正常および心房負荷疾患における心磁図P波に関する研究

心電図と心磁図は同じ電気現象をとらえたものであるが、磁界と電流はその物理学的特性が異なる ことより、得られる情報は必ずしも同一ではない。一般に心房興奮は心房壁に平行に電波するため、 前胸壁に垂直に保持したSQUID磁束計は心房の起電力を極めて鋭敏に記録する。しかしながら、心磁図 QRS波に関する報告は散見されるが、心房脱分極波（P波）はその振幅が小さいため、未だ系統的な研究は 行われていない。本研究においては、心磁図法の心房負荷診断における有用性を明らかにするために、心 磁図P波の正常所見および心房負荷時の変化を検討した。 対象は、健常群60例、右房負荷群12例、左房負荷群21例で、これらの心磁図P波を前胸部30点において記録した。 また、P波各時相の起電力を解析するために、健常群60例、右房負荷群28例、左房負荷群40例について 等磁界図を作成し、各瞬時における心起電力の推定を行った。 得られた結果は以下の通りである。 1.健常群の心磁図P波は、前胸部左上方で陰性、右下方で陽性であり、ビオ・サバールの法則により 推定される起電力は心房脱分極期全体を通じて左下方へ向かった。 　2.右房負荷群の心磁図P波は胸骨左縁で振幅の増大を認め、増大した右房の心起電力の反映を考えられた。 左房負荷群の心磁図P波は胸骨左縁で∓型の二相性を示し、その陽性相の振幅の増大がみられた。 　3.心房負荷例の心磁図P波の特徴的所見と健常群における正常値に基づき、以下の心磁図心房負荷診断基準 を設定した。 1）右房負荷診断基準：C-2における陰性波の振幅≧3.2×10⁻12 tesla 　2）左房負荷診断基準：C-2における∓型二相性P波の陽性相の振幅≧1.5×10⁻12 tesla 　4.本診断基準の感度および特異度を心電図心房負荷診断基準と比較した。右房負荷診断に関する感度は 心電図法25％、心磁図法75％で、心磁図法が有意に高かった。左房負荷診断に関する感度は心電図法29％、 心磁図法43％で、有意差はみられないが心磁図法で高い傾向が見られた。特異度は両方とも98～100％で、 有意差は認められなかった。 5.健常例の磁界図は、負領域が左上方に、正領域が右下方にあり、推定される二重極は前胸部中央にあって 左下方へ向く。右房負荷例はほぼ健常例を同様のパターンを示すが、等磁界線は密になり、極大値および 極小値の絶対値増大を示す。推定される二重極は健常例を同様に左下方を向き、増大した右房の心起電力 を反映していると考えられた。左房負荷例の磁界図は、心房脱分極期後半に右下方から左方へ正領域が 広がり、左下方へ向かう二重極を左上方へ向かう二重極の複数二重極の併存を認めた。 異常のように、心房負荷の心磁図P波は健常例および各心房負荷疾患で特徴的所見を示した。 特に心磁図は右房負荷の診断で高い陽性率を示し、左房負荷例では、心電図でとらえられない心起電力 の把握が可能であり、本法が心房負荷診断に有用であると考えられた。The magnetocardiogram (MCG) was recorded at 30 points on the anterior chest wall of 60 normal subjects，12 patients with right atrial overloading (RAO) and 21 with left atrial overloading (LAO). We studied the P wave of the MCG to investigate the characteristic features of the P wave of the MCG. We established the MCG criteria for RAO and LAO and compared sensitivity and specificity of the MCG criteria with those of ECG criteria. The isomagnetic maps of 60 normal subjects，28 patients with RAO and 40 with LAO were recorded to analyze the instantaneous current source in atrial depolarization. The results were as follows: 1 In normal subjects，the MCG P wave was negative at left upper portions and positive at right lower portions，suggesting the current source directed inferiorly and to the left，a ccording to “Biot-Savart law " 2 Negative amplitude of P wave increased at the left sternal border in the patients with right atrial overloading. Biphasic P wave of negative-positive type with increased amplitude of the positive component was frequently observed at the left parasternal region in the patients with left atrial overloading. 3 Based on the characteristic features of the MCG P wave in the patients with atrial overloading，the MCG criteria of atrial overloading were set as follows. 1) RAO criterion : negative amplitude in C-2≧3.2×10⁻12 tesla， 2) LAO criterion : positive defiection of a biphasic P wave in C-2≧1.5×10⁻12 tesla The specificities of these criteria were 100% and 98% respectively. 4 The sensitivity of MCG criterion for the diagnosis of RAO was significantly higher (75%) than that of the ECG criteria (25%). The sensitivity of MCG criterion for the diagnosis of LAO was slightly higher (43%) than that of ECG (29%)，but not different significantly. 5 In the isomagnetic map of a normal subject，the negative area was located in the left upper part and the positive area was located in the right lower part. The deduced dipole was located in the central portion of anterior chest and directed inferiorly and to the left. 6 In a patient with RAO，pattern of the isomagnetic map was similar to that of the normal subject，but the isomagnetic lines distributed more densely in the former indicating the significant increase of the intensity of the magnetic field of the minimum and maximum. 7 Two dipoles were deduced simultaneously in an isomagnetic map of the patients with LAO，one was directed inferiorly to the left and the other was directed to the left. The MCG P wave of the patients with atrial overloading recorded by a superconducting quantum interference device (SQUID) with a second derivative gradiometer showed characteristic features. Sensitivity for the diagnosis of RAO was much higher in MCG than ECG，because the excitation of the atrial wall spread tangentially along the atrial wall. The MCG could detect multiple dipoles more sensitively because of its excellent facility of the spatial resolution

