Nagashima Hospital

IntroductionClinical data of esaxerenone in hypertensive patients with diabetic kidney disease (DKD) are lacking. We evaluated the efficacy and safety of esaxerenone in patients with DKD and an inadequate response to blood pressure (BP)-lowering treatment.MethodsIn this multicenter, open-label, prospective study, patients were divided into urinary albumin-to-creatinine ratio subcohorts (UACR < 30, 30 to < 300, and 300 to < 1000 mg/gCr). Esaxerenone was initiated at 1.25 mg/day and followed by incremental dose escalation based on BP and serum potassium level monitoring. The treatment period was 12 weeks. The primary endpoint was change in morning home systolic BP/diastolic BP (SBP/DBP) from baseline to end of treatment (EOT). Secondary endpoints included achievement rate of target BP, change in UACR from baseline, and safety.ResultsIn total, 113 patients were enrolled. Morning home SBP/DBP significantly decreased from baseline to EOT in the total population (− 11.6/− 5.2 mmHg, both p < 0.001) and in all UACR subcohorts (all p < 0.001). The target BP achievement rate was 38.5%. Significant reductions in bedtime home and office BPs were also shown in the total population and all UACR subcohorts. UACR significantly improved from baseline to EOT in the total (− 50.9%, p < 0.001) and all UACR subcohorts (all p < 0.001). Incidence of serum potassium elevation as drug-related treatment emergent adverse events was 2.7%. The change from baseline in estimated glomerular filtration rate (eGFR) was − 4.8 mL/min/1.73 m2.ConclusionEsaxerenone demonstrated a BP-lowering effect and improved albuminuria. The effects were consistent regardless of the severity of albuminuria without clinically relevant serum potassium elevation and eGFR reduction.Clinical Trial RegistrationjRCTs06119002.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02294-z.

Objective We examined whether or not day-to-day variations in lipid profiles, especially triglyceride (TG) variability, were associated with the exacerbation of diabetic kidney disease. Methods We conducted a retrospective and observational study. First, 527 patients with type 2 diabetes mellitus (DM) who had had their estimated glomerular filtration rate (eGFR) checked every 6 months since 2012 for over 5 years were registered. Variability in postprandial TG was determined using the standard deviation (SD), SD adjusted (Adj-SD) for the number of measurements, and maximum minus minimum difference (MMD) during the first three years of follow-up. The endpoint was a ≥40% decline from baseline in the eGFR, initiation of dialysis or death. Next, 181 patients who had no micro- or macroalbuminuria in February 2013 were selected from among the 527 patients for an analysis. The endpoint was the incidence of microalbuminuria, initiation of dialysis, or death. Results Among the 527 participants, 110 reached a ≥40% decline from baseline in the eGFR or death. The renal survival was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0073, 0.0059, and 0.0195, respectively). A lower SD, lower Adj-SD, and lower MMD were significantly associated with the renal survival in the adjusted model (hazard ratio, 1.62, 1.66, 1.59; 95% confidence intervals, 1.05-2.53, 1.08-2.58, 1.04-2.47, respectively). Next, among 181 participants, 108 developed microalbuminuria or death. The nonincidence of microalbuminuria was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0241, 0.0352, and 0.0474, respectively). Conclusions Postprandial TG variability is a novel risk factor for eGFR decline and the incidence of microalbuminuria in patients with type 2 DM.

要旨: 補聴器装用者は, グループワークや会議などの発話者が多数の場合には補聴援助システムを使用しても聞取りにくいことが多い。我々は少人数グループワークなどで, 補聴器, 補聴援助システムを使用した場合の客観評価と主観評価を行い検討した。

The PillCam patency capsule (PPC) is an Agile tag-less patency capsule used to evaluate gastrointestinal (GI) patency. We determined the appropriate use of PPC to preclude subsequent small bowel capsule endoscopy (SBCE) retention. This prospective multicenter study consecutively enrolled patients indicated for SBCE with suspected or established small bowel stenosis. Excretion of an intact PPC or its radiologic visualization in the large bowel was considered GI patency. Primary and secondary study endpoints were SBCE retention rates in patients with confirmed patency and identification of factors associated with patency and SBCE retention, respectively. Of 1096 patients enrolled in the study, patency was confirmed in 976 (89.1%). PPC excretion occurred in 579 patients. Of the remaining 517 patients, patency was confirmed using imaging modalities in 401 (77.5%). SBCE retention occurred in five (0.51%) of 963 patients who underwent SBCE: 1.0% in established Crohn's disease (CD) patients, 0% in suspected CD, 0% in tumors, and 1.6% in patients with obscure GI bleeding, for which PPC localization had been radiographically misinterpreted. The non-confirmation of patency was associated with established CD, stenosis identified using imaging modalities, abdominal fullness, serum albumin levels <4.0g/dL, and previous small bowel obstruction (adjusted odds ratios: 4.21, 2.60, 2.47, 2.12, and 2.00; 95% confidence intervals: 2.62-6.78, 1.62-4.17, 1.43-4.27, 1.32-3.40, and 1.15-3.47, respectively). The PillCam™ patency capsule helped preclude SBCE retention in most patients, but its accurate localization was essential for cases without excretion (Study registered the University Hospital Medical Information Network, #UMIN000010513).

