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老年高血压合并糖尿病患者社区护理研究进展摘要：老年高血压合并糖尿病患者的临床治疗难度较大，疾病难以彻底治愈，需长期用药将血糖及血压控制在合理范围内。
但患者治疗周期较长，容易出现不依从用药、不健康生活习惯等问题，需及时提供有效护理展开干预。
社区护理是现今比较推崇的护理方案，不受空间及时间限制，方便随时为患者提供服务，可持续监督、指导患者，让患者遵医嘱。
文章介绍社区护理相关内容，希望能为相关医护人员提供指导。
关键词：老年高血压合并糖尿病；社区护理；血糖；血压高血压、糖尿病均是常见慢性病，发生率高、治疗难度大、难以根治、并发症多，老年人是高发对象[1-2]。
老年人躯体功能逐步减退，容易同时发生两种并发症，严重影响身心健康[3-4]。
但疾病难以根治，需要长期治疗，对患者依从性有较高要求[5-6]。
为保证疾病治疗效果，需做好患者的社区护理工作，最大化护理监督及指导作用，让患者遵医行为，提高疾病治疗效果。
一、健康教育临床调查[7]表明，疾病认知缺陷是患者不遵医嘱的主要原因之一。
老年人的记忆力、认知能力有一定下降，发生高血压合并糖尿病后，需使用较多药物治疗[8-9]。
再受认知水平影响，并未认识到不遵医嘱用药的危害性，容易出现遗忘用药、用药规律混乱等问题，不利于患者病情控制。
针对这一问题，常规提供知识手册、医护人员随时解答、社区医疗机构定时讲座、公告栏图文等途径干预，可让患者认识自身疾病，增强器健康意识，丰富其健康知识，让患者明确疾病发生原因、两种疾病合并的危害、疾病康复注意事项等，让患者约束不良行为，主动遵守医嘱，充分发挥健康教育作用。
鉴于老年人的文化水平参差不齐，还需结合患者个体情况及实际需求进行宣教，如定时和患者一对一沟通，面对面与线上均可，解答患者的每一个问题，丰富患者对疾病的准确认知，让患者依从临床治疗。
若患者经济状态良好，让患者自行配备家用血压仪与家用血糖仪，传授准确的测量方法，让患者定时检测患者的血压及血糖，做好相关记录，及时发现异常变化并进行干预。
围术期控制性降压的研究进展黄硕，韦珊珊广西河池市第三人民医院麻醉科，广西河池547000[摘要]控制性降压是在手术麻醉中采用各种药物和方法，在保证患者安全、不引起重要器官损害的前提下，有意识地使患者血压维持在较低水平的方法，目的是减少术中出血、改善手术视野、缩短手术时间，增加手术安全性。
随着医学的不断发展，控制性降压的新药物和方法不断涌现，而脑氧饱和度监测也为控制性降压提供了新的指导。
本文就目前控制性降压的用药和方法展开综述。
[关键词]术中；控制性；降压；进展[中图分类号]R4 [文献标识码]A [文章编号]2096-1782（2023）05(b)-0194-05 Research Progress of Perioperative Controlled HypotensionHUANG Shuo, WEI ShanshanDepartment of Anesthesiology, Hechi Third People's Hospital, Hechi, Guangxi Zhuang Autonomous Region, 547000 China[Abstract] Controlled hypotension is a method to consciously maintain the patient's blood pressure at a low level un‐der the premise of ensuring patient safety and not causing damage to vital organs by using various drugs and methods in surgical anesthesia. The objective is to reduce intraoperative bleeding, improve surgical field of view, shorten opera‐tive time and increase surgical safety. With the continuous development of medicine, new drugs and methods of con‐trolled hypotension keep emerging, and cerebral oxygen saturation monitoring also provides new guidance for con‐trolled hypotension. This article reviewed the current drugs and methods of controlled hypotension.[Key words] During surgery; Control; Reduce pressure; Progress控制性降压是指通过各种血压调控技术或药物干预，人为地降低患者血压。
日本的老龄化社会英语作文Japan is facing a rapidly aging society. The number of elderly people is increasing, while the birth rate is declining. This has led to a shrinking workforce and a higher demand for healthcare and social services.The aging population has also put pressure on the pension system. With fewer people paying into the system and more people drawing from it, there are concerns about its long-term sustainability.In addition, the aging population has led to a shortage of caregivers for the elderly. This has become a major issue as the demand for long-term care services continues to grow.On the other hand, the aging population has also created new opportunities. Many businesses are now catering to the needs of the elderly, such as providing products and services that are tailored to their specific needs andpreferences.Furthermore, the aging population has led to a greater emphasis on healthy aging and preventative healthcare. There is a growing focus on promoting active and independent living for the elderly, as well as encouraging healthy lifestyle choices.Overall, the aging population in Japan has had a significant impact on various aspects of society, from the economy to healthcare to social services. It is a complex issue that requires careful planning and innovative solutions to address the challenges and opportunities it presents.。
不同高血压人群的降压目标值尤玲;崔炜【摘要】Hypertension is a major independent risk factor for the development of coronary artery disease, stroke,and renal failure.The direct goal of antihypertensive therapy is to restore the blood pressure(BP)to the level of normal range,and the ultimate goal of hypertension is to reduce the risk of mortality and adverse events.Though some guidelines recommend more aggressive BP management in hypertensive patients, the target value of antihypertensive therapy is still uncertain because of lack of support in evidence-based medicine .The current review summarized BP reduction goals in different cohorts from the most recent guidelines.%高血压是冠心病、脑卒中和肾功能衰竭发展的一个主要独立危险因素。
降压治疗的直接目的是达标，终极目的是降低患者的心血管事件风险。
然而，降压治疗的目标值确定却缺乏足够的循证医学证据支持。
