glycemic control in T2DM, and that abdominal obesity might be a target for the treatment of SDB and prevention of potential cardiovascular diseases in T2DM.
  • Hiroshi Matsumoto, Yume Nagaoka, Tomonari Okada, Toshikazu Wada, Asako ...
    2011 年 50 巻 18 号 p. 1905-1910
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Objective The optimal therapeutic approach to patients with idiopathic membranous nephropathy (IMN) remains controversial. In this study, we assessed the efficacy of single daily dose cyclosporine (CsA) combined with low-dose prednisolone (PSL) and an angiotensin II receptor blocker (ARB) in patients with IMN.
    Methods We studied 13 nephrotic patients (8 men, 5 women) with IMN diagnosed on biopsy. An initial single daily dose of 2 mg/kg, but not exceeding 150 mg, CsA was given for 12 months, tapered by a 25 mg reduction every 2 months. An initial twice-daily dose of 0.5 mg/kg PSL was given for 2 months and was also tapered. An ARB was given to all patients and the same dosage was used throughout the study. Patients were followed up for 6 to 66 months.
    Results Nine patients achieved complete remission at 6.7±2.9 months, and incomplete remission was obtained in the remaining patients. After a follow-up period of 32.7±20.0 months, their serum creatinine and estimated glomerular filtration rate values were similar to baseline levels. The 9 patients who completed the treatment course have not relapsed. Moreover, there were no adverse effects requiring discontinuation of this triple therapy.
    Conclusion A single daily dose of CsA combined with a low dose of PSL and an ARB in new-onset nephrotic patients with IMN induced a high remission rate of nephrotic syndrome, with a low incidence of relapse and a low risk of adverse effects. The triple therapy and prospective follow-up shows potential as a treatment approach for patients with IMN.
  • Akira Youkou, Takashi Hasegawa, Kazuo Suzuki, Toshiyuki Koya, Takuro S ...
    2011 年 50 巻 18 号 p. 1911-1916
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Background Despite the use of inhaled corticosteroid (ICS) becoming increasingly widespread, many problems related to asthma management still need to be addressed. One of them, obesity, has been reported to exert a harmful influence on asthma control. However, there have been few reports focusing not only on both obesity and its influence on Japanese asthma patients but also on the Japanese definition of obesity, as defined by the Japan Society for the Study of Obesity (JASSO).
    Aims & Methods The aim of this study was to confirm the influence of obesity, as defined by the JASSO, on asthma management in Japanese asthmatic patients. Using data from the Niigata Asthma Treatment Study Group 2008 questionnaire survey, differences between the "normal" group (18.5 kg/m2 ≤ BMI <25 kg/m2) and the "obese" group (25 kg/m2 ≤ BMI) were analyzed.
    Results There was a significantly lower step 1 rate (19.4% v.s. 26.8%) and a higher proportion of patients using inhaled salmeterol (43.6% v.s. 35.8%) and leukotriene receptor antagonist (49.8% v.s. 40.8%) in the obese group relative to the normal group, although there were no significant differences in indicators of asthma control, including asthma control test scores.
    Conclusion This study investigated influences of JASSO-defined obesity on asthma severity and management in a clinical setting in Japan. It is possible that there are strong interactions between asthma and obesity, such as obesity causing decreased ICS therapy efficacy and leukotriene (LT)-related inflammation, although further investigation is necessary.
  • Hajime Fukuyama, Tadashi Ishida, Hiromasa Tachibana, Hiroaki Nakagawa, ...
    2011 年 50 巻 18 号 p. 1917-1922
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Objective Several scoring systems have been derived to identify patients with severe community-acquired pneumonia (CAP). Recently, España et al (Am J Respir Crit Care Med 174:1249-1256, 2006) developed a clinical prediction rule that predicts hospital mortality, the need for mechanical ventilation, and risk for septic shock. We assessed the performance of this rule and compared it with other published scoring systems.
    Methods A prospective study was conducted of patients with CAP who were hospitalized at our hospital from April 2007 till May 2009. Clinical and laboratory features at presentation were recorded and used in order to calculate España rule, the pneumonia severity index (PSI), CURB-65, A-DROP, the 2007 Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) prediction rule and SMART-COP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared for adverse outcomes. We also assessed the association of the España rule criteria and adverse outcomes.
    Results A total of 505 patients were enrolled in the study. The overall in-hospital mortality rate was 6.5%, and 6.3% of patients were admitted to the intensive care unit (ICU). Sixty-two (12.3%) patients were defined as having severe CAP (in-hospital death or need for mechanical ventilation or septic shock). España rule achieved highest sensitivity and NPV in predicting severe CAP. When ICU admission was the outcome measure, the IDSA/ATS rule and SMART-COP were regarded to be good predictors.
