Angiotensin converting enzyme (ACE) inhibitors inhibit angiotensin converting enzyme, thereby reducing vessel tone and lowering the blood pressure. In addition to decreasing blood pressure, ACE inhibitors are also known to suppress cardiovascular events, and are particularly effective for ischemic heart disease, heart failure and atrial fibrillation.
Angiotensin II receptor blockers (ARB) represent a class of drugs that inhibit the renin angiotensin system in the treatment of hypertension. However, the efficacy of ARB is not only due to their hypotensive effects but also to their organ protective effects. In this paper, we clarify the characteristics and the latest knowledge to explain the recent trends in the use of angiotensin II receptor blockers.
Voltage-dependent calcium channels are divided into L-, T- and N-types. Calcium channel blockers (CCBs) are widely used to treat hypertension and generally act on L-type calcium channels. Recent studies have suggested that L-type calcium channel blockade combined with T- or N-type calcium channel blockade may provide additive benefits in preventing cardiovascular and renal diseases.
Many clinical studies have been conducted to assess the ability of renin-angiotensin aldosterone system (RAAS) blockade to lower blood pressure and reduce end-organ damage. Direct renin inhibitors (DRI) have emerged as an attractive option to inhibit the RAAS and thus prevent cardiovascular damage. In this review, we examine the data related to the administration of the DRI, aliskiren, as an antihypertensive agent and describe the most recent publications assessing the effects of aliskiren on end-organ protection.
Beta-blockers, which exhibit sympathoinhibitory, cardioprotective and antioxidant actions, have been demonstrated as a drug class that can improve life prognosis in a number of large-scale studies. However, since most of these studies were conducted using oral drugs, injectable drugs have not been investigated sufficiently. It has been reported that injectable β-blockers are effective for tachyarrhythmia in emergency situations because sympathetic hyperactivity is often observed after invasive treatment, such as surgery. We report the current status of injectable β blockers in this article.
The effectiveness of β-blockers in the management of chronic heart failure has been widely validated. Patients with simple hypertension are not good candidates for β-blockers. β-blockers should be used for complicated cardiovascular diseases, including coronary artery disease, heart failure, and arrhythmia.
Preoperative pneumococcal vaccination and postoperative antibacterial medication are recommended to prevent serious infection after splenectomy (overwhelming post-splenectomy infection: OPSI). We retrospectively analyzed the prophylactic procedures for OPSI in 12 pediatric patients that recently underwent splenectomy at our hospital. This was an integrated case study. Patients underwent splenectomy between 1999 and 2011, and included 4 males and 8 females, with 7 cases of hereditary spherocytosis and 5 cases of chronic immune thrombocytopenic purpura. The ages at the time of splenectomy were 4 to 21 years old (median: 8 years old), and the follow-up times were from 2 years 4 months to 14 years 4 months. All patients underwent preoperative treatment with 23-Valent pneumococcal vaccine, and two patients received preoperative influenza type b vaccine. None of the patients received Meningococcal vaccine or 7-Valent pneumococcal vaccines. Prophylactic penicillin G (PCG) was administered in all cases after the splenectomy. Doctors stopped administration of PCG to 3 patients within one month. Four patients stopped PCG administration between 4 years 3 months and 9 years 1 month based upon their self-judgment. Only five patients continue to take prophylactic antibacterial medicines from 2 years 4 months to 11 years 1 month (median: 5 years). Six patients ceased to attend the outpatient clinic. While OPSI has not been experienced, OPSI-like severe infection was observed in one patient. The importance of the education of patients and their families regarding the rapid treatment with antibiotics whenever they had fever and the necessity for regular follow-up was recognized.
Simulated patient/standardized patient (SP) training between the School of Medicine/Dentistry and the College of Art at Nihon University was retrospectively investigated to determine what the practical considerations should be in future. There were 63 participants (18 males; 45 females) from the Nihon University College of Art. There were a total of 162 students enrolled for practical medical interview training and the Objective Structured Clinical Examination (OSCE) of the Common Achievement Tests Organization at the School of Medicine. At the department of dentistry 12 participants (male 5: female 7) attended the practical medical interview training and the OSCE. A total of 23 students were enrolled for the diagnostic practical training and OSCE at the School of Dentistry. SP certification was issued to 10 participants (male 3: female 7) from the SP approval committee of the Nihon University School of Medicine in June 2013. Future issues highlighted in our study include the following: (1) remuneration for Nihon University College of Art graduates acting as SP trainers, (2) Nihon University general certification for SP training.
Recently, there has been an increase in the number of patients with cervical intraepithelial neoplasia grade 3 (CIN3), corresponding to human papillomavirus (HPV) infection. Long-term HPV infection before surgery impacts recurrence at the cervical margin and vaginal stump, because HPV infection persists postoperatively. However, host immunocompetence also plays a role. In particular, elderly women have an immunodepleted local vaginal environment since depuration declines with hormonal dysfunction. A 77-year-old woman underwent simple total hysterectomy for severe dysplasia. High-risk HPV type 51 was identified prior to surgery. Pathological findings of the uterine sample were consistent with CIS. Four months later, atypical squamous cells were detected in the vaginal stump and the cytological report was “atypical squamous cells, cannot exclude HSIL (ASC-H)”, although the margin had been clear at hysterectomy. HPV type 51 was also detected in the vaginal stump. Cytological abnormalities are likely to influence high-risk HPV with long-term exposure and broad involvement from the cervix to the vagina.
Mast cells arise from hematopoietic stem cells in the bone marrow and finally differentiate within peripheral tissues. Mast cells reside in virtually all organs, among which they are distributed in a great number particularly in tissues at the interface between the internal and external environments, such as the skin and mucosal membranes of the airway and intestine, where they are in close contact with the external environment. This suggests that mast cells act as effectors in response to antigen (allergen) and that they also play an important role in immune systems including host defense. In this memorial lecture, I introduce our research regarding the molecular mechanisms of mast cell activation via the high-affinity IgE receptor (FcεRI) and its regulation of the many versatile roles of mast cells. I also discuss our efforts for developing drugs against novel molecular targets in allergic disorders.