Nihon rinsho. Japanese journal of clinical medicine
-
Obesity is a heterogeneous pathologic condition that is driven by interactions between multiple genetic and environmental factors. The discovery of leptin has provided the useful clue to the molecular dissection of central pathways involved in the regulation of food intake and body weight. ⋯ The patients who have a mutation of such genes developed early onset of obesity and distinct metabolic abnormalities. Also, several gene mutations have been identified in some syndromes presenting hereditary symptomatic obesity.
-
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction resulting in apneas, hypopneas, oxygen desaturation, and arousal from sleep. Obesity is one of the most significant risk factors for OSA. ⋯ And obesity hypoventilation syndrome (OHS) is defined as chronic daytime hypercapnia in combination with obesity and OSA. OHS patients are more likely to suffer from congestive heart failure, pulmonary hypertension and have worse prognosis than obese eucapnic OSA patients.
-
Dabigatran is an oral, direct, and competitive inhibitor of thrombin, which is administered to patients with non-valvular atrial fibrillation for prevention of stroke at a dose of 110 mg twice daily or 150 mg twice daily. Anticoagulation by dabigatran is "hybrid anticoagulation", consisting of action of both dabigatran and physiological coagulation inhibitors because warfarin inhibits production of protein C and protein S but dabigatran does not. ⋯ The RE-LY trial confirmed effectiveness and safety of both doses of dabigatran for prevention of stroke and both doses of dabigatran had much lower risks of intracranial bleeding compared with warfarin. Compliance to guidance of dabigatran treatment is essential for avoidance of severe hemorrhagic complications.
-
Electrophysiological study should be done in patients who suppose to undergo the treatment including pulmonary vein isolation using catheter ablation for atrial fibrillation. The purpose of the electrophysiological study consist with confirmation of the induction and the origin of atrial fibrillation, and with recognition of electrical potential and arrhythmogenic substrate for maintenance of atrial fibrillation. ⋯ Moreover, the complex fractionated atrial electrograms(CFAE) and ganglionated plexus(GP) play an important role in maintenance of atrial fibrillation. As it is indispensable to record and distinguish the electrical potential of atrium and pulmonary vein for the ablation of atrial fibrillation, every physician who is concerned in the catheter ablation requires accustoming to these potentials.
-
Melanoma is one of the most immunogenic tumors. However, objective response of immunotherapies has remained less than 5%. Since suppressive immunoreactions in tumor microenvironment have been illustrated in the past decade, immunosuppressive molecules are supposed to be useful targets of antibody therapies. ⋯ PD-1 blockade also showed more safe and great durable antitumor reactivity. Anti-CD137 agonist antibody and anti-CD40 agonist antibody are also good candidates for melanoma therapy. These immunomodulating therapies are the most promising treatment to overcome immunosuppression of melanoma.