因此，对于高血压患者，什么是合理的降压目标值，那些因素决定降压目标值成为临床实践中关注的焦点。
本文将依据近年高血压指南对高血压不同人群的降压目标值做一综述。
日本的老龄化作文英语The Aging Population in Japan。
Japan is facing a significant demographic challenge with its rapidly aging population. The country has one of the highest life expectancies in the world, and a low birth rate, which has led to a rapidly aging population. This demographic shift has far-reaching implications for the country's economy, healthcare system, and social structure.One of the most immediate impacts of Japan's aging population is the strain it puts on the country's healthcare system. As people age, they are more likely to require medical care, and the increasing number of elderly people in Japan is putting a strain on the country's healthcare resources. This is particularly concerning given the shortage of healthcare workers in Japan, which is only expected to worsen as the population continues to age.The aging population also has significant implicationsfor Japan's economy. With a shrinking workforce and a growing number of retirees, the country is facing a potential labor shortage. This could have a negative impact on economic growth, as there may not be enough workers to support the country's aging population. Additionally, the increasing number of retirees means that there are fewer people contributing to the country's pension system, which could put a strain on the government's finances.In response to these challenges, the Japanese government has implemented a number of policies aimed at addressing the country's aging population. One of the most significant of these is the "Japan Revitalization Strategy," which includes measures to increase the retirement age, promote the employment of older workers, and improve access to healthcare for the elderly. These measures are designed to help mitigate the economic and social impact of Japan's aging population.In addition to government policies, there are also a number of cultural and social changes taking place in Japan in response to the aging population. For example, there isa growing trend of older people continuing to work past the traditional retirement age, either out of financial necessity or a desire to stay active and engaged in society. There is also a growing emphasis on creating age-friendly communities, with better access to healthcare, transportation, and social services for the elderly.Despite these efforts, Japan's aging population continues to present significant challenges for the country. The government will need to continue to develop and implement policies to address the economic and social implications of the aging population. Additionally, there will need to be a shift in societal attitudes towards aging, with a greater emphasis on valuing and supporting the elderly.In conclusion, Japan's aging population is asignificant demographic challenge with far-reaching implications for the country's economy, healthcare system, and social structure. The government and society as a whole will need to work together to address these challenges andensure that the needs of the elderly are met in the years to come.。
CirculationJournalOfficial Journal of the Japanese Circulation Society http://www.j-circ.or.jpand influences on lactation in patients with cardiovascu-lar disease,4. C oronary artery complications of Kawasaki disease, and others.There are various developmental processes in childhood to adulthood, such as functional development of the cardiovas-cular system and developmental changes in the liver, kidney, endocrine system and density of receptors. Therefore, the therapeutic dose for children should be determined by taking into account their complex modifiers, other than simply age, and not by regarding children as “miniature adults”.1The present guideline documents were developed with a focuson appropriate drug therapy in pediatric patients with cardio-vascular diseases, under the principle of “the Right drug for the Right pediatric patient at the Right time.”The reason for this effort is that it has recently become more common for not only pediatricians but also specialists in adult cardiovascular diseases to see the following diseases and con-ditions:1. C ardiovascular diseases in children and youth,2. A dult congenital heart disease patients with