わが国は、今日世界有数の長寿国である。量的な豊かさ わが国は、今日世界有数の長寿国である。量的な豊かさに加え、質的な豊かさを考えてみる必要がある。幸せな人生の基本は、常に激しく変化している環境（季節や気候などの自然現象とともに職場や家庭などの社会的環境）との関わりを十分に持って生きていくことであろう。私たち人間は、常に変化する環境の中で、心身の恒常状態を維持して生活することが極めて重要である。その為には、感覚器の果たす役割が極めて重要となる。五感の中で、私たち人間は視覚に大きく依存して生活している。 視覚器には、角膜、虹彩、水晶体、硝子体や網膜が含まれる。外界の入射光は、透明な角膜を通過し網膜に焦点を合わせ、光のエネルギーを化学エネルギーからさらに電気エネルギーに転換し、視神経を通じて脳に情報を提供している。角膜の透明性と形状が適切に維持されていることが、良い視機能を得る第一歩である。 今日、多くの角膜疾患を治すことができるようになってきたが、同時にまだまだ治癒せしめ得ない角膜疾患も多く存在する。私たちは、角膜上皮創傷治癒の機序に関する研究を行ってきた。これらの科学的な研究に基づき、遷延化した角膜上皮欠損を治療する新しい薬剤を開発することができた。本稿では、見えるということの意義を考察し、私たちの難治の角膜上皮疾患に対する橋渡し研究の足跡を述べる。

大島眼科病院では医療事故防止を目的に、ヒヤリ・ハットの集計を行っている。今回、視能訓練士が行った検査に関するヒヤリ・ハットの内容について検討したので報告する。対象は当院視能訓練士13名。方法は当院検査部が独自に作成したヒヤリ・ハット表を毎月集計し、今回2005年1月から2006年3月までの15ヵ月間のヒヤリ・ハットについて検討した。その間のヒヤリ・ハットの総数は192件であった。その内容は、眼科検査に関することが89件、カルテの取り扱い22件、転倒20件などであった。さらに眼科検査に関する89件を検査種別に分類すると視力26件、超音波23件、屈折・眼圧・視野9件などであった。また、ヒヤリ・ハットの起こる要因の内訳は、思い込み・注意散漫64件、確認不足55件、環境・システム21件、知識・技術不足16件などであり、視能訓練士自身に要因があることも分かった。ヒヤリ・ハットを未然に防ぐためには本人の技術・知識の向上や集中力などの意識の改革は勿論のこと、職員の安全に関する研修、危険防止のための工夫も必要であると考えられた。

患者は76歳,男性. 1カ月前から食思不振と胸やけがあり,近医で治療を受けていたが改善せず,体重減少をきたしたため受診した.上部消化管内視鏡で,胃体部大彎を基部とした有茎性腫瘍が十二指腸に嵌頓しており, ball valve syndrome (以下本症)と診断した.血液生化学的に肝障害と胆管炎を併発しており,腹部CTで膵管および胆管の拡張を認めた.内視鏡的に嵌頓を解除できず,緊急開腹術を行った.全身麻酔下に胃切開を行い,十二指腸へ嵌頓した胃腫瘍を胃内に環納し切除した.術後経過は良好で,肝障害はすみやかに改善し,術後8日目に軽快退院した.病理組織学的にはI型早期胃癌であった.検索したかぎり本症による膵胆管拡張を画像上とらえられた報告はなく,稀な症例と考えられた.

A 28-year-old male was admitted to our hospital with tonsillitis and jaundice. Laboratory findings showed leukocytosis (rate of atypical lymphocytes was 40%), liver dysfunction and hyperbilirubinemia. Epstein-Barr virus (EBV) viral capsid antigen (VCA) IgM and IgG antibodies were positive, and EB nuclear antigen (EBNA) antibody was negative. Abdominal ultrasonography demonstrated hepato-splenomegaly and swelling of intraperitoneal lymph nodes. A diagnosis of infectious mononucleosis was made due to EBV infection. Conservative therapy was given. Total bilirubin and alkaline phosphatase increased to maximum levels of 10.2 mg/dl and 1,590U/l. A liver biopsy specimen revealed infiltration of lymphocytes in sinusoids and portal areas, focal necrosis and intrahepatic cholestasis in parenchyma. Liver function tests returned to normal limits and EBV VCA IgM antibody became negative within 10 weeks from onset.

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia with clinical symptoms that include punching, kicking, yelling and leaping out of bed in sleep. Polysomnographic (PSG) finding showed REM sleep without muscle atonia. Clonazepam is generally used for treating RBD symptoms but melatonin was reported to be effective so we reconfirmed the effect of melatonin on RBD patients in the present study. We used melatonin (3-9 mg/day) which could ameliorate problem sleep behaviors remarkably, as well as %tonic activity in PSG variables. In the present study, melatonin was reconfirmed to be effective in RBD symptoms, especially for patients with low melatonin secretion, while its mechanism was not clearly known in the present study.

In order to analyze the relation between the lepromin reaction and the tuberculin reaction, both animal experiments and investigations in human bodies were conducted.The results were obtained as follows.1) In the guinea pigs injected with tubercle bacilli or BCG the tuberculin and lepromin reactivity appeared at the same time.2) In healthy human bodies which had ever received natural tuberculous infection or BCG vaccination, a high correlation was observed between the tuberculin and early lepromin reactions concerning the size of redness.3) In leprous patints, however, such a correlation was scarcely observed regardless of the clinical type.