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30件中1~30を表示しています
EDITORIAL
ORIGINAL ARTICLES
  • Tatsuki Ichikawa, Mio Yamashima, Shinobu Yamamichi, Makiko Koike, Yusu ...
    2025 年 64 巻 9 号 p. 1296-1302
    発行日: 2025/05/01
    公開日: 2025/05/01
    [早期公開] 公開日: 2024/09/18
    ジャーナル オープンアクセス
    電子付録

    Objective To evaluate the effect of pemafibrate (PEM) on metabolic dysfunction-associated steatotic liver disease (MASLD).

    Methods We retrospectively evaluated 43 patients with hyperlipidemia and MASLD to determine changes in clinical factors between the start of PEM treatment and 0.5 years later. Using FibroScan, 39 of 43 patients were evaluated for liver stiffness (LS; kPa) and controlled attenuation parameter (CAP; dB/m). None of the patients had decompensated cirrhosis.

    Results Thirty patients were women, the median age was 66 years old, the median fibrosis-4 (FIB-4) score was 2.52, the median LS was 8.05 kPa, and the median CAP was 280.5 dB/m at the start of PEM treatment. AST, ALT, ALP, γGTP, and triglyceride levels decreased 0.5 years after starting PEM treatment, but FIB-4, LS, and CAP values did not decrease. However, LS decreased in patients with a FIB-4 index ≥1.3 at the start of PEM treatment, whereas it did not change in patients with a FIB-4 index <1.3. Similarly, LS decreased in patients with a value ≥8 kPa at the start of treatment and did not change in those with <8 kPa. The decreased LS group had higher baseline ALT and LS levels and lower ALT levels during 0.5 years of follow-up than the increased LS group.

    Conclusion At the initiation of PEM treatment, the LS decreased in patients with MASLD complicated by hyperlipidemia and moderate LS (FIB-4>1.3 or LS >8 kPa). Although there is currently no approved treatment for MASLD, PEM may be a viable treatment option for MASLD with mild LS.

  • Masanori Tamaki, Taizo Inagaki, Masanori Minato, Eriko Shibata, Rika N ...
    2025 年 64 巻 9 号 p. 1303-1314
    発行日: 2025/05/01
    公開日: 2025/05/01
    [早期公開] 公開日: 2024/10/04
    ジャーナル オープンアクセス
    電子付録

    Objective Roxadustat, a hypoxia-inducible factor-prolyl hydroxylase inhibitor, increases the hemoglobin (Hb) levels in patients with chronic kidney disease (CKD). To date, limited clinical studies have focused on the excessive increase in the Hb levels in the early weeks after switching from erythropoiesis-stimulating agents (ESA) to roxadustat in adult non-dialysis patients. We conducted a retrospective study to examine whether early overshoot frequently occurs after switching to roxadustat.

    Methods This 8-week retrospective pilot study examined patients with anemic, non-dialyzed CKD who switched from ESA (darbepoetin or epoetin beta pegol) to roxadustat or continued ESA. The Hb levels >12.5 g/dL after starting our observation was defined as Hb overshoot.

    Patients: Twenty-three patients who switched to roxadustat (roxadustat group) and 63 who continued ESA (ESA group) were included.

    Results The baseline median estimated glomerular filtration rate and mean Hb levels were 15.7 mL/min/1.73 m2 and 10.77 g/dL in roxadustat group and 15.2 mL/min/1.73 m2 and 10.64 g/dL in ESA group, respectively. Eight patients (34.8%) in the roxadustat group and two patients (3.2%) in the ESA group had Hb overshoot within the 8-week visit [odds ratio: 20.2 (95% confidence interval 3.13-130.0, p<0.01) in the background adjusted model]. Among the patients with Hb overshoot in the roxadustat group, the Hb levels were maintained close to baseline 4 weeks after roxadustat discontinuation. A younger age and higher baseline Hb and Hct levels were risk factors for Hb overshoot.

    Conclusion Hb overshoot was frequently observed in patients switched to roxadustat. Clinicians should be aware of Hb overshoot and emphasize the importance of early Hb level checks.

  • Tatsuya Ueno, Rie Haga, Takayasu Utsugisawa, Michiru Horiuchi, Maki Mi ...
    2025 年 64 巻 9 号 p. 1315-1320
    発行日: 2025/05/01
    公開日: 2025/05/01
    [早期公開] 公開日: 2024/09/27
    ジャーナル オープンアクセス
    電子付録

    Objective Short-term levodopa-carbidopa intestinal gel (LCIG) treatment using nasojejunal (NJ) tubes (NJ-LCIG test) is recommended for patients with advanced Parkinson's disease to ensure compatibility with this treatment system prior to permanent percutaneous endoscopic gastrojejunostomy. However, there have been no studies on NJ tube insertion by neurologists or on possible differences in treatment efficacy based on the NJ tube insertion method or tube tip position. We therefore investigated the effects of LCIG with NJ tube placement performed by a neurologist.

    Methods This retrospective observational study included 13 patients with advanced Parkinson's disease and NJ tube placement between March 1, 2020, and October 31, 2023. A neurologist performed all NJ tube placements, and the daily off-time and dyskinesia time before and after NJ tube placement were compared. We also investigated the effects of differences in the NJ tube tip site.

    Results NJ tubes were placed using either a combination of X-ray fluoroscopy-guided insertion and gastric motility methods (23.1%) or X-ray fluoroscopy-guided insertion alone (76.9%). All tubes were successfully placed in the descending duodenum (15.4%), ascending duodenum (23.1%), or jejunum (61.5%). The off-time decreased significantly after the NJ-LCIG test [pre-NJ-LCIG test, 6.6 h (5.1-8.1) vs. post-NJ-LCIG test, 2.0 h (0.8-3.5), p<0.01]. There was no difference in effectiveness based on the site of NJ tube tip placement.

    Conclusion Our results suggest that neurologists can place NJ tubes and that the NJ-LCIG test can also improve off-time, regardless of the placement site.

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