Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Therapeutic Effects of Adding Thiazide Diuretic or Mineral Corticoid Receptor Antagonist in Hypertensive Patients Given ARB and Calcium Channel Blocker
Get PDFアンジオテンシンⅡ受容体拮抗薬とカルシウム拮抗薬の併用で目標血圧に達しなかった高血圧患者13例を対象に，利尿薬としてサイアザイド系利尿薬（TZD）あるいはミネラルコルチコイド受容体遮断薬（MRA）の追加による治療効果を比較検討した．ARBとCCBに加え，トリクロルメチアジド（TCM）1-2 mgまたはエサキセノン（ESX）1.25-2.5 mgをそれぞれ12-16週間投与する無作為クロスオーバー試験を実施した．診察室血圧はTCM期（131/73 mmHg）とESX期（129/72 mmHg）で同等であり，朝と夜の家庭血圧もTCM期とESX期で同等であった．血液検査では，TCMにより血清Naが有意に減少（-1.2 mEq/L，p＝0.013）するとともに尿酸が増加し（＋1.1 mg/dL，p＜0.001），ESXでは血清Kがわずかに増加した（＋0.2 mEq/L，p＝0.042）．TCM，ESXともに推算GFRは有意に低下し（66, 67 vs 72 mL/min/1.73 m2, p＝0.023, 0.047），ESXでは尿中のアルブミン（81 vs 148 mg/gクレアチニン，p＝0.035）と肝型脂肪酸結合蛋白が有意に低下した．血中脳性ナトリウム利尿ペプチドと高感度CRPは，TCM期とESX期でそれぞれ有意に低下した．酸化LDLや活性酸素代謝物などの酸化ストレスの指標は，TCMとESXのいずれにも影響を受けなかった．降圧薬の併用療法において，MRAであるESXはTZDと同等の血圧降下作用を有し，血清Kの上昇に注意が必要であるが，血清尿酸値への影響は少なく，腎保護の点で有利であると考えられる．We compared the addition of a thiazide diuretic（TZD）and a mineral corticoid receptor antagonist （MRA） in 13 hypertensive patients who did not achieve the target blood pressure level with the combination of an angiotensin II receptor blocker（ARB）and a calcium channel blocker（CCB）. A randomized crossover study was performed giving 1-2 mg trichlormethiazide （TCM） or 1.25-2.5 mg esaxerenone（ESX）in addition to ARB and CCB combination for 12-16 weeks each. The office blood pressure was comparable between the TCM period （131/73 mmHg） and the ESX period （129/72 mmHg）. The morning and the evening home blood pressures were also comparable in the TCM and the ESX periods. As for the laboratory data, serum Na was significantly decreased （-1.2 mEq/L, p＝0.013） and uric acid was increased （＋1.1 mg/dL, p＜0 . 0 0 1） by TCM, while serum K was slightly increased by ESX（＋0.2 mEq/L, p＝0.042）. The estimated GFR was significantly reduced both by TCM and ESX（66 and 67 vs 72 mL/min/1.73 m2, p＝0.023 and 0.047）, however, ESX but not TCM significantly reduced the urinary excretions of albumin （81 vs 148 mg/gCreatinine, p＝0.035） and liver-type fatty acid binding protein. Reductions in plasma brain natriuretic peptide（ BNP）and high sensitivity C-reactive protein （CRP） were significant in the TCM and the ESX periods, respectively. Circulating markers of oxidative stress such as oxidized LDL and reactive oxygen metabolites were not affected by either TCM or ESX. In the combination drug therapy of hypertension, ESX, as a MRA, has a hypotensive effects comparable to TZD and may have advantage in protecting kidney without raising serum uric acid although care should be taken for the increase in serum K.journal articl
Sagittal Alignment of the Spine in Patients with Adult Spinal Deformity
Get PDFAdult spinal deformity (ASD) is common spinal disorder in the elderly. The feature of spinal alignment in ASD patients is loss of lumbar lordosis, which results in a forward leaning posture. Sagittal imbalance has been shown to correlate with poor health related QOL especially concerning upright standing and walking. Past studies have been conducted to understand ideal sagittal global alignment, and some formulas have been developed to calculate the ideal lumbar lordosis matching pelvic incidence, which assists in surgical planning when deciding the amount of correction. To evaluate the individual spinal deformity in the sagittal plane, understanding the presence of compensatory mechanisms is indispensable. The basic mechanisms of sagittal compensation are extension of the neighboring flexible spine or backward rotation of the pelvis to avoid anterior translation of the gravity line. Global evaluation of the entire spine and pelvis including compensatory mechanisms allows for better planning for surgical management of these patients. This paper provides an overview of the sagittal spinal parameters which concern the diagnosis and treatment of patients with ASD, and describes a therapeutic solution for future ASD care.journal articl
Successful Treatment with Pembrolizumab of a Patient with Advanced Non-small Cell Lung Cancer Containing a Spindle Cell Carcinoma Component
Get PDFPulmonary sarcomatoid carcinoma accounts for 0.1%-0.5% of all lung cancers. It has an aggressive biological behavior and is often resistant to conventional chemotherapy and radiation therapy. An 84-year-old man presented with a painful mass in the left breast. Physical examination revealed two palpable subcutaneous nodules on the back. Computed tomography (CT) scan revealed a 4-cm mass in the upper lobe of the right lung and mediastinal lymphadenopathy. Positron emission tomography (PET) /CT scan revealed excessive FDG hyperaccumulation in the right pulmonary mass, left breast mass, subcutaneous nodules on the back, left second rib, and third thoracic vertebra. Histopathological examination of a needle biopsy specimen obtained from the breast mass revealed atypical spindle cell proliferation with numerous mitoses. Immunohistochemical examination revealed positive staining of the tumor cells for CAM 5.2, and the Ki-67 positive rate was 70%. The patient was diagnosed with non-small cell lung carcinoma containing a spindle-cell carcinoma component, cT4N2M1c, stage IVB. The PD-L1 (22C3) tumor proportion score was 90%. The patient received pembrolizumab 200 mg every three weeks with a partial response. He has continued to receive pembrolizumab for over one year. Further studies on a large number of patients are warranted to evaluate the efficacy of PD-1/PD-L1 inhibitor therapy for pulmonary sarcomatoid carcinoma.journal articl
Generalized Discoid Lupus Erythematosus with Systemic Lupus Erythematosus: A Therapeutic Challenge
Get PDFIntroduction: Generalized discoid lupus erythematosus (DLE) is a rare skin manifestation; however, about 15-28% of cases may develop into Systemic Lupus Erythematosus (SLE). Generalized DLE with SLE showed a poorer prognosis and required holistic therapy.
