Therapeutic Research
Volume 40, Issue 5, 2019
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Topics:日本循環器学会ガイドライン2018年改訂版のポイント
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安定冠動脈疾患の血行再建ガイドライン(2018年改訂版)/急性冠症候群診療ガイドライン(2018年改訂版)/慢性冠動脈疾患診断ガイドライン(2018年改訂版)/心筋症診療ガイドライン(2018年改訂版)/不整脈非薬物治療ガイドライン(2018年改訂版)/心疾患患者の妊娠・出産の適応,管理に関するガイドライン(2018年改訂版)
40巻5号(2019);View Description Hide Description
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Information:高血圧治療ガイドライン2019,高血圧基準は変更せず,降圧目標引き下げ
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Information:日本循環器学会 第49回プレスセミナー ソーシャルネットワークと循環器疾患
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原著
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メトホルミンの糖尿病患者のビタミンB12と葉酸,貧血に対する影響について
40巻5号(2019);View Description Hide DescriptionIt has been recently reported that metformin result in reducing the serum vitamin B12(Vit B12)level in patients with diabetes, and American Diabetes Association (ADA) recommended the regular measurement of Vit B12 in 2017. However, since we could not actually feel the decrease, we examined the effect of metformin on the changes of Vit B12, folic acid and red blood cells in patients with diabetes in the study. 304 patients with diabetes undergoing outpatient treatment in our hospital, were divided metformin‒treated(n=212)and control(n =92)groups, and the clinical parameters, including age, gender, duration of diabetes, body mass index, blood pressures, plasma levels of glucose, HbA1c (NGSP value), serum levels of Vit B12 and folic acid, blood cell counts, and presence of atrophic gastritis and peripheral neuropathy, were compared. In addition, the current dosage, the administration period, and the total administered amount of metformin were evaluated in the metformin‒treated group. There were not different in the levels of Vit B12, folic acid and red blood cell volume(MCV) between two groups. On the current dosage of metformin, the Vit B12 level in the metformin‒treated group was significantly lower than that of the control group, and the level was dose‒dependently decreased within the reference range. In contrast, the levels of folic acid and MCV were not changed by metformin. In addition, although there was no difference in the administration period of metformin, the level of Vit B12 at 3000 g or more was significantly lowered than that at 1000 g or less within the reference range. This study suggested that the reduction of Vit B12 by the treatment with metformin might not be observed in Japanese patients with diabetes, unlikely to ADA recommendation. -
コントロール不良な日本人重症喘息患者を対象とした主観的負荷に関するインターネット調査―SHIRAHAE study―
40巻5号(2019);View Description Hide DescriptionBackground:Severe, uncontrolled asthma is associated with increased exacerbations, use of oral corticosteroids, and frequent hospitalizations. Few studies have examined the patient‒reported subjective burden of severe, uncontrolled asthma. Object:To evaluate the type and extent of the subjective burden of severe, uncontrolled asthma in Japanese patients, and descriptively compare their perceptions with those of patients with severe, controlled asthma. Method:SHIRAHAE was a non‒inter ventional, internet sur vey of Japanese patients(aged≧20 years)with a diagnosis of asthma, who were on continuous treatment with an inhaled corticosteroid(ICS)or ICS/long‒acting β2 agonist. Patients completed a 42‒item questionnaire on the subjective burden of asthma. Asthma control status and patient satisfaction with current asthma treatment were separately evaluated. Results:Among 3272 enrolled patients, 698 patients had severe asthma, which included 499 with uncontrolled asthma and 199 with controlled asthma. Greater percentages of patients with severe, uncontrolled asthma selected“extremely applicable”or “applicable”for all questions as compared with patients with severe, controlled asthma, indicating a greater subjective burden of severe, uncontrolled asthma. Although asthma control status was not well controlled in whole patients population, approximately 60% of whole patients were satisfied with their current asthma treatment. Conclusion:This study showed that patients with severe, uncontrolled asthma had a greater subjective burden of asthma compared with patients with controlled asthma or non‒severe asthma. -
乳児血管腫の疾患・治療に関する保護者および医師アンケート調査
40巻5号(2019);View Description Hide DescriptionBackground:Infantile hemangioma(IH) is the most common benign vascular tumors of infancy in which spontaneous regression is observed, but IH often leaves sequelae that may cause disfigurement. If sequelae are left, the result may be unbearable, so sometimes positive treatment is required. There is no research report on the guardians’ anxiety about the disease, treatment, or impression of sequelae. Objectives:The aim of this study was to clarify the guardian’s anxiety about the disease and treatment of IH, and the impression of therapeutic outcome of guardian and physician. Methods:Questionnaire surveys for guardians and physicians were conducted via the Internet. Subjects selected for the questionnaire for guardians were mothers with children diagnosed with IH, and for the physician’s questionnaire, physicians who treated one or more IH patients in the past 3 months. The guardian’s questionnaire consisted of 13 items, including anxiety about the disease and treatment and impression of treatment results. The physician’s questionnaire consisted of 11 items, including expectation for treatment and impression of therapeutic outcome. Results:In the guardian survey, 71.9%(222 of 309) of respondents had anxiety of sequelae during treatment and chose to “wait and see”. There were no differences with respect to gender or location. When sequelae such as redundant skin, pigmentation, and depigmentation remained on the face, the percentage of “very unsatisfied” and “unsatisfied” among guardians was greater than that of physicians. Conclusion:As a result of the survey, we have concluded that it is necessary to carry out ongoing mental support regardless of gender and location, and consider early treatment to prevent sequelae.
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