Therapeutic Research
Volume 38, Issue 5, 2017
Volumes & issues:
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INFORMATION:「小児肥満症診療ガイドライン2017」のポイント―小学生,中学生,高校生に接するすべての方へ
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Information:日本循環器学会 第29回プレスセミナー
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Symposium:第49回埼玉不整脈ペーシング研究会
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- 一般演題
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Thoracic Vein, Non Thoracic Veinを起源とする心房細動患者の臨床的特徴の比較検討
38巻5号(2017);View Description Hide Description - 特別講演
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総説
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原著
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フェキソフェナジン塩酸塩60 mg/フェニレフリン塩酸塩10 mg 配合剤(FEX60/PE10 錠)のアレルギー性鼻炎患者に対する有効性および安全性の検討―多施設共同,オープンラベル試験―
38巻5号(2017);View Description Hide DescriptionBackground:Treatment with histamine H1 receptor agonists tends to be less effective for nasal congestion than for the other two primary symptoms of allergic rhinitis (repeated sneezing and rhinorrhea). We thus explored the efficacy and safety of a fixed dose combination(FDC)of 60 mg fexofenadine hydrochloride(FEX), a second‒generation antihistamine known for its good safety profile, and 10 mg phenylephrine(PE), an α1 receptor agonist effective against nasal congestion. Methods:A multicenter open‒label study comparing the effectiveness before and after 2‒week twice‒daily administration of oral FEX60/PE10 FDC tablets for at least 1 year in patients aged 15 years and older with allergic rhinitis. The primary endpoint was mean change from baseline in nasal congestion score. The secondary endpoints were mean change from baseline in daily, daytime, and nighttime scores for the following:combined scores for sneezing, rhinorrhea, and nasal congestion;individual scores for sneezing, rhinorrhea, and impact on daily activities;change in nasal cavity findings;patient impressions;and change in symptom severity. Results:This 3‒center study was conducted from March to July 2015 in Japan. The intent‒to‒treat population was 105 patients with a mean age of 38.9 years;all were included in safety analysis and in the modified intent‒to‒treat group. Slightly more subjects were male(56 subjects, 53.3%). The allergy diagnosis was seasonal allergic rhinitis in 48 subjects(45.7%), perennial allergic rhinitis in 25 (23.8%), and mixed allergic rhinitis in 32(30.5%). Mean improvement in nasal congestion score was statistically significant(-0.798;95%CI -0.91 to -0.68;p<0.001). Secondary endpoints also improved significantly. Patient impressions were favorable, and physician assessment tended toward improvement for all symptoms. Adverse events were noted in 7 patients (6.67%);the most common was rhinopharyngitis in 4 patients(3.81%). Adverse drug reactions were 1 case of aggravated preexisting hepatic steatosis and 1 case of somnolence(0.95% each). The hepatic steatosis was confirmed to have been relieved, and the other adverse events were confirmed resolved. No serious adverse events were reported. Conclusion:FEX60/PE10 tablets were effective against nasal congestion, and also improved other rhinitis symptoms and reduced the impact of those symptoms on daily activities. The drug was generally well‒tolerated. -
最重症OSAS におけるCPAP 導入効果の解析
38巻5号(2017);View Description Hide DescriptionStudy objectives:To evaluate the adherence in most severe sleep apnea patients using CPAP(continuous positive airway pressure). The study was concluded at one urban community‒based clinic sleep laboratories. Design:Retrospective study. Patients:Data were collected on 645 OSAS(obstructive sleep apnea syndrome) patients in whom CPAP was novel applied. Intervention:Appropriate CPAP level was titrated to totally diminished oxygen desaturation and apnea under the one night in laboratory(group T, n=318). Auto titration CPAP was applied to purpose of early therapeutic intervention(group A, n=327). Measurements and results:Group A(84%)had better adherence of CPAP treatment than Group T(73%)in 5 years. Group A had also longer treatment time than Group T in daily usage time. Auto titrating CPAP might have possibility for replacing in laboratory titration of CPAP, but this needs to be further tested in large studies. This strategy also remains as an option in current guidelines of the American Academy of Sleep Medicine. -
骨粗鬆症患者におけるイバンドロネート経口製剤とエルデカルシトールの併用療法の検討
38巻5号(2017);View Description Hide DescriptionThe efficacy of the combination therapy of monthly oral ibandronate and eldecalcitol in 57 osteoporosis patients was compared by using tartrate‒resistant acid phosphatase‒5b(TRACP‒5b)levels, and the safety was also determined. When determined in 2 groups of those whom the osteoporosis therapy was newly introduced and those whom the osteoporosis therapy was switched from risedronate, the TRACP5‒b level significantly decreased in both groups, which showed a significant difference especially in female patients(p<0.001). Secondly, while fasting duration after dosing is 60 minutes for the monthly product of monthly oral ibandronate, which is longer than that of existing bisphosphonate products, the survey with patient questionnaire showed that 81% of patients did not have any changes in their daily morning life. It is considered that their life style did not suffer any changes. -
テーピング施術経験の差が両膝関節へのテーピング施術時の体力要素にもたらす影響
38巻5号(2017);View Description Hide DescriptionAlthough taping is used to prevent sports injuries, the quality of the procedure varies depending on practitioners’ experience. In the present study, we examined differences between experienced and inexperienced practitioners in fitness –related factors when taping both knees. Sixteen healthy male university students were treated under 3 conditions: no taping, taping by an inexperienced practitioner, and taping by an experienced practitioner. The following items were examined: knee flexibility(knee flexion range of motion), instantaneous force (standing long jump), agility(jumping side to side), static balance(standing on one leg with the eyes open/closed), dynamic balance(functional reach), and the time needed for taping. Inexperienced practitioners needed a longer time to perform the procedure. However, the experience of taping or time needed for it did not markedly influence knee flexibility, instantaneous force, agility, or static/dynamic balance.
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症例
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ベザフィブラートによる担癌C 型肝硬変の抗肝細胞癌効果を示した1 例
38巻5号(2017);View Description Hide Description症例は79 歳,男性。C 型肝硬変で外来通院中に定期腹部エコーでS5 に12 mm の占拠性病変を発見した。経過観察1 年2 ヵ月後に占拠性病変は18.5 mm に増大し,AFP は25 ng/mL より188 ng/mL に上昇した。腹部血管造影で血管新生,腫瘍濃染像を認めなかった。9 ヵ月間に肝動脈化学塞栓療法(TACE)を3 回,経皮的エタノール注入療法(PEIT)を2 回行うも腫瘍径は増大し,AFP 72,821 ng/mL,PIVKA‒Ⅱ 2369mAU/mL に上昇した。PET‒CT ではS5 にのみviable HCC を認めた。腫瘍マーカーピーク時1週間前よりベザフィブラート400 mg/日の投与を開始した。開始4 ヵ月後胆石,胆のう炎のため手術入院し,服薬は2 週間中断した。入院時849 ng/mL まで低下していたAFP は退院時1831 ng/mLに再上昇したが,服用再開4 ヵ月後AFP 254 mAU/mL,PIVKA‒Ⅱ 43 mAU/mL に低下,腫瘍サイズも78.5 mmより27 mmに縮小し以後サイズ増大はなかった。その後,腫瘍濃染を示したS8 中心に多発性のHCC を認め,TACE を行うも効果は一時的であり肝不全にて死亡した。急激な腫瘍マーカーの上昇があったHCC に,ベザフィブラートが抗腫瘍効果を示した症例を経験した。全経過は4 年2 ヵ月であった。
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