Therapeutic Research
Volume 34, Issue 3, 2013
Volumes & issues:
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Symposium:第 60 回日本心臓病学会学術集会ランチョンセミナー 見直される硝酸薬―基礎研究とガイドラインの両面から―
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Symposium:第 25 回 Nicorandil 研究会
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- 基礎の部
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演題 6.喫煙による酸化ストレスに対するニコランジルの脳血管内皮保護効果―ラット Closed Cranial Window 法を用いた検討―
34巻3号(2013);View Description Hide Description -
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演題 8.ニコランジルは NO 非依存性に cGMP を産生し,チトクローム P450 の低下や硝酸剤耐性を起こさない
34巻3号(2013);View Description Hide Description - 臨床の部
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演題 1.急性心筋梗塞再灌流療法に対する末梢保護デバイスとニコランジルの有用性―Index of Microcirculatory Resistance(IMR)による冠微小循環障害の評価―
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演題 3.Nicorandil Prevents Troponin T Release in Patients with Acute Heart Failure
34巻3号(2013);View Description Hide Description -
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Review
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原著
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血糖コントロール不良インスリン治療中の2 型糖尿病に対し,シタグリプチン追加とインスリン増量の比較検討―CASA study―
34巻3号(2013);View Description Hide DescriptionAim:Individuals requiring insulin therapy for type 2 diabetes often require escalation of their regimen to achieve glycemic control. Optimal management strategies for uncontrolled type 2 diabetes would improve glycemic control without hypoglycemia and weight gain. This study compared the efficacy and tolerability of adding sitagliptin, an oral dipeptidyl peptidase-4 inhibitor, and an up to 20% increase in insulin dose in patients with uncontrolled type 2 diabetes on insulin therapy. Method:We conducted a 24-week, randomized, active-competitor, parallel-group study in subjects with uncontrolled type 2 diabetes[hemoglobin(Hb)A1c, 7.5-11.0%] currently using insulin therapy. Subjects were randomly assigned to either the sitagliptin-adding arm(50 mg/day, n=24)or insulin-increasing arm(≧10% at week 24, n=10)while continuing other medications. Results:Sitagliptin-adding and insulin-increasing treatment arms did not differ with respect to baseline characteristics, including HbA1c(8.8±0.8% vs 8.1±0.7%, respectively). HbA1c was decreased at 24 weeks in both the sitagliptin-adding and insulin-increasing treatment arms(-0.9±0.7% vs-0.6±0.5%, not significant). Insulin was increased by 18.9% at 24 weeks in the insulin-increasing group. Hypoglycemic events were less common in the sitagliptin-adding arm than in the insulin-increasing arm(0 vs 0.4 events per patient-year, respectively, p<0.05). Severe hypoglycemic events were not encountered in either group. Weight was stable in both sitagliptinadding subjects and insulin-increasing subjects(+0.3±0.9 kg vs +0.6±1.7 kg, respectively; not significant). No other adverse events occurred in either group. Conclusions:Compared to a 19% increase in insulin dose, adding sitagliptin to an insulin-based regimen was more effective at lowering HbA1c and was not associated with hypoglycemia or weight gain over 24 weeks. -
2 型糖尿病患者を対象としたミチグリニドカルシウム水和物/ボグリボースの配合薬の臨床研究―HbA1c,グリコアルブミン,1,5-AG を指標とした有効性評価―
34巻3号(2013);View Description Hide DescriptionPurpose:To assess the efficacy and safety of fixed-dosed mitiglinide/voglibose in terms of glycemic and lipid parameters, in patients with type 2 diabetes mellitus who switch their therapy from glinides or α-GIs. Methods:Fourteen outpatients with type 2 diabetes mellitus, who had inadequate glycemic control with diet and exercise therapy, and antidiabetic medication with a glinide or α-GI alone, were eligible for this study. After switching from their prior glinide or α-GI monotherapy to fixed-dosed mitiglinide/voglibose combination therapy for 16 weeks, we evaluated the effects of the combination on fasting glycemic and lipid parameters in the observation period(0 week), and at 4, 8, 12, 16 weeks after administering the combination. In addition, we conducted meal load tests using a test meal in 8 non-hemodialysis patients and evaluated postprandial glycemic and lipid parameters at 30 and 60 minutes after this loading in the observation period(0 week)and at 16 weeks after administering the combination. Results:Four of 14 subjects were hemodialysis patients who started the combination therapy from once a day. Based on this patient background, we evaluated efficacy of the combination by dividing them into 10 non-dialysis patients and 4 dialysis patients with type 2 diabetes mellitus. In 10 non-dialysis patients, 8 patients switched from a prior α-GI, and 2 patients from a prior glinide. After switching to the combination therapy from the prior drugs, HbA1c and GA significantly decreased(p<0.05)in a parallel fashion after 4 weeks. The mean HbA1c and GA values were 8.38±0.48% and 23.16±1.69% respectively in the observation period, then 6.87±0.19% and 18.09±0.92% after 16 weeks. The differences from the observation period were -1.49±0.53% and -4.61±1.70% respectively. 