arrhythmia or heart failure,3. M anagement of pregnancy and delivery, fetal therapy,Released online December 26, 2013Mailing address: Scientific Committee of the Japanese Circulation Society, 18F Imperial Hotel Tower, 1-1-1 Uchisaiwai-cho, Chiyoda-ku, Tokyo 100-0011, Japan. E-mail: meeting@j-circ.or.jpThis English language document is a digest version of Guidelines for Drug Therapy in Pediatric Patients with Cardiovascular Diseases reported at the Japanese Circulation Society Joint Working Groups performed in 2010–2011 (Website: http://www.j-circ.or.jp/guideline/pdf/JCS2012_sachi_d.pdf).Joint Working Groups: The Japanese Circulation Society, The Japan Society for Transplantation, The Japanese Society of Kawasaki Disease, The Japanese Society of Pediatric Hypertension, The Japanese Society of Pediatric Hematology, The Japan Society Lipid Pediatric Conference, The Japanese Society of Pediatric Cardiology and Cardiac Surgery, The Japanese Society for Pediatric Nephrology, The Japanese Society of Pediatric Electrocardiography, The Japanese Society of Pediatric Anesthesiology, The Japan Society of Develop-mental Pharmacology and Therapeutics, The Japanese College of Cardiology, The Japan Society of Premature and Newborn Medicine, The Japanese Society of Clinical Pharmacology and Therapeutics ISSN-1346-9843 doi: 10.1253/circj.CJ-66-0083All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jpTable of ContentsIntroduction ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙507General ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙508 I. Purpose of the Present Guideline Documents ∙∙∙∙∙∙∙∙∙∙∙∙∙∙508 II. Special Consideration of Clinical Trials in Children ∙∙∙∙∙∙∙∙∙∙508 III. Approval by Medical and Pharmaceutical PublicKnowledge ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙508 IV. Clinical Development of Pediatric CardiovascularDrugs ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙509 V. Basics of In Vivo Pharmacokinetics ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙509 VI. Developmental Changes in PediatricPharmacokinetics ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙510 1. Neonatal and Infantile Period ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙510 2. Early Childhood and After ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙510Specific Medications ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙510 I. Congesive Heart Failure Medications ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙510 1. Renin-Angiotensin-Aldosterone System Inhibitors ∙∙∙∙510 2. β-Blockers ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙510 3. Phosphodiesterase 3 Inhibitors ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙511II. Cardiovascular Complications of KawasakiDisease ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙511 III. Hyperlipidemia ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙515 IV. Arrhythmia ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙516 V. Hypertension ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙517 VI. Hypotension ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙519 VII. Pulmonary Arterial Hypertension ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙520 V III. Myocardial Diseases ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙521 IX. Infective Endocarditis ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙522 X. Premature and Newborn Medicine ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙522 XI. Radionuclide Imaging ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙522 XII. Immunosuppressive for Organ Transplantation ∙∙∙∙∙∙∙∙∙∙∙∙525 X III. Anesthetics and Sedatives ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙525Summary ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙527 I. List of Cardiovascular Drugs for Children ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙527References ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙531(Circ J 2014; 78: 507 – 533)JCS GUIDELINES508JCS Joint Working GroupIndications for Drug Use in Pediatric Patients and Off-Label UseThe limitations described in the package insert as “safety in children has not been established (no clinical experience)” are generally interpreted as follows:1. T here are no limitations about