Endotoxin-Induced L-Arginine Pathway Produces Nitric Oxide and Modulates the Ca2+-Activated K+ Channel in Cultured Human Dermal Papilla Cells

Endotoxin induces an enzyme that synthesizes nitric oxide (NO) from L-arginine (NO synthase) in vascular smooth muscle cells, macrophages, and fibroblasts, leading to the release of NO. We evaluated the release of NO and its intracellular action on the Ca2+-activated K+ channel (Kca channel) in cultured human dermal papilla cells by use of the electron paramagnetie response (EPR) spin trapping method and the patch clamp technique. In dermal papilla cells pretreated for 24h with endotoxin (1 μg/ml), application of 1mM L-arginine generated NO, although no measurable release of NO was observed in cells without endotoxin pretreatment, as determined by the EPR spin trapping method. With the patch clamp technique, we found that the Kca channel of dermal papilla cells had high conductance and was voltage dependent. In addition, after endotoxin pretreatment, the extracellular application of 100 μM L-arginine modulated the Kca channel in the cellattached patch confignrations. In inside-out patch configuration, however, NO produced by L-arginine itself did not modulate the Kca channel. This modulation of the Kca channel was suppressed by pretreatment with 100 μm Nω-nitro-L-arginine methyl ester, an inhibitor of inducible and constitutive NO synthases. Methylene blue, a blocker of guanylate cyclase, inhibited the L-arginine-induced activation of the Kca channel. These results indicate that the endotoxin-induced L-arginine pathway generates NO, which consequently modulates the Kca channel in cultured human dermal papilla cells by increasing of cyclic GMP-dependent phosphorylation

A Study on the energy consumption of Awaodori-Taisou and Awaodori

阿波踊り体操と阿波踊りのエネルギー消費量を測定することを目的とし，男性13名，女性27名（平均年齢43歳）の被験者に対し，実施中の呼気ガス分析を行った。 阿波踊り体操の平均エネルギー消費は1回（3分半）あたり12kcalで，しっかり強めに実施すると18%増加し，シニア編を座位で行うと8.6kcalであった。 阿波踊りの平均エネルギー消費は1分間あたり5.7kcalで，阿波踊り体操の平均メッツは3.3，しっかり強めに実施すると3.9メッツであった。 エネルギー消費量に影響を与えている要因は，阿波踊り体操の場合は性別と運動習慣であり，阿波踊りでは性別と有名連での経験の有無であった。本研究ではこれらの要因を組み入れたエネルギー消費量の推定式を作成した。Purpose: the aim of this study was to measure an average energy consumption of Awaodori-Taisou and Awaodori. Methods: The participants for this experimentation were composed of 13 males and 27 females, and the average age was 43. The breath was examined during the exercise of Awaodori-Taisou and Awaodori. Result: The average energy consumption of Awaodori-Taisou was 12 kcal/time. When did it briskly, the energy consumption increased by 18%. In the case of senior version with sitting, the average was 8.6 kcal/time. The average of energy consumption of Awaodori was 5.7 kcal per minute. The average mets of Awaodori-Taisou was 3.3. Brisk Awaodori-Taisou was 3.9 mets. Senior version with sitting was 2.3 mets. Awaodori was 5.4 mets. The effect factors influencing energy consumption of Awaodori-Taisou were gender and custom of exercise. The estimate formula of energy consumption was made as follows: Energy consumption (kcal) = weight×0.2×1.1(if male)×1.1(if do exercise more than 3 times a week)×1.1(if do briskly) The effect factors influencing energy consumption of Awaodori were gender and experience of professional group. The estimate formula of energy consumption and mets as follows: Male (professional): 0.13 kcal × time (minutes) × weight: (7.5 mets) Male (none-professional): 0.12 kcal × time (minutes) × weight: (6.5 mets) Female (professional): 0.11 kcal × time (minutes) × weight: (6 mets) Female (none-professional): 0.09 kcal × time (minutes) × weight: (5 mets) Conclusion: The result shows that Awaodori-Taisou and Awaodori have effective intensity for life-style related disease. However, since the quantity of energy consumption of doing Awaodori-Taisou just one time is so little, those who wish to prevent life-style related disease have to do more exercise. Next subject is to measure 'Metabolic Syndrome Prevent Version of Awaodori-Taisou' which was released on November 2008

