薬理と治療
Volume 39, Issue 2, 2011
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扉・目次
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DRUG PROFILE SERIES
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WHO 方式がん疼痛治療法,3 段階除痛ラダーの第 2 段階に位置づけられるオピオイド鎮痛薬トラマドール塩酸塩カプセル(トラマールカプセル)の基礎と臨床
39巻2号(2011);View Description Hide Description
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SERIES
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一流誌にアクセプトされる医学論文執筆のポイント[第5回]考察の書き方
39巻2号(2011);View Description Hide Description考察Discussionは,得られた結果の意味合いを解釈し,著者の結論を記載するセクションである。考察はサブセクションを設けずに記載されることが多いが,Annals of Internal Medicine(Ann Intern Med)がその投稿規定で考察の構造化を推奨してから1),医学論文の執筆に関する指針や教科書も構造化した考察を推奨するようになり2~5),最近では考察にサブセクションを設ける論文が増えている。これらの指針や教科書が提案する構造を表1に示す。項目数は若干異なるものの,いずれも提案している内容はほぼ同一である。すなわち,以下の順序で考察を記載するのが現在の標準となっている。①主要な結果を簡潔に要約する。②なぜそのような結果が得られたのか,考えうる機序を説明する。③ 得られた結果を関連する研究の結果と比較する。④研究の限界に言及する。⑤得られた結果の医学的な意味を述べ,追加すべき研究があれば,その内容を示す。以下では,この順序に従って考察を記載する際の留意点を解説する。 -
「いろいろな臨床試験のケースレポート: 温泉の RCT から看護の SR まで」12.刑事施設における薬物依存治療プログラムの評価と課題
39巻2号(2011);View Description Hide Description
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ORIGINAL ARTICLES
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プレフィルドシリンジ製剤によるインフルエンザワクチン接種の便益に対する一般市民の支払い意思額に関する研究
39巻2号(2011);View Description Hide DescriptionThe purpose of this study was to reveal individuals’willingness to purchase a PrefilledSyringe Containing Influenza Vaccine Preparations, their willingness to pay, WTP, and otherrelated factors.The survey was executed by using the contingent value method in medical facilitywhere a Prefilled Syringe Containing Influenza Vaccine Preparations provides the vaccine forindividuals.A web questionnaire was conducted to 269 individuals who lived across the country.As a result, it was indicated that 83.6% of respondents showed willingness to purchasethe vaccine:the mode for WTP was 500 yen, the average was 460 yen, and the median was300 yen. There was also indicated significant relationship between WTP and their valuationof the vaccine.The willingness to purchase the vaccine was also related to household income and experienceof influenza vaccine inoculation in the past one year. On the other hand, WTP wasrelated to having a child and having enough in the family finances, but not to age, sex, marriageand chronic disease. -
マウス急性アルコール中毒モデルの血中エタノールおよび代謝物濃度に及ぼす肝臓水解物の効果
39巻2号(2011);View Description Hide DescriptionObjective To study effects of liver hydrolysate(LH)containing various functional componentswhich promote antioxidant and bioregulational effects on acute alcohol intoxication inmice.Methods To investigate the effects of LH on hepatic ethanol metabolism, LH(1 g/kg bodyweight)were orally administered to 9-week-old male C3H/HeNCrj(C3H/He)mice(LHgroup), followed by oral administration of ethanol(2 g/kg body weight). The changes in concentrationsof ethanol, acetaldehyde and acetic acid in serum and activities of enzymesrelated to ethanol metabolism in the liver were measured from 0 to 5 hours after the ethanoladministration.Results The concentrations of ethanol, acetaldehyde and acetic acid in serum of the LHgroup at 0.5, 2 and 3 hours after the ethanol administration were significantly lower thanthose of the control group(mice administered distilled water instead of LH). The specificactivities of alcohol dehydrogenase(ADH), high-Km aldehyde dehydrogenase(ALDH)in thecytosolic fraction and low-Km, high-Km and total ALDH in the mitochondrial fraction of theLH group at 2 hours after the ethanol administration were significantly lower than those ofthe control group.Conclusion The present study demonstrates that oral administration of LH suppresses theincrease in the serum concentration of acetaldehyde in mice. As acetaldehyde is consideredto be a major contributing factor in the development of acute alcohol intoxication, theobserved effects of LH may be relevant for symptom improvement in acute alcoholintoxication.(Jpn Pharmacol Ther 2011;39:199-207) -
Microalbuminuria is Associated with Morning Hypertensionin Hypertensive Patients with Glucose Intolerance