the use of the drug in children at the physician’s discretion.2. B ecause clinical experience with the drug is limited, and therefore pharmacokinetics is unclear, the efficacy and safety in children are not established as they are in adults.3. A ppropriate dosage and administration have not been established.4. T he drug should be administered with caution.5. B ecause proper usage cannot be determined, pediatric patients are not covered by the national insurance for health hazards.6. H owever, complete prohibition of the use of the drug is not intended.I. Purpose of the Present Guideline DocumentsDrugs used in clinical practice often do not have pediatric in-dications. Only about 30~40% of recently approved drugs are permitted for pediatric use.However, many pediatricians use off-label drugs in their practice when it is considered indispensable although they are aware that the drugs are off-label, and they use these drugs with caution, attaching importance to the safety as well as the usefulness of the drug and the balance of risk and benefit. In recent years, it has been becoming apparent that the response to the drugs, such as warfarin, varies among children accord-ing to the individual’s pharmacogenetic profile. The factors shown in Table 1 are involved in the pharmacokinetic vari-ability of drugs used in children.II. Spcial Considerations of Clinical Trials in ChildrenClinical trials of new drugs in children and youth are limited by the U.S. F ood and Drug Administration (F DA) and the European Medicines Evaluation Agency (EMEA) in terms of the following:1. S election of the therapeutic dose and the drug formulation2. D evelopmental and age-related changes in human organs3. U nexpected effects on normal developmental process4. P harmacokinetics5. P harmacodynamicsTherefore, considering the difficulties in clinical trials and corporate attitude toward drug development, incentives, Na-tional Health Insurance (NHI) pricing formula, patent terms, and others, off-label use is necessarily frequent in children and youth, and it is often based on experience in a limited number of patients. In addition, because there are age-related limita-tions in surgical manipulations and techniques, the importance of medical therapy is higher in this population. In most cases, selection of the therapeutic dosage and treatment results de-rived from experience with adult patients, and sometimes trends in preceding use in overseas countries as well, are used as reference information.Recently, guidelines of the clinical evaluation of new drugs in pediatric patients have been prepared, and the movement of new drug development for these patients has been accelerated.III. Approval by Medical and Pharmaceutical Public KnowledgeOver the past decade, it has become possible to approve somedrugs for use in children without conducting additional clini-509JCS Guidelines for Drug Therapy in Pediatric Patients With CVD cal studies. This is because the policy of “application based on medical and pharmaceutical public knowledge” on the drug’s safety and efficacy was applied. Application based on public knowledge requires that the certain conditions listed in Table 2 are met (See “the handling of drugs in off-label use”, Notice from the Ministry of Health, Labour and Welfare, Ken No. 4, Iyakushin No. 104, issued on February 1, 1999).2IV. Clinical Development of Pediatric Cardiovascular DrugsThe cardiovascular drugs shown in Table 3 have been ap-proved for pediatric use since January 2001 to November 2012.V. Basics of In Vivo Pharmacokinetics 3,4It is generally accepted that only free or unbound form of drugs can reach the site of action. Therapeutic drug monitor-ing (TDM) is a means of measuring drug levels in the blood. Because total (free plus bound) drug levels are measured with TDM service, caution should be exercised when drug efficacy or toxicity are interpreted in the light of measured drug levels in disease conditions where the plasma protein binding is al-tered as compared healthy subjects. It should also be noted that drug interactions take place at each step of in vivo phar-macokinetics (i.e., absorption, distribution, metabolism andexcretion).1CYP, cytochrome P450; UGT, UDP-glucuronosyltransferase.510JCS Joint Working