Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
64 巻, 1 号
選択された号の論文の31件中1~31を表示しています
EDITORIALS
REVIEW ARTICLES
  • Mariko Hojo, Tomoyoshi Shibuya, Akihito Nagahara
    2025 年 64 巻 1 号 p. 7-15
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2023/11/13
    ジャーナル オープンアクセス

    Traditionally, the treatment of chronic constipation has focused on lifestyle modification, dietary guidance and therapy, and osmotic and stimulant laxatives. Recently, several drugs with new mechanisms of action have been introduced as treatments for chronic constipation. In Japan, polyethylene glycol and lactulose can now be administered under insurance coverage. The number of treatment options for constipation has increased dramatically. First, lifestyle modifications and dietary therapies must be implemented. If constipation does not improve sufficiently, specialized functional tests are performed to diagnose physiological subgroups. If functional tests are not available, patients are classified as having the "decreased frequency of defecation" type or the "difficult defecation" type based on the patient's symptoms, with treatment applied according to each type. Medical therapy includes osmotic laxatives, secretagogues, bile acid transporter inhibitors, probiotics, prokinetics, and Kampo medicines. The temporary use of stimulant laxatives, suppositories, enemas, and digital evacuation is also recommended. The usefulness of biofeedback is yet to be determined.

  • Yuko Morishima, Nobuyuki Hizawa
    2025 年 64 巻 1 号 p. 17-23
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2024/03/04
    ジャーナル オープンアクセス

    Asthma and chronic obstructive pulmonary disease (COPD) have long been debated regarding their similarities and differences in clinical presentation and pathology. There has also been a discussion about how common therapeutics should be used differently for each disease. Traditionally, a "one size fits all" stepwise treatment has been chosen based on the severity of each case after categorizing the diseases, such as asthma or COPD. However, recently, the need for a precise approach for the treatment of individual patients beyond the disease category has been emphasized, especially in severe cases. To achieve precise personalized therapy, it has become necessary to focus on the individual phenotypes and underlying causal molecular mechanisms (endotypes) and to identify key therapeutic targets, which are called treatable traits. This review discusses the evidence for the importance of identifying treatable traits and therapeutic strategies based on the broader perspective of chronic obstructive airway disease rather than on individual diseases such as asthma or COPD.

  • Yohei Kirino
    2025 年 64 巻 1 号 p. 25-30
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2024/02/01
    ジャーナル オープンアクセス

    Vacuoles, E1-ubiquitin-activating enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome, caused by an acquired mutation in the ubiquitin-activating enzyme ubiquitin-like modifier activating enzyme 1 (UBA1), was discovered in 2020. Since then, many cases have been reported worldwide. Recently, we performed UBA1 genetic testing in suspected cases of VEXAS throughout Japan and investigated the clinical features of these cases. Most cases were elderly patients in their 70s with clinical features consistent with VEXAS syndrome, such as myelodysplastic syndrome, high-grade fever, skin rash, chondritis, and pulmonary infiltration. However, approximately half of the analyzed patients were negative for the UBA1 variant. As the concept of "acquired autoinflammatory diseases," including VEXAS syndrome, has gained popularity, the number of suspected cases is expected to increase. Currently, there are no established diagnostic or treatment guidelines for these conditions, and they need to be urgently developed. This review summarizes the clinical problems faced by patients with acquired autoinflammatory diseases, including VEXAS.

  • Mitsuhiro Kawano
    2025 年 64 巻 1 号 p. 31-39
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2024/02/19
    ジャーナル オープンアクセス

    IgG4-related disease (IgG4-RD) is a systemic and chronic inflammatory disorder that can affect every part of the body. The formation of tertiary lymphoid tissues (TLT) in the affected organs may be a key phenomenon in understanding the pathogenesis of this disease because T follicular helper (Tfh) 2 cells play an important role in IgG4 class switching within TLT in the affected organs or tissues. TLT formation leads to the formation of masses or swelling of the affected organs. Interleukin (IL)-4 and IL-10 are critical cytokines for IgG4-class switching and are produced in TLT. Other factors, such as CD4-positive (CD4+) cytotoxic T cells, M2 macrophages, and LAG3+ Tfh cells, have been identified as disease-specific contributors to lesion formation. In this review, I describe the current knowledge necessary to understand the pathogenesis of this disease and recent developments in treatment strategies beyond B-cell depletion therapy.

