Japanese clinical medicine最新文献

{"title":"ROADMAP and ORIENTAL Trials: the Re-emergence of J-Curve Ghost?","authors":"Yoshiyuki Hamamoto, Hiroyuki Koshiyama","doi":"10.4137/JCM.S7521","DOIUrl":"10.4137/JCM.S7521","url":null,"abstract":"<p><p>It still remains unknown whether angiotensin-receptor blockers (ARBs) are cardioprotective in patients with type 2 diabetes. The recent two clinical trials, the ROADMAP and the ORIENT, have suggested that fatal cardiovascular events or cardiovascular deaths were unexpectedly higher in olmesartan group. These results suggest that aggressive blood pressure lowering may cause a higher risk in some high-risk patients, especially in those with preexisting coronary heart disease, indicating a possibility that the J-curve phenomenon may exist in some group of patients. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"2 ","pages":"25-8"},"PeriodicalIF":0.0,"publicationDate":"2011-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31247429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-exercise ankle-brachial pressure index demonstrates altered endothelial function in the elderly.","authors":"Shinji Sato,&nbsp;Kozue Masami,&nbsp;Shingo Otsuki,&nbsp;Shiro Tanaka,&nbsp;Noriko Nakayama,&nbsp;Shigeru Makita,&nbsp;Hiroyuki Koshiyama,&nbsp;Ryuji Nohara","doi":"10.4137/JCM.S7173","DOIUrl":"https://doi.org/10.4137/JCM.S7173","url":null,"abstract":"<p><strong>Background: </strong>The ankle-brachial pressure index (ABI), the ratio of the systolic blood pressure of the ankle to the systolic brachial pressure, is commonly measured at rest, but ABI values post-exercise enhance the sensitivity of the test and can be used to identify atherosclerotic vascular damage. However, it has not been established whether or not enhanced post-exercise ABI is also associated with endothelial dysfunction. We hypothesized that a decrease in post-exercise ABI is related to impaired endothelial function.</p><p><strong>Purpose: </strong>To investigate alterations in post-exercise ABI values and endothelial dysfunction in the elderly.</p><p><strong>Methods: </strong>The study population comprised 35 men and women aged 51-77 years (mean age: 66 years). Patients with peripheral arterial disease or a history of heart failure were excluded. The ABI was estimated at rest and immediately after exercise. The exercise protocol comprised 2.5 min of active pedal flexion exercises at a speed of 60 times/min. Endothelial function was assessed by measuring flow-mediated vasodilation (FMD) in the brachial artery using ultrasound imaging.</p><p><strong>Results: </strong>No correlation was found between FMD and the ABI at rest. However, a weak correlation was found between FMD and post-exercise ABI (r = 0.46, P = 0.06). A strong correlation was observed between FMD and a decrease in post-exercise ABI compared to baseline readings (r = -0.52, P = 0.01). Multiple linear regression analysis was used to generate a prediction equation for FMD using the percentage decrease in post-exercise ABI. Significant correlations were observed between the ultrasound imaging-measured FMD and the predicted FMD (R(2) = 0.27, P = 0.001).</p><p><strong>Conclusions: </strong>Post-exercise ABI appears to be a simple surrogate marker for endothelial function in the elderly, although larger studies are required for validation.</p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"2 ","pages":"21-4"},"PeriodicalIF":0.0,"publicationDate":"2011-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S7173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31605913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphocytic panhypophysitis: its clinical features in Japanese cases.","authors":"Yoshiharu Wada, Yoshiyuki Hamamoto, Yoshio Nakamura, Sachiko Honjo, Yukiko Kawasaki, Hiroki Ikeda, Jun Takahashi, Yoshiaki Yuba, Akira Shimatsu, Hiroyuki Koshiyama","doi":"10.4137/JCM.S6254","DOIUrl":"10.4137/JCM.S6254","url":null,"abstract":"<p><p>Lymphocytic hypophysitis is divided into three forms according to the involved tissues, lymphocytic adenohypophysitis, lymphocytic infundibulo-neurohypophysitis, and lymphocytic panhypophysitis (LPH). The term LPH was first proposed by us in 1995, although its entity and pathogenesis still remain controversial. Here we report five cases of LPH, who visited our clinics during 1994 to 2009. All cases were female of 20 to 77 years of age, and one case was associated with pregnancy. They presented with polyuria (n = 4), headache (n = 3), general malaise, polydipsia (n = 2), blunted vision, diplopia, amenorrhea or appetite loss (n = 1). Magnetic resonance imaging showed the pituitary swelling, the thickened stalk, the loss of the T1 hyperintense neurohypophysis (n = 4), or the atrophic pituitary (n = 1). Endocrinological examinations revealed deficiencies of TSH, ADH in all cases, GH, ACTH in three cases, LH, PRL in two cases, and FSH in one case, respectively. The severity of ADH deficiency varied among the cases. Anti-pituitary antibody was not detected in the cases examined. The biopsy of the pituitary lesions was performed except for one case, all of which revealed the diffuse lymphocytic infiltration. These results suggest that LPH is characterized by the female predominance, the atypical patterns of anterior pituitary hormone deficiencies and the variable degrees of diabetes insipidus in Japanese. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"2 ","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2011-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31605912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Component Structure of Roland-Morris Disability Questionnaire (RDQ), a Lumbago-Specific QOL (Quality of Life) Measure.","authors":"K Yoh,&nbsp;M Yoshizawa,&nbsp;A Kuwabara,&nbsp;K Tanaka","doi":"10.4137/JCM.S6224","DOIUrl":"https://doi.org/10.4137/JCM.S6224","url":null,"abstract":"<p><p>Lumbago is one of the most prevalent symptoms in patients with osteoporotic vertebral fracture. Roland-Morris Disability Questionnaire (RDQ) is a quality of life (QOL) questionnaire targeted for evaluating lumbago. Although total score is the usual way of analysis, we have tried to make more use of it by subscale analysis. Forty-four osteoporotic patients were evaluated for their QOL using RDQ and SF-8; a widely accepted generic (non disease-specific) QOL questionnaire. Subscales and summary scores of SF-8 were significantly lower than Japanese norm. Patients with fracture had significantly lower scores including RDQ. Multiple regression analysis has shown that total score of RDQ was significantly contributed by bodily pain as well as other subscales of SF-8. Principal component analysis has revealed that RDQ consists of two components representing general, and mental or social aspect of lumbago. Defining the component structure and determining the procedure to obtain the subscales would make the most use of RDQ, and contribute to the better evaluation of patients with lumbago. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"2 ","pages":"9-14"},"PeriodicalIF":0.0,"publicationDate":"2011-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S6224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31605911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of the First Japanese Family Harboring a Novel Hemoglobin Variant \"Perpignan\", Which Caused Low HbA1c Measurement During Diabetic Follow-Up.","authors":"Mami Nakamura,&nbsp;Ayako Miyazaki,&nbsp;Takayuki Takubo,&nbsp;Yoko Matsuzawa,&nbsp;Jun Saito,&nbsp;Masao Omura,&nbsp;Tetsuo Nishikawa","doi":"10.4137/JCM.S5971","DOIUrl":"10.4137/JCM.S5971","url":null,"abstract":"Hemoglobin A1c (HbA1c) is an important parameter for evaluating long-term (6–8 weeks) control of blood glucose levels in patients with diabetes mellitus. We report a Japanese diabetic case who harbored abnormal Hb and demonstrated falsely low HbA1c levels in the regular ion exchange HPLC-based assay. His abnormal β-globin chain had an amino acid replacement that corresponded to glycine to serine substitution at amino acid position 136 of the β-globin chain (Hb Perpignan). Accordingly, a heterozygotic point mutation replacing guanine by adenine at nucleotide position 406 (β136G > S) was identified in the β-globin gene of the proband and his son. These results indicate that the patient had Hb Perpignan, and this abnormal Hb interfered with the HPLC-based HbA1c assay commonly used in the clinic. The cases presented are the first report of patients in the Japanese population harboring Hb Perpignan (β136G > S).","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"2 ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2011-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S5971","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31605910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Transient ACTH Deficiency Associated with Polymyalgia Rheumatica.","authors":"Hitoo Nishi,&nbsp;Yuichi Nishi,&nbsp;Masato Yagita,&nbsp;Yoshiko Tamaru,&nbsp;Sadayuki Matsumoto,&nbsp;Hiroyuki Koshiyama","doi":"10.4137/JCM.S6215","DOIUrl":"https://doi.org/10.4137/JCM.S6215","url":null,"abstract":"<p><p>We report a case of 79-year-old man, who was diagnosed to have transient ACTH deficiency associated with polymyalgia rheumatica (PMR). The patient presented with sudden onset bilateral shoulder pain, which was gradually aggravated. Plasma ACTH was undetectable, and both serum cortisol and urinary 17-OHCS were very low. Other pituitary hormones were normal, suggesting that hypothalamo-pituitary-adrenal (HPA) axis