GroupVI. Developmental Changes inPediatric Pharmacokinetics3–61. N eonatal and Infantile PeriodHepatic metabolism and renal excretion of drugs is immature at birth, but they show substantial increase during the neonatal and infantile period.The time course of development of drug metabolism varies according to the molecular species of drug-metabolizing en-zymes. Renal function (glomerular filtration, tubular secretion and resorption) also develops progressively after birth. The drug clearance in the unit-weight of liver and kidney tissue appears approaching those of adults at or around 2 years, and the developmental increase in their organ clearance is largely associated with that of their organ weights.2. E arly Childhood and AfterIn school-age children and adolescents, the ratio of the weight of the drug-eliminating organs (liver and kidneys) to the total body weight is at most twice greater than that of adults. This means that these children have greater drug clearance normal-ized to body weight than adults. As a result, pediatric doses of drugs extrapolated from corresponding adult doses in body weight basis (e.g., mg/kg) often underestimate those actually needed. And because the ability of these children to eliminate drugs per body weight (clearance) is apparently greater than that in adults, the drug requirements per body weight is up to 2-fold higher (e.g., warfarin) for this age of pediatric patients. In children, values of drug clearance that are normalized by the body surface area proportional to the weight growth of the liver and kidney (values per m2) are, in many cases, similar to those in adults. A new formula should be created to obtain useful estimates of therapeutic doses for pediatric patients, taking into account the physiological and developmental changes in pharmacokinetics.Table 4 shows the ontogeny of hepatic metabolism and renal excretion per unit organ weight in the neonatal and in-fantile period.6 Clinical studies in children should be con-ducted to determine whether the observed findings can be at-tributed to developmental pharmacokinetics or differences in sensitivity.As for pharmacodynamics, it has been reported that chil-dren respond differently from adults for a number of drugs (e.g., cyclosporine and warfarin) even when the concentration of the drug exposed to the action site is comparable. In addi-tion, some drugs (e.g., valproic acid and isoniazid) are known to cause severe drug-induced hepatic injury at higher risks in children than adults.I. Congestive-Heart Failure Medications7–111. R enin-Angiotensin-Aldosterone System Inhibitors(Table 5)The use of renin-angiotensin-aldosterone (RAA) system in-hibitors is basic treatment for heart failure. Although these drugs are not approved for pediatric heart failure, enalapril, lisinopril, and valsartan have already been approved for hyper-tension in children.Table 6 shows a comparison of the use of enalapril in adults and children/youth. In children, the first-dose phenomenon at the starting of administration and adverse reactions such as cough are not common. Caution is necessary in patients with possible renal dysfunction.2. β-blockers (Table 7)12,13A U.S. study of carvedilol for heart failure in children showed no significant difference between placebo group and low- or high-dose carvedilol groups for the composite end point (heart failure outcomes).14 However, subgroup analysis demonstrated possible beneficial effect in patients with systemic left ventri-cle.15,16 Adverse reactions include bradycardia, complete atrio-ventricular block, and exacerbation of heart failure. Character-istically in children, these drugs are reported to be less effective for cardiac disease in which the right ventricle is the systemic ventricle (e.g., corrected transposition of the great arteries). Propranolol is approved for pediatric tachyarrhythmia in Japan.Table 8 shows a comparison of carvedilol (covered by theNHI) in adults and children/youth. RAA, renin-angiotensin-aldosterone.511JCS Guidelines for Drug Therapy in Pediatric Patients With CVD 3. P hosphodiesterase 3 Inhibitors 17–19The mechanism of their action is inhibition of phosphodiester-ase (PDE) 3 that leads to increased concentrations of cAMP (cyclic adenosine monophosphate) and cGMP (cyclic guanosine monophosphate) in vascular smooth muscle cells and myocar-dial cells. PDE3 inhibitors are indicated for acute heart failure.Intravenous milrinone and olprinone (both covered by the NHI) and oral pimobendan are available. Although none of these are approved for pediatric use, they are used in general clinical practice. None of these drugs are approved for use in children and youth in Japan. Fetal growth retardation has beendemonstrated with olprinone in animal experiments, and this should be noted to protect pregnant women and fetuses.Table 9 shows a comparison of the use of milrinone in adults and children/youth.II. Cardiovascular Complications of Kawasaki Disease (Tables 10~16)20–21Kawasaki disease, the most common acquired heart disease inchildren, occurs in about 11,500 individuals annually, and 3%ISA, intrinsic sympathetic activity.ACE, angiotensin converting enzyme; NHI, National Health Insurance.NHI, National Health Insurance.512JCS Joint Working Groupof these patients have coronary artery sequelae in Japan.Table 10 shows treatments for coronary artery complica-tions of Kawasaki disease using antiplatelet and anticoagulant drug therapy. Long-term antiplatelet or anticoagulant drug therapy is often required for coronary artery complications, particularly when a concomitant giant aneurysm (at least 6 mm in diameter) is present.Tables 11,12, and 13 show a comparison of the use of as-pirin, clopidogrel, and warfarin, respectively, in adults and children/youth.When a concomitant coronary aneurysm is present, it is highly likely that thrombotic obstruction occurring in the an-eurysm will result in acute myocardial infarction. Therefore,acute thrombolytic therapy is attempted intravenously in chil-NHI, National Health Insurance.JCS Guidelines for Drug Therapy in Pediatric Patients With CVD513- S afety has not been established.- B reast-feeding should be avoided because of possible transfer into breast milk.*0.2 mg/kg/day is recommended for infant 0~24 months of age by PICOLO (Platelet Inhibition in Children On cLOpi-dogrel) trial.222sics, psychoneurotic drugs, antiarrhythmic drugs, antibiotics, antifungal drugs, clopidogrel, ticlopidine, bucolome, andothers, enhance the drug effect.PT/INR, prothrombin time-international normalized ratio.ACCP, American College of Chest Physicians; t-PA, tissue plasminogen activator.514JCS Joint Working GroupPhosphodiesterase (PDE) 3 inhibitors are contraindicated for coadministration. Diuretics, nitrates, and nitrite esters require precautions for coadministration.515JCS Guidelines for Drug Therapy in Pediatric Patients With CVD dren as it is in adult patients, although the agents are off-labelfor children. This treatment is chosen particularly when emer-gency cardiac catheterization is difficult in infants (Table 14).Prevention of myocardial ischemia is extremely important in patients who have coronary artery aneurysm (Tables 15 and 16).23–29III. Hyperlipidemia (Table 17)26,30Antihyperlipidemic drugs may be used for the treatment of familial hyperlipidemia in children, taking the growth of the vascular wall in childhood into due consideration (Table 17).Particular caution is necessary if the patient is a young girl.The drug with an asterisk (*) is covered by National Health Insurance.516JCS Joint Working GroupIV. Arrhythmia (Tables 18 and 19)31–34Antiarrhythmic drugs approved for pediatric use are flecainide (Ic) and the β-blocker propranolol, and the calcium channel blocker verapamil (IV). Mexiletine, pilsicainide, atenolol, and landiolol are covered by the NHI (Table 18).In particular, the dosage of flecainide (Tambocor) has been indicated as the following: minutely as 4 m g/kg/day (Table 19);infants more than 6 months after birth and young or older children: 50~100 mg/m 2/day, at 2~3 divided doses per day, (increase and decrease); infants less than 6 months after birth: 50 mg/m 2/day, at 2~3 divided doses per day, (increase and decrease); and at a maximum daily dose: 200 mg in each case.Although the dose of the calcium channel blocker verapamil (Vasolan) is set at 3~6 m g/kg/day, caution is necessary for use in conditions such as cardiac dysfunction, postoperative arrhythmia, because the drug tends to be more potent in children (Table 20).V. Hypertension 