1,5-AG significantly increased(p<0.05)after 4 weeks, and was inversely correlated with HbA1c and GA. The mean 1,5-AG value was 7.41±1.68μg/mL in the observation period, and 14.26 ±2.51μg/mL after 16 weeks, which was a difference from the observation period of +6.40±2.56μg/mL. In the subgroup of patients with an HbA1c of more than 7.4% and with less than 10μg/mL of 1,5-AG in the observation period, both glycemic parameters clearly improved after treatment with the combination, demonstrating its clinical usefulness. In addition, with test meal loads, the combination significantly increased(p<0.05)early insulin secretion and improved postprandial hyperglycemia at 30 and 60 minutes post-load in the patients with prior use of an α-GI. Furthermore, in 3 hemodialysis patients, the combination also improved GA and HbA1c. Conclusions:A fixed-dosed mitiglinide/voglibose combination significantly improved the glycemic parameters of HbA1c, GA and 1,5-AG by reducing postprandial glycemic excursions in patients with type 2 diabetes mellitus who had switched therapy from glinides or α-GIs. -
骨粗鬆症の薬物治療―治療率と治療継続率についての検証―
34巻3号(2013);View Description Hide Description欧米においてはビスホスホネート製剤の登場により大oe 骨近位部骨折率の低下が認められているが,わが国における大oe 骨近位部骨折率は依然として増加傾向にある。その背景として,骨粗鬆症患者の治療率・治療継続率の低さが指摘されている。筆者が今回実施した調査では,骨粗鬆症患者の治療開始のきっかけは医師の勧めが大半を占めており,治療率の向上には医師の役割が大きいと考えられた。また骨粗鬆症患者の 55%は「骨粗鬆症の治療を続けるのは大変である」と回答しており,治療継続の難しさがうかがわれた。治療継続のために,57%の患者が「今よりも服薬にかかる手間を減らしたい」と回答しており,現状の骨粗鬆症薬物治療における服薬の煩雑さが治療中断の原因の一つである可能性が示唆された。また「医師から疾患や治療に関して,もう少し詳しく説明してほしい」と回答した患者が 67%を占め,治療率・治療継続率の両方において医師の関与が重要であると考えられた。今後,医師の積極的な関与ならびに服薬アドヒアランス良好な薬剤の選択により,効果の高い骨粗鬆症治療が実現されることが期待される。 -
マイクロファイバー素材クリーニングクロスによる医療機器清拭効果について
34巻3号(2013);View Description Hide DescriptionCleaning effectiveness of Torayseefor CE(hereafter referred to as“Toraysee”) developed by Toray specifically for the purpose of cleaning liquid crystal displays and other equipment, was evaluated with adenosine triphosphate(ATP)wipe test. The use of Toraysee requires neither chemicals nor cleaning agents. <Experiment 1>Test method:The surface of a stainless steel flat panel was contaminated to the ATP level (luminescence level) of 10000±500 RLU using yeast extract solution prepared to the concentration of 5 wt% by diluting with purified water. The flat panel was then wiped with Toraysee and then the ATP wipe test was conducted for evaluation. Results:Wiping with a sheet of Toraysee(24 cm×24 cm)reduced the ATP level to less than 500 RLU over the surface area of 34560 cm2 of a stainless steel flat panel onto which a yeast extract solution containing 10000 RLU of ATP was applied. <Experiment 2>Test method:ATP wipe test was conducted and evaluated on a total of 150 units of syringe pumps which were separated into three 50 unit groups. [Protocol A]For the pre-cleaning group, the surface of the control panels of 50 consecutive units returned from the hospital wards after having been used for patients, was subjected to ATP wipe test immediately upon the return. For the Toraysee group the returned units were first moistened with tap water and then were wiped with Toraysee before the ATP wipe test. For the disinfection cloth group the returned units were wiped with alcohol towel before the ATP wipe test. This product is currently being used in our hospital. For the Protocol A test procedure, all 150 units(50 from each group)were, therefore, subjected to ATP wipe test and results were evaluated. [Protocol B]Taking into consideration the impact of the measurement principles of the ATP wipe test, the order of the test was changed to start from the Toraysee group, followed by the pre-cleaning group, and then the disinfection cloth group. The test was performed on 50 units for each group and the results were compared. Results:Average ATP level was 1820.4±2972.9 RLU(mean±SD)in the precleaning group, 126.5±128.4 RLU in the Toraysee group and 142.1±145.1 RLU in the disinfection cloth group. It was found that wiping with Toraysee significantly purified the surface of contaminated syringe pump units and reduced the ATP level to below 1000 RLU which is considered to be an environmentally favorable level. There was a clear indication that Toraysee’s cleaning effectiveness is comparable to the disinfection cloth. In addition, staphylococci bacteria were found in the used Toraysee suggesting that it can remove bacteria as well.<Conclusions>Toraysee is able to clean medical equipment without using any chemicals or cleaning agents. It can also be impregnated with agents if so needed. In summary Toraysee is effective in cleaning medical equipment and at the same time it is environmentally friendly
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