Nihon rinsho. Japanese journal of clinical medicine
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Human gene mutations and polymorphisms of adipocytokines, adipocyte-derived bioactive molecules, have been reported to be implicated in the pathogenesis of obesity. Leptin and its receptor gene mutations are well-established in the development of severe obesity. ⋯ The polymorphisms of adiponectin, another important adipocytokine with anti-atherogenic and anti-diabetic properties, are reported to associate with the pathophysiology but not with the severity of obesity. Adipocytokine dysregulation due to lifestyle-mediated obesity would be common at this stage, although further study of adipocytokine mutation should be necessary.
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Zygomycosis is an invasive fungal infection with extremely high mortality caused by filamentous fungi which belong to Class Zygomycetes (Rhizopus spp., Mucor spp., Cunninghamella spp., etc). Despite of the similarities of the ecological characteristics and of the patients' backgrounds, zygomycosis is much rarer than invasive aspergillosis. ⋯ The mainstay of the treatment is surgical resection, reversal of immunosuppressive factors, and administration of high-dose amphotericin B or its liposomal formulation. Because of the difficulty of culture detection and the absence of reliable serological diagnostic methods, premortem diagnosis and no delaying of effective treatment remain a challenge to physicians.
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Two randomized clinical trials were reported using mild therapeutic hypothermia following cardiac arrest in the 2002. One is the multicenter randomized clinical trial projected by The Hypothermia after Cardiac Arrest Study Group. The other one was performed by four centers in Australia. ⋯ There were some differences between Europe study and Australia study, although their outcome was doing very well. We will discuss cooling techniques (blanket or ice pack or cold saline intravenously), selection of patients (ventricular fibrillation or pulseless electrical activity or asystole), timing of cooling (as possible as earlier or within 3 hours or 6 hours) and monitoring in the hypothermia group in future. In addition, clinicians including cardiologists, intensivists, emergency physicians and neurologists, should work together to practice protocols for mild hypothermia treatment.
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Pulmonary arterial hypertension (PAH) occurs in about 5% of connective tissue disease (CTD) patients. Performing echocardiography, the incidence is much higher at 9.5%, thus confirming the presence of asymptomatic PAH. ⋯ Therefore, it is necessary to screen for PAH by echocardiography after the diagnosis of CTD, irrespective of the existence of PAH-related signs and symptoms. The treatments of PAH with CTD are different from those of idiopathic PAH in that the immunosuppressive therapy is expected to alleviate PAH with CTD.
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Epoprostenol (prostacyclin) has been shown to improve survival in pulmonary arterial hypertension. However, this therapy needs continuous intravenous administration devises because of its short half-life. Recently, an orally active prostacyclin analogue, beraprost sodium, and its drug delivery system have been developed in Japan. ⋯ In addition, we have developed ONO-1301, a novel long-acting prostacyclin agonist with thromboxane synthase inhibitory activity. Subcutaneous administration of ONO-1301 markedly attenuated monocrotaline-induced pulmonary hypertension and improved survival in rats. These prostacycline derivates may be promising for the treatment of pulmonary arterial hypertension.