ORIGINAL ARTICLES
  • Kiyotaka Asanuma, Takashi Chiba, Toshihiro Tadano, Katsuaki Kato
    2025 年 64 巻 1 号 p. 41-46
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2024/05/09
    ジャーナル オープンアクセス
    電子付録

    Objective In recent years, there has been a growing focus on health risks associated with alcohol consumption. The present study investigated whether or not the genetic variant of aldehyde dehydrogenase 2 (ALDH2) influences the risk of gastric cancer among individuals identified as hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT), which provides a comprehensive assessment of hazardous drinking behavior.

    Patients We enrolled men with hazardous drinking behavior (AUDIT score ≥8) who had undergone gastric cancer screening (either endoscopy or a barium X-ray examination of the upper gastrointestinal tract) between April 2013 and March 2020 within 1 year from entry and who had subsequently undergone at least one more gastric cancer screening up to March 2021. Functional single-nucleotide polymorphisms of ALDH2 (rs671) were measured using a direct TaqMan polymerase chain reaction method with unprocessed saliva.

    Results A total of 246 men were enrolled, comprising 193 individuals with active ALDH2 (ALDH2*1/*1) and 53 with less-active ALDH2 (ALDH2*1/*2). The cumulative incidence of gastric cancer in the less-active group was higher than in the active ALDH2 group (p=0.01, hazard ratio: 4.6, 95% confidence interval: 1.2-16.7). Alcohol consumption was lower in the less-active ALDH2 group than in the active ALDH2 group, although no marked difference was observed in the AUDIT score.

    Conclusion In individuals with hazardous drinking behavior, a heightened risk of gastric cancer was observed among those with less-active ALDH2 variants, even when their alcohol consumption was comparatively lower than in those with active ALDH2 variants.

  • Norio Akuta, Yusuke Kawamura, Hitomi Sezaki, Kenichi Nakamichi, Eiji S ...
    2025 年 64 巻 1 号 p. 47-54
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2024/05/09
    ジャーナル オープンアクセス
    電子付録

    Objective The long-term impact of personalized diet and exercise programs for steatotic liver disease (SLD) remains unclear.

    Materials The subjects of this retrospective cohort study included 104 consecutive Japanese patients with SLD. The long-term treatment efficacy of personalized diet and exercise treatment was evaluated two years after the start of observation. Regular and repeated hospitalizations every 6 months (RRH group, n=23) indicated the 4 times of the number of hospitalizations, and irregular hospitalizations (IH group, n=56) showed the 1 to three times. The group without hospitalization was defined as the no hospitalization group (NH group, n=25). To balance confounding biases, the difference in treatment efficacy between the RRH and IH groups was evaluated using propensity score (PS)-matched analysis. A diet of 25 to 30 kcal/kg multiplied by ideal body weight (BW) daily, and aerobic and resistance exercise (exercise intensity of 4 to 5 metabolic equivalents daily, respectively) was performed for 6 days.

    Results At 2 years compared to baseline, the decrease rates of liver function tests, HbA1c, and physical findings in the RRH group were significantly higher than those in the NH or IH groups by multiple comparisons. According to the liver function tests and physical findings, the rate of decrease in the RRH group (17 cases) was significantly higher than that in the IH group (17 cases) using a PS-matched analysis.

    Conclusion The present study indicated the long-term favorable efficacy of personalized diet and exercise programs for SLD. In particular, this RRH program was effective in improving the findings of liver function tests and might help to sustain diet and exercise.

  • Satoshi Wasamoto, Hisao Imai, Takeshi Tsuda, Yoshiaki Nagai, Takayuki ...
    2025 年 64 巻 1 号 p. 55-64
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2024/05/16
    ジャーナル オープンアクセス
    電子付録

    Objective Pembrolizumab plus platinum and pemetrexed (Pemb-Plt-PEM) combination therapy is an effective first-line treatment for advanced non-squamous non-small-cell lung cancer (NSCLC), regardless of programmed death-ligand 1 expression. However, the effectiveness and feasibility of first-line Pemb-Plt-PEM therapy in elderly patients (≥75 years old) remain unclear. Therefore, this study investigated the safety and efficacy of first-line Pemb-Plt-PEM in elderly patients with non-squamous NSCLC.

