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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Only bisphosphonates have reliable evidence to decrease the risk of vertebral fractures in patients taking glucocorticoids. Relative risk at 1 year treatment with bisphosphonates for incident vertebral fractures and non-vertebral fractures were 0.46 (95% confidence interval: 0.28-0.77) and 0.77 (95% confidence interval: 0.39-1.51), respectively. Two year extension of the alendronate trial showed that relative risk for incident vertebral fractures was 0.10 (95% confidence interval: 0.01-0.90). The bisphosphonates have been recommended as first-line drugs and active vitamin D3 and vitamin K2 have been recommended as second-line drugs in Japanese guidelines on the management and treatment of glucocorticoid-induced osteoporosis of The Japanese Society for Bone and Mineral Research (2004 edition).