A Study on the energy consumption of Awaodori-Taisou and Awaodori

阿波踊り体操と阿波踊りのエネルギー消費量を測定することを目的とし，男性13名，女性27名（平均年齢43歳）の被験者に対し，実施中の呼気ガス分析を行った。 阿波踊り体操の平均エネルギー消費は1回（3分半）あたり12kcalで，しっかり強めに実施すると18%増加し，シニア編を座位で行うと8.6kcalであった。 阿波踊りの平均エネルギー消費は1分間あたり5.7kcalで，阿波踊り体操の平均メッツは3.3，しっかり強めに実施すると3.9メッツであった。 エネルギー消費量に影響を与えている要因は，阿波踊り体操の場合は性別と運動習慣であり，阿波踊りでは性別と有名連での経験の有無であった。本研究ではこれらの要因を組み入れたエネルギー消費量の推定式を作成した。Purpose: the aim of this study was to measure an average energy consumption of Awaodori-Taisou and Awaodori. Methods: The participants for this experimentation were composed of 13 males and 27 females, and the average age was 43. The breath was examined during the exercise of Awaodori-Taisou and Awaodori. Result: The average energy consumption of Awaodori-Taisou was 12 kcal/time. When did it briskly, the energy consumption increased by 18%. In the case of senior version with sitting, the average was 8.6 kcal/time. The average of energy consumption of Awaodori was 5.7 kcal per minute. The average mets of Awaodori-Taisou was 3.3. Brisk Awaodori-Taisou was 3.9 mets. Senior version with sitting was 2.3 mets. Awaodori was 5.4 mets. The effect factors influencing energy consumption of Awaodori-Taisou were gender and custom of exercise. The estimate formula of energy consumption was made as follows: Energy consumption (kcal) = weight×0.2×1.1(if male)×1.1(if do exercise more than 3 times a week)×1.1(if do briskly) The effect factors influencing energy consumption of Awaodori were gender and experience of professional group. The estimate formula of energy consumption and mets as follows: Male (professional): 0.13 kcal × time (minutes) × weight: (7.5 mets) Male (none-professional): 0.12 kcal × time (minutes) × weight: (6.5 mets) Female (professional): 0.11 kcal × time (minutes) × weight: (6 mets) Female (none-professional): 0.09 kcal × time (minutes) × weight: (5 mets) Conclusion: The result shows that Awaodori-Taisou and Awaodori have effective intensity for life-style related disease. However, since the quantity of energy consumption of doing Awaodori-Taisou just one time is so little, those who wish to prevent life-style related disease have to do more exercise. Next subject is to measure 'Metabolic Syndrome Prevent Version of Awaodori-Taisou' which was released on November 2008

リフィーディング ショウコウグン

Refeeding syndrome is a potentially fatal medical condition that may affect malnourished patients in response to an inappropriately rapid overfeeding. This commonly occurs following the institution of nutritional support, especially parenteral or enteral nutrition. The most characteristic pathophysiology of refeeding syndrome relates to the rapid consumption of phosphate after glucose intake and subsequent hypophosphatemia. Refeeding syndrome can manifest as either metabolic changes （hypokalaemia, hypophosphataemia, vitamin B１deficiency, and altered glucose metabolism）or physiological changes（cardiac arrhythmias, unconsciousness, seizures, cardiac or respiratory depression） and potentially death. Preventing refeeding syndrome is the primary goal when initiating nutrition support in severely malnourished patients. Clinicians should be aware of refeeding syndrome when they treat malnourished patients, and most importantly take appropriate steps（careful monitoring）to prevent refeeding syndrome

Efficacy of glimepiride on insulin resistance, adipocytokines, and atherosclerosis

Background : Plasma adiponectin levels increase after the administration of glimepiride. This unique effects would also be expected to improve other adipocytokines and have antiatherosclerotic action in patients with metabolic syndrome. Methods : Thirty-four patients with type 2 diabetes mellitus who were administrated glibenclamide were randomly divided into two groups. In20patients glibenclamide was changed to glimepiride (GP group), and the administration of glibenclamide (GB group) was continued in 14 patients. Twelve patients receiving insulin therapy (INS group) were enrolled for comparison. The levels of plasma adiponectin, high sensitive-CRP, TNF-α, interleukin-6, homeostasis model assessment-insulin resistance (HOMA-IR), brachial-ankle pulse wave velocity (baPWV) and augmentation index (AI) were measured before and 28 weeks after the therapy. Results: HOMA-IR in the GP group was significantly decreased compared to the GB group. Plasma adiponectin levels were significantly increased in the GP group but not in the other groups. TNF-α, interleukin-6 and high sensitive-CRP levels were significantly decreased in the GP group, but not in the other groups. The baPWV and AI levels did not change in either the GB or the INS group, but were significantly decreased in the GP group. Conclusions: Glimepiride appears to improve insulin resistance and atherosclerotic disorders