is selectively damaged. However, within several weeks, plasma ACTH returned to normal, and showed a normal increase response to corticotropin-releasing hormone stimulation test. These results indicated that ACTH deficiency was only transient. After hydrocortisone (10 mg/day) was administered, his symptoms became suddenly improved. Based on those results and clinical course, ie, elevated erythrocyte sedimentation rate, negative rheumatoid factor and the typical symptoms, which showed improvement to glulcocorticoid therapy, the final diagnosis was PMR, which was associated with transient ACTH deficiency. This is the first report of a case of PMR, in which the HPA axis was examined in its very acute phase. It was demonstrated that the case was associated with the transient adrenocortical hypofunction, which was recovered during a short time. It is therefore possible that PMR may show a different responsiveness of HPA axis depending on its phases. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"1 ","pages":"25-7"},"PeriodicalIF":0.0,"publicationDate":"2010-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S6215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31657876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it Possible to Extirpate Cardiovascular Events in Primary Aldosteronism After Surgical Treatment.","authors":"Tetsuo Nishikawa,&nbsp;Yoko Matsuzawa,&nbsp;Jun Saito,&nbsp;Masao Omura","doi":"10.4137/JCM.S6316","DOIUrl":"https://doi.org/10.4137/JCM.S6316","url":null,"abstract":"<p><p>It is well known that primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a surgically curable secondary hypertension. Thus, the differential diagnosis between unilateral hyperaldosteronemia due to APA and bilateral hyperaldosteronemia due to idiopathic hyperaldosteronism (IHA) is crucial to decide surgical indication for treatment in PA patients. Adrenal venous sampling (AVS) can diagnose the laterality of hypersecretion of aldosterone in those patients, while it is still impossible to differentiate bilateral hypersecretion of bilateral aldosterone-producing adenomas (Blt-APAs) from that of bilateral hyperplasia of IHA. To solve the problem, we try to develop a new method of supper-selective ACTH-stimulated adrenal venous sampling (SS-ACTH-AVS). We performed SS-ACTH-AVS by using a strip-tip type 2.2 Fr micro-catheter (Koshin Medical Inc. Japan). Adrenal effluents were sampled super-selectively at the central veins and at one or two tributaries of adrenal veins in each gland. We would like to emphasize that SS-ACTH-AVS can precisely analyze the situation of hyperfunction of steroidogenesis in each side of adrenals as well as in some tiny lesions inside the adrenal cortex which are not visible in the CT images. Moreover, we can differentiate Blt-APAs from IHA, and postulate the decision of surgical treatment, such as partial adrenalectomy. Thus, we should perform SS-ACTH-AVS especially in the case demonstrating the existence of bilateral adrenal lesions such as unilateral and bilateral tumors, or even no tumor in both sides in the patients with PA. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"1 ","pages":"21-3"},"PeriodicalIF":0.0,"publicationDate":"2010-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S6316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31658529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel isoforms of periostin expressed in the human thyroid.","authors":"Yanhua Bai,&nbsp;Misa Nakamura,&nbsp;Gengyin Zhou,&nbsp;Yaqiong Li,&nbsp;Zhiyan Liu,&nbsp;Takashi Ozaki,&nbsp;Ichiro Mori,&nbsp;Kennichi Kakudo","doi":"10.4137/JCM.S5899","DOIUrl":"https://doi.org/10.4137/JCM.S5899","url":null,"abstract":"Periostin is an extracellular matrix protein. Five isoforms of human periostin cDNA have been reported, but the expression of periostin isoforms in the human thyroid tissue is by far unknown. A group of primer sets were designed to amplify the full length of cDNA sequence of periostin. Using human thyroid carcinoma and their paired non-neoplastic tissues together with anaplastic thyroid carcinoma cell lines, we examined the presence of periostin cDNA isoforms by RT-PCR and direct DNA sequence analysis. We identified eight coexisting cDNA isoforms in all the tissue samples and cell lines. Three of them were unique to this study. Especially two of them haven’t been previously reported in any species. The eight periostin isoforms differ in the C-terminus from exon XII to exon XXI where alternative splicing usually happens. This is the first report that demonstrates all the eight isoforms of periostin cDNA expressed in the human thyroid gland and identifies three novel isoforms.","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"1 ","pages":"13-20"},"PeriodicalIF":0.0,"publicationDate":"2010-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S5899","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31658528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Species-specific actions of incretin: from the evolutionary perspective.","authors":"Yukiko Kawasaki,&nbsp;Yoshiyuki Hamamoto,&nbsp;Hiroyuki Koshiyama","doi":"10.4137/JCM.S5915","DOIUrl":"https://doi.org/10.4137/JCM.S5915","url":null,"abstract":"<p><p>Two modes of incretin-based therapy, incretin mimetics (ie, glucagon-like peptide-1 (GLP-1) agonists) and incretin enhancers (ie, inhibitors of dipeptidyl peptidase IV (DPP-IV)), have recently been introduced into the clinical use. From the viewpoint of evolutionary endocrinology of GLP-1 and their receptors, the incretin action of GLP-1 seems to be relatively recent. Exendin-3 and exendin-4 are paralogs of GLP-1 from the lizards, and the synthetic exendin-4, exenatide, is a paralog of GLP-1. It has recently been indicated that GLP-1 and its receptor are expressed in the taste buds of the tongue, suggesting their possible function in the taste sensing signal pathway. In order to elucidate unknown functions of GLP-1 and its agonists and enhancers, ie, other than incretin actions in humans, it is possibly useful to consider GLP-1 from the viewpoint of integrated systems biology and evolutionary endocrinology. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"1 ","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2010-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S5915","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31658527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Grade Inflammation as Trade-Off Causing Chronic Complex Diseases","authors":"H. Koshiyama","doi":"10.4137/JCM.S0","DOIUrl":"https://doi.org/10.4137/JCM.S0","url":null,"abstract":"Recently, it has been suggested that low-grade inflammation may underlie chronic complex diseases, such as diabetes, dyslipidemia, atheroslerosis, and metabolic syndrome.1,2 High-sensitivity C-reactive protein has been adopted as a biomarker.3–5 However, the site of low-grade inflammation has been of debate; whether it is the adipose tissue6 or other tissues such as the periodontal tissue.7 \u0000 \u0000Evolutionary medicine can give us an ultimate cause (ie, “why”) of some disease rather than a proximate cause (ie, “how”).8,9 The key concept of evolutionary medicine is the “mismatch” between the selection pressure and the change of environment.8–13 Some phenotype, which is advantageous for humans against some conditions, can cause several diseases, as trade-off.8–13 \u0000 \u0000Humans have been exposed to infections by helminthes and bacteria, both of which have contributed to develop innate immunity as a defense system.10,12 A proposed mechanism of an increase in allergy, termed the “hygiene hypothesis”, is that the appropriate exposure to helminthes early in life is essential to set up immunoregulatory pathways. \u0000 \u0000Here I propose another paradigm from the viewpoint of evolutionary medicine why low-grade inflammation may underlie many complex diseases. The intestinal bacterial flora has evolved with humans, and they are now known to be fundamental to the development of the human innate immunity system. \u0000 \u0000Increasing evidences have indicated that innate immunity may be associated with some disorders. For example, Toll-like receptors (TLRs) have been indicated in the pathogenesis of atherosclerosis. Free fatty acids, which are secreted from the adipose tissue, may act as an agonist of TLR4 and cause a pro-inflammatory response of macrophages,14 or oxidized LDL may be a ligand for TLR4.15 TLR5 knock-mouse has shown a change of gut microbiota as well as a phenotype of metabolic syndrome.16 Furthermore, very recently, it has been reported that carbohydrate-active enzymes are detected exclusively in intestinal flora of Japanese, which are derived from marine bacteria,17 suggesting a racial difference in co-evolution of intestinal flora and humans. \u0000 \u0000Taken, together, it is possible that trade-offs of the innate immunity, which has evolved with intestinal flora, may underlie chronic complex diseases, such as obesity, atherosclerosis, or diabetes. A recent study has suggested that dark chocolate consumption changes gut microrbiota in humans.18 Since sweet taste is known to affect the secretion of glucagon-like peptide 1(GLP-1), one of the incretin hormones, it may be of interest to investigate whether incretin analog may change the gut microbiota.19","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"1 1","pages":"3 - 4"},"PeriodicalIF":0.0,"publicationDate":"2010-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70708238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}