Nihon rinsho. Japanese journal of clinical medicine
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Although heart failure is a final common consequence of various heart diseases and is a leading cause of mortality worldwide, the precise molecules and signaling pathways that mediate heart failure progression are largely undefined. In this review, we discuss about the potential mechanisms of heart failure focusing on three subjects, (i) myocardial ischemia, (ii) cardiac muscle cell death, and (iii) abnormalities in calcium handling. These factors are not mutually independent but considered to contribute to the pathogenesis of contractile dysfunction and heart failure in a cooperative manner. Elucidation of molecular mechanisms of heart failure will lead to the development of novel therapeutic strategies for heart diseases.
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The proportion of cardiac etiology is more than 50% of the patients of out-of-hospital cardiac arrest and the cause of cardiac etiology is acute coronary syndromes (ACS) in about 70%. Although the mortality rate of acute myocardial infarction with ST elevation was about 7% in the cardiac reperfusion era, there is a high mortality rate in the patients with ACS who developed out-of-hospital cardiac arrest. We summarized the emergency medical service system in Japan and its problems. Achieving the optimal survival rate for out-of-hospital cardiac arrest due to ACS is the challenge now and in the future.
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HER2 gene is overexpressed or amplified in approximately 30% of breast cancer. Breast cancer patients with HER2-overexpression or amplification have shortened disease free and overall survival. ⋯ However, much controversy exists on the optimal use of trastuzumab. In this paper, positioning of trastuzumab in the treatment algorithm for HER2 positive MBC as well as early breast cancer will be reviewed and discussed on the basis of our experience.