Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
最新号
選択された号の論文の26件中1~26を表示しています
ORIGINAL ARTICLES
  • Nobuo Sasaki, Hideya Yamamoto, Ryoji Ozono, Ryo Maeda, Yasuki Kihara
    2020 年 59 巻 18 号 p. 2213-2219
    発行日: 2020/09/15
    公開日: 2020/09/15
    [早期公開] 公開日: 2020/06/15
    ジャーナル オープンアクセス
    電子付録

    Objective It is well known that poor sleep increases the risk of heart failure (HF). However, the underlying mechanisms remain unclear. In this study, we investigated the association of poor sleep with hemodynamic stress on the left ventricle, which was a key factor for the development of HF in elderly individuals.

    Methods A total of 2,301 participants (≥65 years old) without cardiac disease were enrolled in this cross-sectional analysis. We evaluated the subjective sleep quality, sleeping difficulty, subjective sleep duration, use of sleeping pills, and daytime dysfunction using the Pittsburgh Sleep Quality Index, a 19-item self-reported questionnaire. We assessed serum N-terminal pro-brain natriuretic peptide (NT-proBNP) as a marker of hemodynamic stress on the left ventricle, and we defined high NT-proBNP as a serum NT-proBNP level ≥ 125 pg/mL.

    Results Sleeping difficulty was significantly associated with high NT-proBNP levels [odds ratio (OR), 1.46; 95% confidence interval (CI), 1.16-1.85; p<0.005]. A subjective short sleep duration was also significantly associated with high NT-proBNP levels (OR, 1.69; 95% CI, 1.03-2.75; p<0.05). A subjective poor sleep quality, the use of sleeping pills, and daytime dysfunction were not associated with serum NT-proBNP levels. All data were adjusted for the age, sex, body mass index, serum hemoglobin concentration, serum creatinine level, systolic blood pressure, diastolic blood pressure, and use of antihypertensive medications.

    Conclusion Poor sleep was associated with high hemodynamic stress to the left ventricle in elderly population.

  • Hiromitsu Sekizuka, Hitoshi Miyake
    2020 年 59 巻 18 号 p. 2221-2228
    発行日: 2020/09/15
    公開日: 2020/09/15
    ジャーナル オープンアクセス

    Objective Snoring is a common physical condition in active workers. However, the link between snoring and health problems is poorly understood. Therefore, the prevalence of snoring in Japanese workers and the relationships between snoring and lifestyle-related diseases were investigated.

    Methods This was a retrospective, single-center, cross-sectional study. The results of a single year's medical examinations were investigated for 25,141 Japanese active office workers 20 to 59 years old. The presence and duration of snoring were investigated using a personal computer at a medical interview before the medical checkup. The snoring frequency was investigated for each gender. In addition, the relationships between snoring and hypertension, diabetes, and dyslipidemia were also analyzed.

    Results Men (21,774) were a mean 46±6 years old with a snoring prevalence of 43%. Women (3,367) were a mean 46±6 years old with a snoring prevalence of 20%. In men, snoring was an independent comorbid factor of hypertension and dyslipidemia. In particular, a long snoring vintage (multiple years) was an independent comorbid factor for hypertension [odds ratio (OR), 1.14; 95% confidence interval (CI), 1.05-1.24; p=0.002; and OR, 1.20; 95% CI, 1.07-1.34; p=0.001]. In women, snoring was not an independent comorbid factor for lifestyle-related diseases when adjusted for the age and body mass index.

    Conclusion Snoring was shown to be a frequent pathophysiology in active workers. It was a health indicator for active workers, and especially in men, intervention for snoring may reduce the risk of developing lifestyle-related diseases.

  • Hisao Wakasaki, Takeshi Shono, Ryutaro Nakao, Shohei Yamamoto, Takamas ...
    2020 年 59 巻 18 号 p. 2229-2235
    発行日: 2020/09/15
    公開日: 2020/09/15
    ジャーナル オープンアクセス

    Objective The measurement of C-peptide immunoreactivity (CPR) is essential for evaluating the pancreatic β-cell function and selecting appropriate therapeutic agents in patients with diabetes mellitus. The meal tolerance test (MTT) is simple to administer physiological insulin-stimulating test. Previous studies have reported that several CPR-related indices are useful markers for predicting insulin requirement in type 2 diabetes. In the present study, we investigated the serum CPR response during the MTT in hospitalized patients with type 2 diabetes mellitus in order to clarify the clinical utility of the MTT.

    Methods We performed the MTT using a test meal with timed measurements of the serum CPR level based on the oral glucose tolerance test over 180 minutes and tested the correlation of various CPR-related indices and clinical factors in patients with type 2 diabetes mellitus.

    Patients The subjects were patients with type 2 diabetes mellitus who had been admitted to our hospital for diabetes management and education. The final study population consisted of 68 patients.

    Results The fasting CPR level was correlated with the 24-hour urinary CPR excretion and body mass index. The serum CPR level at 120 minutes in the MTT was strongly correlated with the area under the curve of CPR during the MTT. The patients who needed insulin therapy at 6 months after hospitalization showed a significant lower incremental CPR value from 0 to 120 minutes in the MTT than those who did not need insulin therapy.

    Conclusion The plasma C-peptide levels at 0 and 120 minutes in the MTT provide essential information for the clinical management of patients with type 2 diabetes mellitus.

  • Taro Aoki, Naro Ohashi, Shinsuke Isobe, Sayaka Ishigaki, Takashi Matsu ...
    2020 年 59 巻 18 号 p. 2237-2244
    発行日: 2020/09/15
    公開日: 2020/09/15
    ジャーナル オープンアクセス
    電子付録

    Objective The intrarenal renin-angiotensin system (RAS) is activated in chronic kidney disease (CKD) patients and is not suppressed at night in CKD patients showing nocturnal hypertension, contributing to renal damage. Furthermore, changes in RAS inhibitor administration from morning to evening, namely chronotherapy, ameliorates renal damage at night. We attempted to clarify whether or not chronotherapy ameliorates renal damage by suppressing the intrarenal RAS activity.

    Methods We recruited 34 CKD patients with RAS inhibitors in the morning. We conducted ambulatory blood pressure (BP) monitoring and urine collection and evaluated urinary albumin (Alb) and angiotensinogen (AGT), which are surrogate markers for intrarenal RAS activity during the day and at night, respectively. The same experiments were conducted after changing the administration time. The ratio of values associated with morning versus evening dosing was defined as the morning to evening (M/E) ratio.

    Results The M/E ratio of urinary Alb had a significant and positive relationship with that of urinary AGT during the day and at night in all CKD patients. However, no significant relationships were found between the M/E ratios of urinary Alb and AGT using multiple linear regression analyses. Conversely, there was a significant and positive relationship between the M/E ratios of urinary Alb and AGT at night but not during the day in CKD patients whose estimated glomerular filtration rate was <45 mL/min/1.73 m2 and whose night-to-day ratio of systolic BP was >0.90, even after adjustment.

    Conclusion This study indicated that chronotherapy with RAS inhibitors improved the renal damage via intrarenal RAS suppression, especially in CKD patients with an impaired renal function and nocturnal hypertension.

CASE REPORTS
PICTURES IN CLINICAL MEDICINE
feedback
Top