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Measurement of Plasma Cortisol Using Blood Self-Collection is Useful for Optimal Glucocorticoid Replacement and Screening in Adrenal Insufficiency.
Get PDFAdrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment. Glucocorticoid replacement therapy in patients with adrenal insufficiency is lifesaving. However, the patients usualy need to visit or be admitted to hospital for monitoring of the temporal pattern of the cortisol level, which is required for the diagnosis and evaluation of the optimal glucocorticoid replacement. To reduce the burden on the patient and to assess the pattern of cortisol level in the patient's daily life, we subjected self-collected blood to the cortisol measurement using a DetectX® Cortisol Enzyme Immunoassay Kit. The new measurement was evaluated by comparison with an established in vitro diagnostic Cortisol Ⅱ that has been introduced in hospitals. Bland-Altman analysis was used for assessing the degree of agreement between two measurements by studying the mean difference and configuring limits of agreement. The bias (mean difference) was 20.01%. This bias was significant, because the line of equality (0%) was not in the confidence interval of the bias. The 95% limits of agreement were from - 55.71 to 95.74%. Although the cortisol values obtained with Cortisol Ⅱ were 1.450μg/dL higher on average than those obtained with DetectX, the measurements of DetectX correlated with those obtained with Cortisol Ⅱ. Therefore, we conducted cortisol measurement using blood self-collected by patients at home. Plasma cortisol levels in a patient with hypopituitarism responded to administration of hydrocortisone in a dose-dependent manner A patient who had been diagnosed with depressive disorder did not show the natural cortisol circadian rhythm. Low levels of cortisol during the morning seemed to be a cause of the reduced arousal level. We concluded that the measurement of cortisol using self-colected blood was useful for determining optimal glucocorticoid replacement therapy and screening for adrenal insufficiency
Two cases of Taeniasis Infection.
Get PDFWe report two cases of taeniasis caused by tapeworm infection. The first was a Japanese female, 23 years old, who had a history of eating raw meat during a visit to Thailand. She was referred to our hospital with a history of passing proglottids in feces. Taenia saginata or T. asiatica was suspected based on the proglottid morphologic features in addition to supportive information regarding her travel and dietary history. The patient was given praziquantel and the tapeworm was excreted. The second was a 35-year-old Thai male who had lived in Japan since 2000 and not left the country since that time. He had consumed beef cooked in the so-called yakiniku style and also sometimes raw, because of nostalgia for that Thai custom. The patient passed proglottids several times and then came to us. The proglottids were compatible with those of T. saginata. Praziquantel was prescribed and the tapeworm was excreted. In both cases, mitochondrial DNA analysis identified the worm species as T. saginata. Since morphological discrimination of three human-infecting Taenia species, T. saginata, T. solium, and T. asiatica, is not always possible, it is necessary to employ DNA analysis for diagnosis of taeniasis to confirm the worm species
ラット非アルコール性脂肪肝炎モデルに対するプロバイオティクスとアンギオテンシンⅡ受容体拮抗薬併用療法の肝線維化に対する有効性
