日本医科大学医学会雑誌
Online ISSN : 1880-2877
Print ISSN : 1349-8975
ISSN-L : 1349-8975
15 巻 , 1 号
選択された号の論文の9件中1~9を表示しています
橘桜だより
グラビア
原著
  • 小林 茂樹
    2019 年 15 巻 1 号 p. 8-11
    発行日: 2019/02/15
    公開日: 2019/03/26
    ジャーナル フリー

    Purpose: To evaluate the efficacy of using 1 drop twice daily of epinastine hydrochloride ophthalmic solution 0.05% (epinastine eye drops) instead of the recommended 1 drop 4 times daily in patients with allergic conjunctivitis.

    Subjects and Methods: Thirteen patients with subjective symptoms of allergic conjunctivitis who had not used epinastine eye drops and who visited our clinic in March and April 2017 were included in this study; they were instructed to use 1 drop twice daily. The subjective symptoms and objective findings before and after therapy were quantified at follow-up and statistically analyzed using the Wilcoxon signed-rank test. If improvement was insufficient with twice-daily administration, the dosing regimen was changed to 4 times daily.

    Results: Excluding 1 subject who did not appear for the follow-up after initiation of therapy, the dose remained at twice daily in all 12 subjects. Itching was the only subjective symptom in all subjects. A comparison of subjective symptoms before and after therapy showed significant improvement in subjective symptoms (p<0.002) and objective findings (p<0.005) after therapy.

    Conclusions: Reduced-dose therapy resulted in medication compliance. Since most children are not administered eye drops by school staff, twice-daily instillation enables parents to provide treatment at home.

綜説
  • 小谷 英太郎, 赤尾 昌治, 清水 渉
    2019 年 15 巻 1 号 p. 12-23
    発行日: 2019/02/15
    公開日: 2019/03/26
    ジャーナル フリー

    Hypertension is a well-known risk factor for cardiovascular diseases. In addition, since hypertension is associated with the development of electrical and structural remodeling of atrial myocardium, control of blood pressure (BP) is important to prevent new-onset atrial fibrillation (AF). In patients presenting with AF during anticoagulation therapy, hypertension is a risk factor for both thromboembolism and hemorrhagic complications, especially intracranial hemorrhage (ICH). Therefore, strict BP control is required to reduce, or at least not to increase, the risk of both events. In the Japanese Guidelines for the Management of Hypertension 2014 (JSH2014), a BP of less than 130/80 mmHg is currently recommended to reduce the risk of ICH, based on the results of the Bleeding with Antithrombotic Therapy (BAT) study. However, because the BAT study was observational and included patients without AF, a true appropriate target BP for patients with AF during anticoagulation therapy remains uncertain. Therefore, we have reviewed the influence of hypertension and BP control on adverse outcomes in the subanalyses of the J-RHYTHM Registry, the Fushimi AF Registry, and the phase III clinical trials of non-vitamin K antagonist oral anticoagulants (NOACs). In the J-RHYTHM Registry, hypertension was an independent risk factor for major hemorrhage (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.05~2.21). The BP at baseline was not associated with any event, whereas the highest quartile of systolic BP (≥136 mmHg) at the time closest to the event or at the end of the follow-up was significantly associated with the incidence of thromboembolism (odds ratio [OR] 2.88, 95% CI 1.75~4.74) and major hemorrhage (OR 1.61, 95% CI 1.02~2.53). In the Fushimi AF Registry, although hypertension was not a significant risk for any event, the incidence of stroke/systemic embolism (SE) and major bleeding was significantly higher in patients with uncontrolled hypertension (systolic BP ≥150 mmHg) than in those without hypertension (HR 1.74, 95% CI 1.08~2.53 for stroke/SE; HR 2.01, 95% CI 1.21~3.23 for major bleeding). In the phase III trials of NOACs, hypertension was significantly associated with major hemorrhage in the RE-LY trial and with stroke/SE in the ROCKET-AF and ARISTOTLE trials. Although no specific target BP could be determined from these studies, it is consistent that the incidence rates were higher in patients with uncontrolled hypertension than in those with controlled BP or without hypertension. A decrease in the risk of adverse events can be expected if BP is appropriately controlled in patients with AF during anticoagulation therapy.

  • 渡部 寛, 石井 寛高, 大島 康史, 高井 信朗, 小澤 一史
    2019 年 15 巻 1 号 p. 24-31
    発行日: 2019/02/15
    公開日: 2019/03/26
    ジャーナル フリー

    Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is a simple and effective method to quantify RNA molecules. This technique has become an essential tool to determine gene expression profiles in target cells and tissues. Although RT-qPCR is highly sensitive and specific, it requires appropriate selection of optimal reference genes for normalization to assure accurate and reliable results. In our recent study, we assessed expression stability of the candidate reference genes for normalization in the synovium of knee osteoarthritis and evaluated the impacts of the reference gene choice on gene expression profiles. In the present manuscript, we will introduce our recent article, explain the way to select suitable reference genes for normalization of RT-qPCR data, and review the suitable reference genes for RT-qPCR analyses in orthopaedic research.

症例報告
  • 上田 純志, 牧野 浩司, 横山 正, 平方 敦史, 関 奈紀, 吉田 寛
    2019 年 15 巻 1 号 p. 32-37
    発行日: 2019/02/15
    公開日: 2019/03/26
    ジャーナル フリー

    Carcinosarcoma of the uterine body is a rare mixed tumor composed of both carcinoma and sarcoma. The 5-year survival rate for this cancer is 33-39%. We present a case study of a woman treated with multidisciplinary therapy who survived carcinosarcoma of the uterine body with liver metastasis for over ten years. After she was diagnosed with carcinosarcoma of the uterine body at the age of 61 years, a hysterectomy was performed. Seven years later, she was diagnosed with cecal carcinoma, and ileocecal resection and tumorectomy were performed. Pathological findings revealed recurrence of the carcinosarcoma with cecal adenocarcinoma. After an additional 6 months, multiple liver metastases were also detected on abdominal enhanced computed tomography. We performed a partial hepatectomy. The patient survived for over ten years from the first operation. Therefore, a relatively long survival time can be expected for carcinosarcoma of the uterine body when treated with multidisciplinary therapy including surgery.

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