39巻2号(2011);View Description Hide DescriptionObjective It is thought that morning blood pressure(BP)measurements at home are animportant independent predictive factor of cerebrovascular and cardiovascular incidents. Inaddition, it is said that the appearance of microalbuminuria is a predictive factor of cardiovascularincidents. In this study, we investigated the association between microalbuminuria andmorning BP at home.Methods Subjects who had received medical treatment for hypertension in our outpatientclinic from October to December 2007 were enrolled. Of the 380 patients studied, which subjectsgave informed consent for this study, 122(32.1%;59 men, 63 women)showed glucoseintolerance(fasting blood sugar(BS)≧110 mg/dL and/or HbA1c≧5.8%)and 91(41 men,50 women)brought their home BP records to the outpatient clinic(74.6%). We examined theassociation between microalbuminuria and morning BP in these 91 patients.Results There were 41 male patients(64.9±10.8 years old)and 50 female patients(67.0±9.1 years old). Logistic analysis showed that age[odds ratio(OR)=1.04;95% confidenceinterval(CI):1.00-1.07;p<0.01], SBP at the outpatient clinic(OR=0.94;95%CI:0.92-0.97;p<0.01), sex(OR=0.96;95%CI:0.71-1.29;p=0.02)and microalbuminuria(OR=1.69;95%CI:1.04-2.80;p<0.01)were independent factors contributing to morning hypertensionmeasurements at home.Conclusion The contributing factors determining morning hypertension were:male gender,higher age, higher SBP at the outpatient clinic, and positive microalbuminuria. Microalbuminuriais known as a marker of disorders throughout the body. It is necessary to recommendmore aggressive BP control for individuals with morning hypertension and glucoseintolerance.(Jpn Pharmacol Ther 2011;39:209-15) -
2 型糖尿病患者の HbA1c,中性脂肪およびレムナントコレステロールに対するシタグリプチン 10 ヵ月投与の効果
39巻2号(2011);View Description Hide DescriptionObjective In 2009, sitagliptin became available in Japan. Sitagliptin is an orally active,potent and selective dipeptidyl peptidase-4(DPP-4)inhibitor for the treatment of type 2 diabeticpatients. Sitagliptin acts through increasing incretin(GLP-1 and GIP)hormone concentration,and reduces plasma glucose and HbA1c levels. In addition, DPP-4 inhibitor wasreported to reduce plasma triglyceride(TG)level. Remnant lipoproteins which underlie hypertriglyceridemiaare known to be atherogenic as well as LDL. However, there is little informationabout the effects of long-term sitagliptin therapy on HbA1c, TG and remnant cholesterollevels in Japan. The effects of 10-month add-on therapy with sitagliptin on HbA1c, TG andremnant cholesterol levels were examined in Japanese type 2 diabetic patients. In addition,obesity and/or disease duration may impact patient therapeutic response to medication.Thus, this study also evaluated the effect of obesity and/or diabetes duration on glycemicresponse to sitagliptin therapy in patients whose type 2 diabetes was not optically controlledwith glimepiride or pioglitazone.Methods Sixty four patients with type 2 diabetes and baseline HbA1c(JDS)≧6.2% to≦7.5% were studied. Mean age was 63 years. All patients were treated with glimepiride(n=55, mean dose 1.5±0.1 mg/day)or pioglitazone(n=9, dose 30 mg/day)at least for 3 monthsbefore the study entry. Sitagliptin 50 mg/day was added on after the dose of glimepiride(mean dose 0.6±0.1 mg/day)or pioglitazone(15 mg/day)was reduced to approximately half.Patients were treated with sitagliptin add-on glimepiride or pioglitazone over 10 months.HbA1c and plasma lipid levels were compared before and 10 months after add-on therapywith sitagliptin. HbA1c was measured by high-performance liquid chromatography. Plasmaremnant cholesterol was determined as RLP-cholesterol(normal range <5.2 mg/dL)by themethod of Nakajima et al. Obesity was defined as BMI ≧25 kg/m2 according to the criteriain Japanese. Results Overall, 10-month add-on therapy with sitagliptin significantly reduced HbA1c level(6.8±0.1%→6.1±0.1%, p<0.001). Reduction in HbA1c from baseline at 10 months was significantly(p<0.01)greater in patients with obesity(7.2±0.2%→6.1±0.1%, percent change -13.0%) than in patients without obesity (6.5±0.1% →6.1±0.1%, percent change -6.8%). Patients were divided into 4 groups according to BMI and diabetes duration. Group A;24 patients with BMI <25 and diabetes duration <10 years, Group B;12 patients with BMI <25 and diabetes duration ≧10 years, Group C;21 patients with BMI ≧ 25 and diabetes duration <10 years, Group D;7 patients with BMI ≧25 and diabetes dura- tion ≧10 years. Group C showed the greatest reduction in HbA1c level(7.1±0.2%→6.0± 0.1%, percent change -13.8%). Overall, 10-month add-on therapy with sitagliptin signifi- cantly reduced TG level(149±8→109±5 mg/dL, p<0.001)and remnant cholesterol level (7.6±1.0→4.4±0.4 mg/dL, p<0.05). There was no significant change in LDL-cholesterol and HDL-cholesterol levels before and after add-on therapy with sitagliptin. Body weight was not significantly changed, and no adverse reactions such as hypoglycemia were observed over the study period.Conclusion It is concluded that 10-month add-on therapy with sitagliptin is effective to reduce HbA1c as well as plasma TG and remnant cholesterol levels in Japanese type 2 dia- betic patients. In addition, sitagliptin therapy is more effective to reduce HbA1c level in patients with obesity and diabetes duration <10 years. This is the first report that DPP-4 inhibitor reduces plasma remnant cholesterol.
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