35–38Calcium channel blockers bind selectively to the voltage-de-pendent calcium channels and block them, and thereby causea reduction in the flow of calcium ions into the cells, resulting in a relaxation of the smooth muscle of coronary or peripheral vessels, thus exerting antihypertensive and antianginal effects.Nifedipine is indicated for essential hypertension and renal hypertension, Perdipine injection for emergency treatment of abnormal hypertension during surgery and hypertensive emer-gency, and amlodipine for hypertension (Table 21).Among these drugs, amlodipine is the only calcium channel blocker approved for use in children and youth.Table 22 shows a comparison of the use of amlodipine inadults and children/youth. In children, the dose should not ex-PDE, phosphodiesterase.ceed the adult dose (overseas package inserts describe that therehas been no study that examined doses exceeding 5 mg/day in children).*However, the present guideline documents also refer to the dosage “0.06~0.3 mg/kg/day, at one dose” as described in the 2009 guidelines of the European Society of Hypertension.36Table 23 shows a comparison of the use of nifedipine inadults and children/youth. Nifedipine sustained-release tablets should be used without changing the formulation.Table 24 shows a comparison of the use of nicardipine inadults and children/youth.PDE, phosphodiesterase.Drugs with an asterisk (*) are covered by the National Health Insurance.WHO-FC: World Health Organization functional class.VI. Hypotension (Table 25)40Orthostatic hypotension associated with orthostatic dysregula-tion is common in childhood. Midodrine hydrochloride is theonly antihypotensive drug approved for pediatric use. Table 26 shows a comparison of the use of midodrine hydrochloride (Metligine) in adults and children/youth.The mechanism of action of antihypotensive drugs is blood pressure elevation by contraction of vascular smooth muscle. These drugs are indicated for essential hypotension and ortho-static hypotension. This type of drugs includes 1) α receptoragonists (phenylephrine hydrochloride, midodrine hydrochlo-ride, and ergotamine mesilate), and 2) sympathetic stimulants (amezinium metillsulfate).Because of its uterotonic activity and placental and umbili-cal vasoconstrictor action, Dihydergot is contraindicated for pregnant and breast-feeding women.Use of phenylephrine hydrochloride in children is off-label. In adults, a dose of 2~5 mg is given by repeated subcutaneous injection, or 0.5~1.0 mg is diluted and given intravenously. In children, this drug is administered by continuous infusion at a rate of 0.1~2.0 μg/min. Major adverse reactions include head-ache, numbness in limbs, erythema, and cardiac palpitation.The drug with an asterisk (*) is covered by National Health Insurance.Drugs with a double-asterisk (**) are approved for use in pediatric arrhythmias in Japan.VII. Pulmonary Arterial Hypertension(Tables 27~29)41–43The same as in adults, major drugs of prostacyclin, PDE5 in-hibitors, and endothelin receptor antagonists are used in chil-dren, but all these are off-label for pediatric use.Tables 28 and 29 show a comparison of the use of PDE5 inhibitor, and endothelin receptor antagonist bosentan, respec-tively, in adults and children/youth.GOT, glutamic oxaloacetic transaminase; NA, not available.VIII. Myocardial Diseases (Table 30)14,44,451. C ontrac tile ImpairmentDilated cardiomyopathy is the representative disease. See also the section on heart failure as needed.2. D ilation Management (Table 31)Hypertrophic cardiomyopathy is the representative disease.3. C ardiomyopathy Complicated by Specific Diseases (Table 32)This group of cardiomyopathies is chiefly associated with in-COX, cyclooxygenase; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis.born errors of metabolism, and mainly treated by enzyme re-placement therapy.IX. Infective Endocarditis(Table 33)46–48Various antibacterial drugs are available. Tables 34 and 35 show therapeutic drugs and prophylactic drugs, respectively, for bacterial endocarditis.X. Premature and NewbornMedicine (Table 36)49–52Intravenous indomethacin is used to assist in ductus arteriosus closure. In cases of patent ductus arteriosus depending con-genital heart disease, continuous intravenous