    Conclusion España rule performed well in identifying patients with severe CAP. As a result, each of the severity scores has advantages and limitations for predicting adverse outcomes.
  • Kazuhito Kimoto, Saiko Aiba, Ryotaro Takashima, Keisuke Suzuki, Hidehi ...
    2011 年 50 巻 18 号 p. 1923-1928
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Objective Barometric pressure has been reported as a triggering and exacerbating factor in migraine headaches, although there are few reports concerning the association of weather change and migraine headache. The relationship between barometric pressure changes and migraine headaches was prospectively examined.
    Methods A total of 28 migraine patients who lived within 10 km of the Utsunomiya Local Meteorological Observatory kept a headache diary throughout the year. Daily and monthly mean barometric pressure data of the Utsunomiya Local Meteorological Observatory were obtained via the homepage of the Meteorological Office.
    Results The correlation between headache frequency obtained by the headache diaries for 1 year and changes in the barometric pressure during the period of 2 days before and 2 days after the headache onset were evaluated. The frequency of migraine increased when the difference in barometric pressure from the day the headache occurred to the day after was lower by more than 5 hPa, and decreased when the difference in barometric pressure from the day the headache occurred to 2 days later was higher by more than 5 hPa. Of 28 patients, weather change was associated with migraine headache development in 18 (64%) patients, 14 of which reported low barometric pressure to be a cause of headache. There was no association between the monthly mean barometric pressure and headache frequency throughout the year.
    Conclusion Barometric pressure change can be one of the exacerbating factors of migraine headaches.
  • Nobuharu Fujiwara, Tsukasa Nakamura, Eiichi Sato, Yasuhiro Kawagoe, Yu ...
    2011 年 50 巻 18 号 p. 1929-1934
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Background/Aims Erythropoietin (EPO) has been widely used for the treatment of anemia in chronic kidney disease (CKD). A growing body of evidence indicates that the therapeutic benefits of EPO could extend beyond the improvement of anemia. The aim of the present study was to determine whether EPO affects renovascular and oxidative stress biomarkers in pre-dialysis CKD patients with anemia.
    Methods The study was a single-arm prospective study. Fifteen CKD patients (9 males and 6 females, mean age 63 years) with anemia (mean Hb: 8.1 g/dL) were treated with recombinant human EPO; 12,000 U administered subcutaneously once every 2 weeks. Various parameters were measured before and 6 months after treatment. These included serum hemoglobin (Hb), creatinine, estimated glomerular filtration rate (eGFR), proteinuria, urinary liver-type fatty acid binding protein (L-FABP - a biomarker of renal injury), urinary 8-hydroxydeoxyguanosine (8-OHdG - a marker of oxidative stress), serum asymmetrical dimethylarginine (ADMA), carotid artery intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) as vascular markers and plasma brain natriuretic peptide (BNP) levels and left ventricular ejection fraction (LVEF) as cardiac function markers and cardio-thoracic ratio (CTR) and inferior vena cava dimension (IVCS) as extra fluid retention markers.
    Results After 6 months, serum Hb was significantly increased (p<0.001) and urinary levels of protein, L-FABP and 8-OHdG, carotid IMT, baPWV, plasma BNP and serum ADMA levels were significantly decreased (p<0.001). Serum creatinine, eGFR, LVEF, CTR and IVCS showed little difference throughout the experimental period.
    Conclusion These data suggest that recombinant human EPO may ameliorate renal injury, oxidative stress and progression of atherosclerosis in addition to improving anemia in CKD patients.
  • Thibaut Fraisse, Julien Crouzet, Laurence Lachaud, Anne Durand, Sylvie ...
    2011 年 50 巻 18 号 p. 1935-1940
    発行日: 2011年
    公開日: 2011/09/15
    ジャーナル オープンアクセス
    Objective Candiduria is a common finding in the growing population of very old patients that has not been previously studied. The objective was to study candiduria in the population aged 85 and over, including an estimation of the incidence, factor of acquisition, and evaluation of treatment and mortality.
    Methods retrospective monocentric study.
    Materials medical charts of patients aged of 85 and over who have candiduria diagnosed at Nimes University Hospital.
    Results The prevalence of candiduria in the hospitalized very old patients was 8.9%. More than half of strains isolated were C. albicans (59%). Mean age was 89.7 years old with 53 women and 20 men. Urinary catheter (55%) and prior antibiotic use (67%) were commonly found. Fifteen patients with candiduria were treated, consistently with fluconazole. Patients treated had higher Mini Mental Test score than the others. A high C-reactive protein level, Mac Cabe score or Charlson's score >7 were associated with 6 months mortality.
    Conclusion Episodes of candiduria in oldest old were associated with frailty and vulnerability of the patient. The medical decision for antifungal treatment is usually difficult to make but it did not seem to influence mortality.
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