    Methods We retrospectively evaluated the data of patients ≥75 years old with non-squamous NSCLC who were treated with first-line Pemb-Plt-PEM from December 2018 to December 2020 at 10 institutes in Japan. Data on patient characteristics, efficacy of Pemb-Plt-PEM therapy, and the type and severity of adverse events were reviewed.

    Results Thirty patients [20 men and 10 women; median age: 76 (range: 75-82) years old] were included in the analysis. The overall response rate, disease control rate, median progression-free survival (PFS), and median overall survival (OS) were 40.0%, 66.7%, 7.5 and 24.0 months, respectively. The treatment-related deaths were caused by pneumonitis. First-line Pemb-Plt-PEM was associated with the PFS, based on the neutrophil-to-lymphocyte ratio (NLR). The PFS for low and high NLR values was 10.1 and 2.0 months, respectively. Furthermore, the sex and NLR influenced the association between Pemb-Plt-PEM and the OS. The OS for low and high NLR values was 32.8 and 2.6 months, respectively.

    Conclusion First-line Pemb-Plt-PEM therapy is effective and feasible in elderly patients with non-squamous NSCLC.

  • Haruhiko Fukada, Shuko Nojiri, Takuya Uematsu, Yuji Nishizaki
    2025 年 64 巻 1 号 p. 65-72
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2024/05/30
    ジャーナル オープンアクセス
    電子付録

    Objective To assess the association between concomitant use of central nervous system drugs and femoral fracture risk in individuals ≥80 years old in Japan.

    Methods A case-crossover design was used, defining the case period as 3 days before the fracture diagnosis and the control period as 31-33, 34-36, and 37-39 days prior. The association between the daily intake of central nervous system drugs (Anatomical Therapeutic Chemical codes) and fracture risk was analyzed using conditional logistic regression.

    Patients Using the Japanese administrative claims database, we examined elderly patients diagnosed with femoral neck fractures between January 1, 2009, and December 31, 2020.

    Results In 255,875 patients, the concomitant use of central nervous system drugs increased the odds ratios of femoral fracture [3.41 (95% confidence interval: 3.27-3.55), 3.69 (3.46-3.91), 3.76 (3.42-4.13), and 4.34 (3.86-4.86) for an intake of >0-1, >1-2, >2-3, and >3 central nervous system drugs, respectively].

    Conclusion The concomitant use of central nervous system drugs is associated with an increased risk of femoral fractures in individuals ≥80 years old in Japan.

  • Masafumi Shimoda, Yoshiaki Tanaka, Kozo Morimoto, Kozo Yoshimori, Ken ...
    2025 年 64 巻 1 号 p. 73-80
    発行日: 2025/01/01
    公開日: 2025/01/01
    [早期公開] 公開日: 2024/05/16
    ジャーナル オープンアクセス

    Objective Intravenous fluid therapy, including peripheral parenteral nutrition (PPN), administered via a peripheral intravenous catheter (PVC) can occasionally lead to bloodstream infections (BSIs). PPN may thus be a risk factor for PVC-related BSI (PVC-BSI). However, the risk factors and incidence of PVC-BSI have not been previously reported, and evidence for these conditions remains unclear.

    Methods We retrospectively collected data from 391 patients who underwent PPN therapy with PVC at the Fukujuji Hospital from August 2022 to November 2023. We compared 20 patients who developed BSI during PPN therapy (BSI group) with 371 who did not develop BSI during PPN therapy (no-infection group).

    Results The incidence rate of PVC-BSI during PPN therapy was 5.1%. The BSI group had a significantly longer average daily infusion time of PPNs [median 24.0 (range 6.0-24.0) h vs. 6.0 (2.0-24.0) h, p<0.001] and of all intravenous fluids [median 24.0 (range 8.8-24.0) h vs. 10.3 (2.0-24.0) h, p<0.001] than the no infection group. An average daily infusion time of PPNs ≥12.0 h and an average daily infusion time of intravenous fluids ≥18.0 h were identified as predictive risk factors for BSI. When both risk factors were present, the sensitivity, specificity, and odds ratio for the development of BSI were 85.0%, 83.2%, and 27.9, respectively.

    Conclusion This study identified the incidence of and risk factors for developing BSI, such as a longer average daily infusion time of PPNs and all intravenous fluids, in patients receiving PPN therapy.

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