Nihon rinsho. Japanese journal of clinical medicine
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As for standard controls for life style diseases in older adults, the standard control for hypertension in elderly is defined in detail by the guideline for hypertension, however, that for diabetes or dyslipidemia is not clearly defined by each guideline although each has additional descriptions for elderly. The reports about 'Diabetes in Older Adults' and 'Standards of Medical Care in Diabetes 2013' have been published from American Diabetes Association (ADA), and the standard controls for diabetes might be reviewed in the light of these reports in Japan. Here we would like to consider the standard control and recent trends for diabetes in older adults on the basis of the current practice guidelines.
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Delirium is an acute condition often affecting acutely ill hospitalized patients, particularly in the elderly patients. Delirium is under-detected and associated with adverse healthcare outcomes, including institutionalization and elevated mortality. ⋯ There is neither any medication approved for the treatment of delirium nor strong evidence supporting the effectiveness of medications. In the management of delirium, recent studies show that delirium prevention(i.e., multidisciplinary delirium prevention programs) leads to improved outcomes, rather than waiting for delirium to develop and then intervening.
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A gastric cancer elimination project that combines H. pylori eradication therapy and endoscopic examination is both appropriate and feasible for Japan, where excellent methods of diagnosis and endoscopic treatment for early gastric cancer are already available. In this country, the baby-boom generation is now passing 60 years old and reaching the cancer-prone age, so an increase of medical costs related to gastric cancer is impending. Application for medical insurance in patients with H. pylori related chronic gastritis due to the Basic Plan to Promote Cancer Control Programs might be a first step to eliminate gastric cancer deaths in Japan.
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Biologics targeting inflammatory cytokine has become a standardized tool for remission induction in rheumatoid arthritis (RA). However, it is handled under restricted conditions and their cost of acquisition is high. ⋯ Moreover, inhibitory effect on bone destruction has been demonstrated and has been approved in 2012 as a new disease modifying anti-rheumatic drug in USA. However, since the inhibition of JAK results in inhibition of multiple cytokine signaling pathways, the clinical studies have also shown adverse events differing from biologics.
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The aged patients are susceptible to respiratory failure, especially acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The mortality rate for ARDS ranges from 40-70% despite of intensive care using currently available drugs. ⋯ Recent studies using genetically-engineered mice have shown that PAF and cytosolic PLA2 (cPLA2) play an important role in the pathogenesis of ALI. The inhibition of these pathways, PAF and cPLA2, might provide a novel therapeutic approach to ALI.