Nihon rinsho. Japanese journal of clinical medicine
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Based on the national surveys in Japan, the most common symptoms of dilated cardiomyopathy(DCM) were dyspnea, palpitation, general fatigue and edema. Palpitation, dyspnea, general fatigue and anginal pain were common in hypertrophic obstructive cardiomyopathy(HOCM) and hypertrophic non-obstructive cardiomyopathy (HNOCM). Dyspnea was the most common symptom in constrictive cardiomyopathy (RCM). ⋯ In both of HOCM and HNOCM, frequent electrocardiographic abnormalities were ST-T abnormality, left ventricular hypertrophy and wide QRS complex. Moreover, abnormal Q wave was frequently observed in HOCM. Ventricular arrhythmia, including fatal ventricular tachycardia or ventricular fibrillation, was frequently found in patients with any type of cardiomyopathy.
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Action of 1,25-dihydroxyvitamin D, the most active metabolite of vitamin D, is exerted by the nuclear vitamin D receptor (VDR) mediated gene expression. Toward the expression of vitamin D function, several steps including 1,25-dihydroxyvitamin D production, tissue specific expression of VDR and transcription of target gene by VDR are involved. One of the important progress in vitamin D metabolism is the cloning of 25-hydroxyvitamin D-24-hydroxylase gene and 1 alpha-hydroxylase gene. ⋯ A part of mechanism of tissue specific expression of VDR have recently been reported. Furthermore, VDR recruit several coactivators to achieve vitamin D-induced transactivation. Selective coactivator interaction with VDR may specify the array of biological actions of vitamin D.
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Efficacy of home oxygen therapy (HOT) is well established for patients with chronic obstructive pulmonary disease who fall into chronic respiratory failure. We should consider now how the quality of life improves with HOT in those patients. According to the guideline of the Japanese Respiratory Society, indications of HOT are as follows: 1) A PaO2 of less than 55 Torr at rest while breathing room air, 2) A PaO2 between 55 Torr and 60 Torr in the presence of clear evidence of cor pulmonale, pulmonary hypertension, or a long history of severe hypoxemia during sleep or during exercise. Further studies are definitely required to pick up the patients who do not necessarily meet these indications but who may benefit from HOT.