Case Report: A 20-year-old female complained of red rash on the skin, worsen with sun exposure in the past two years. She complained of joint pain, fever, decreased appetite, and fatigue, twenty months after the skin rash onset. Skin examination on the scalp, face, trunk, hands and feet showed erythematous to hypopigmentation patches, atrophic skin, and erosions covered with crusts. Laboratory investigations revealed anemia, high titers of ANA, and anti-dsDNA. Histopathological results were consistent with lupus erythematosus. Consultation with an ophthalmologist showed no contraindications to hydroxychloroquine. She was diagnosed with generalized DLE with moderate SLE and showed an excellent response to hydroxychloroquine, methotrexate, both systemic and topical corticosteroids, and sunscreen.
Discussion: Generalized cutaneous lupus can be treated with a topical therapy such as corticosteroid, sunscreen, and systemic therapy such as hydroxychloroquine and corticosteroid. Methotrexate, as a steroid-sparing agent, has a role in treating moderate to severe SLE and lupus arthritis.
Conclusion: Early recognition of SLE in a patient with cutaneous lupus and adequate therapy in generalized DLE is essential. Combination therapy showed better efficacy than monotherapy in generalized cutaneous lupus accompanied by SLE.journal articl
Medical Education and AI
Get PDFJapan’s population of 18-year-olds peaked in 1992 and has been declining since then.
If the birth rate does not improve in the future, the population of 18-year-olds in 2040 is expected to decrease to 880,000, and some predict that the number of students who go on to university will remain at 80% of the current level.
In addition, with the advent of Society 5.0, some routine and numerically feasible tasks will be substituted by artificial intelligence （AI） technology, and our lives will change dramatically.
Such changes must necessitate significant adjustments in the field of medical education as well.
With the recent global pandemic caused by COVID-19, changes in social structure due to population shifts, and the rapid evolution of digital technology, the world has become a place where conventional common sense is no longer applicable.
To survive in these unpredictable times, we need to acquire the ability to explore and discover problems on our own, while continuing to learn throughout our lives.
For this reason, higher education needs to transition to learner-centered education, focusing on “learning outcomes” rather than “what students have learned”.
Therefore, it is necessary to proactively introduce Digital Transformation in universities and provide personalized and optimized learning based on data.
It will also be desirable to provide education that effectively utilizes Artificial Intelligence （AI）．
Artificial Intelligence excels in numerical inference and prediction, judgment based on strict rules, and simple tasks based on input data. Therefore, AI will replace human work in these areas.
What is important in the age of AI is the development of the senses, the ability to create new things, and the ability to judge unclear situations.
In this paper, I would like to outline the current state of higher education, the shift to Digital Transformation in medical education, and the utilization of AI.journal articl
The Current Status of Open Access in Medical Journals Published by Japanese Medical School
Get PDFインターネットを通じた大学教育のグローバル化が普遍化した現在，国際競争力の確保が教育機関にとって喫緊の課題となっている．特に，医学部を持つ大学は，国際的な研究力を向上させる責務があり，これはアカデミックな側面だけでなく，ブランディング戦略上の重要な課題といえる．この論文では，日本の医学部を対象に，医学雑誌のオープンアクセス化に焦点を当て，その現状と効果について考察した．調査の方法は，非営利の医学情報プラットフォームを活用し，国内医学部が発行する医学雑誌に関するオープンリソースデータを収集した．結果として，国内医学部が発行する医学雑誌についての情報が整理され，それぞれの雑誌のオープンアクセス化の状況や，国際的な医学情報データベースである MEDLINE，PubMed，PMC への収載状況を明らかにした．また，各大学の学術機関リポジトリやウェブサイトの公開状況についてもまとめた．総括的に，国内医学部におけるオープンアクセス医学雑誌の普及は，国際的な医学研究の発信の場として欠かせない電子媒体であり，大学医学雑誌の国際化戦略により大学のアカデミアとブランディングの双方に貢献する可能性が考察された．journal articl
