Nihon rinsho. Japanese journal of clinical medicine
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Insomnia is common in many patients with chronic obstructive pulmonary disease (COPD). The causes of insomnia are sleep induced pathophysiological effect of COPD itself, COPD comorbidities and the presence of coexisted obstructive sleep apnea. Sleep has profound adverse effects on respiration and gas exchange in patients with COPD. ⋯ They include decreased functional residual capacity, decreased ventilatory responses to hypoxia and hypercapnia, impaired respiratory mechanical effectiveness, respiratory muscle fatigue, decreased respiratory drive, and increased upper airway resistance. COPD comorbidities include DM, cardiovascular diseases, osteoporosis, depression, and GERD. The coexistence of COPD and sleep apnea-hypopnea syndrome has been denominated "overlap syndrome".
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Insomnia has mainly been treated with the hypnotic benzodiazepine (BZ). Recent studies have revealed the role and mechanisms of BZ receptors and have led to the development of non-BZ hypnotics. ⋯ Antipsychotics, antidepressants, and antihistamines are also used for the treatment of insomnia in patients with other medical problems such as schizophrenia and depression. Currently, novel hypnotics are being developed with the manipulation of neurotransmitters and non-GABAergic receptors such as the melatonin and serotonin receptors.
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Advances in medical care have enabled many middle-aged and older adults to live for long periods of time. However, considerable variability is present among those people with regards to both longevity and physical health status. ⋯ The vital age is estimated using a variety of bio-medical, primarily cardiovascular risk factor parameters. Previous research has compared vital age between sedentary persons and those with obesity and chronic diseases and between sedentary persons and those with exercise habituation, and found that exercise habituation can certainly contribute to better physical vitality in previously sedentary persons as well as diseased persons.
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We review diagnostic importance of neutrophil gelatinase-associated lipocalin (Ngal or lipocalin 2) in acute kidney injury and chronic kidney disease, and discuss the impact of novel biomarker analysis upon progress of nephrology.
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It is well-known that osteoporosis treatment should be discussed from the view point of bone quality, however, in vivo assessment of bone quality is limited only for bone geometry and trabecular microstructure. Hip structure analysis (HSA) is a program to evaluate geometry and biomechanical property using two-dimensional DXA data of proximal femur. In vivo assessment of trabecular microstructure has been realized by the benefit of recent developments of imaging technique and technology, such as high resolution clinical CT and MR. These imaging techniques are going to be applied to assess risk of fracture and efficacy of anti-osteoporotic agents, although their spatial resolution is lower than real trabecular structure.