Get PDFAim: Intestinal endotoxin is important for the progression of non-alcoholic steatohepatitis (NASH). Circulating endotoxin levels are elevated in most animal models of diet-induced non-alcoholic fatty liver disease (NAFLD) and NASH. Furthermore, plasma endotoxin levels are significantly higher in NAFLD patients, which is associated with small intestinal bacterial overgrowth and increased intestinal permeability. By improving the gut microbiota environment and restoring gut-barrier functions, probiotics are effective for NASH treatment in animal models. It is also widely known that hepatic fibrosis and suppression of activated hepatic stellate cells (Ac-HSCs) can be attenuated using an angiotensin-II type 1 receptor blocker (ARB). We thus evaluated the effect of combination probiotics and ARB treatment on liver fibrosis using a rat model of NASH. Methods: Fisher 344 rats were fed a choline-deficient/L-amino acid-defined (CDAA) diet for 8 weeks to generate the NASH model. Animals were divided into ARB, probiotics, and ARB plus probiotics groups. Therapeutic efficacy was assessed by evaluating liver fibrosis, the lipopolysaccharide Toll-like receptor (TLR)4 regulatory cascade, and intestinal barrier function. Results: Both probiotics and ARB inhibited liver fibrosis, with concomitant HSC activation and suppression of liver-specific transforming growth factor-β and TLR4 expression. Probiotics reduced intestinal permeability by rescuing zonula occludens-1 disruption induced by the CDAA diet. Angiotensin-II type 1 receptor blocker was found to directly suppress Ac-HSCs. Conclusions: Probiotics and ARB are effective in suppressing liver fibrosis through different mechanisms. Currently both drugs are in clinical use; therefore, the combination of probiotics and ARB is a promising new therapy for NASH.博士（医学）・乙第1465号・令和2年9月30日© 2018 The Japan Society of HepatologyThis is the pre-peer reviewed version of the following article: [https://onlinelibrary.wiley.com/doi/full/10.1111/hepr.13281], which has been published in final form at [https://doi.org/10.1111/hepr.13281]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
高脂血症を合併する急性心筋梗塞における冠動脈血管修復過程に及ぼす多価不飽和脂肪酸の追加投与効果に関する研究
Get PDFBACKGROUND Vascular healing response associated with adjunctive n-3 polyunsaturated fatty acid therapy therapy in patients receiving strong statin therapy remains unclear. The aim of this study was to evaluate the effect of polyunsaturated fatty acid therapy with eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) in addition to strong statin therapy on coronary atherosclerotic plaques using optical coherence tomography. METHODS AND RESULTS This prospective multicenter randomized controlled trial included 130 patients with acute coronary syndrome treated with strong statins. They were assigned to either statin only (control group, n=42), statin+high-dose EPA (1800 mg/day) (EPA group, n=40), statin+EPA (930 mg/day)+DHA (750 mg/day) (EPA+DHA group, n=48). Optical coherence tomography was performed at baseline and at the 8-month follow-up. The target for optical coherence tomography analysis was a nonculprit lesion with a lipid plaque. Between baseline and the 8-month follow-up, fibrous cap thickness (FCT) significantly increased in all 3 groups. There were no significant differences in the percent change for minimum FCT between the EPA or EPA+DHA group and the control group. In patients with FCT <120 µm (median value), the percent change for minimum FCT was significantly higher in the EPA or EPA+DHA group compared with the control group. CONCLUSIONS EPA or EPA+DHA therapy in addition to strong statin therapy did not significantly increase FCT in nonculprit plaques compared with strong statin therapy alone, but significantly increased FCT in patients with thinner FCT. Registration URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN 000012825.博士（医学）・乙第1477号・令和2年12月24日Copyright © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes
Possibility of community-based child maltreatment prevention system using CASII.
No full text我が国の虐待対応の主たる機関である、児童相談所の一時保護入所児童を対象に、精神保健ニーズの視点から子どもへの支援の強度を評価する方法である、児童青年レベル・オブ・ケア評価尺度(Child and Adolescent Service Intensity Instrument:CASII)を実施し、その結果を検討した。6歳から15歳の虐待事例は21例であり、6次元中3次元で中等度以上の精神保健ニーズを示し、中でも推奨されるレベル・オブ・ケアが高い群では、危害のリスクなど本人の特性や状態へのサービスニーズを認めた。また、推奨されるレベル・オブ・ケアが5の子どもが42.9%と最多であったが、実際のサービスにおいては、半数以上が推奨されるレベルより低い支援提供にとどまっていた。以上より、CASIIを用いた評価は、地域を基盤とし子どもを中心とした支援を行う上で、有用であると考えられた。博士（医学）・乙第1488号・令和2年12月24日発行元である世論時報社の許諾を得て登録（2021年1月25日付）ジャーナル公式サイト（世論時報社HP内）：https://seronjihou.com/最新精神医学25巻4号