infusion of pros-taglandin E1-CD (Prostaglandin Injection® 50~150 ng/kg/min) or a lipoidal form of this agent (Palux® or Liple® Injection 5~10 ng/kg/min) is used.In cases of persistent pulmonary hypertension of newborns (Table 37), INOflo® (for inhalation 800 ppm), an inhalation nitric oxide (NO) drug, is used. Therapy is started with the initial inhalation concentration at 20 ppm, and maintained at 20 ppm for subsequent 4 hours. When improved oxygenation is achieved, the dose is decreased to 5 ppm, and therapy should be discontinued after the dose is decreased gradually to 1 ppm. Extracorporeal membrane oxygenation (ECMO) is indicated for severe cases that do not respond to therapy.XI. Radionuclide Imaging(Table 38)53–55Isotope-labeled preparations are used for myocardial imagings in cases of ischemic heart disease (e.g., Kawasaki disease, coronary artery anomaly), cardiomyopathy, and myocarditis. These drugs include technetium-99 m-tetrofosmin, techne-tium-99 m-MIBI (methoxy-isobutyl isonitrile), and thallium-201-chloride for myocardial perfusion imaging; I-123 BMIPP (β-methyl-p-123I-iodophenyl-pentadecanoic acid) for myo-cardial fatty acid metabolism imaging; and I-123 MIBG (m-I123-iodobenzylguanidine) for cardiac sympathetic nerve imaging. All these drugs are approved for use in children and youth in Japan. No pharmacologic stress agent has been ap-proved for use in children.NPO: nothing per OS.XII. Immunosuppressive for OrganTransplantation (Table 39)56–60Cyclosporine (Sandimmune, Neoral) and tacrolimus are ap-proved for use in the transplantation of kidney, liver, heart, lung, pancreas, small intestine, and bone marrow (small intes-tine is not referred to for Sandimmun Capsule). The safety of these drugs has been established in low-birth-weight new-borns, neonates, and infants. Patients with appropriate indica-tions should be selected carefully and observed sufficiently. Cyclosporine and tacrolimus preparations are approved for use in all patients after organ transplantation excluding small intestine transplantation. In addition, CellCept 25~50 mg/kg/day and Bredinin 3~6 mg/kg/day, administered by 1 or 2 divided doses, are used. The recommended therapeutic doses for renal transplantation in children are as follows: Neoral 3~6 mg/kg in 2 divided doses (target trough 80~100 ng/mL), Prograf 0.2~0.4 mg/kg in 2 divided doses (target trough 4~5 ng/mL), CellCept 600~1,200 mg/m2 in 2 divided doses, Bredinin 3~6 mg/kg in 1or 2 divided doses.XIII. Anesthetic and Sedatives61–661. I nhalational Anesthetic DrugsInhalation anesthetic drugs approved for pediatric use are sevo-flurane, isoflurane, and nitrous oxide (See Table 40).A comparison of inhalation anesthetic drugs for adults and children is shown in Table 41.2. A nalgesic sAnalgesics are indicated for pain during anesthesia (morphine, fentanyl, remifentanil), postoperative pain and other severe pain (morphine, fentanyl). The types of drugs used include fentanyl and morphine (Table 42) and remifentanil (Table 43). Analgesics approved for use in children and youth in Japan are fentanyl and morphine.3. I ntravenous Anesthetic DrugsIntravenous anesthetic drugs are indicated for induction and maintenance of anesthesia, premedication, analgesic adjuvant during general anesthesia, sedation at the time of treatment and examination, postoperative pain relief and sedation (ketamine), anticonvulsant medication (barbiturates), and sedation in arti-ficial respiration during intensive care (propofol). The types of drugs used include ketamine, barbiturates (thiopental, thiamylal) (Table 44), and propofol (Table 45). Among these, ketamine and barbiturates are approved for use in children and youth in Japan.4. S edativesSedatives are used for sedation in intensive care units, testing, treatment, anesthetic premedication, and in the induction and maintenance of anesthesia (midazolam). The drugs used include midazolam and dexmedetomidine. Midazolam is approved for use in children and youth in Japan (Table 46).675. M usc le RelaxantsMuscle relaxants are used for muscle relaxation during gen-eral anesthesia and tracheal intubation. There are three types of muscle relaxants: rocuronium, vecuronium, and suxametho-nium. Among these drugs, the one approved for use in chil-dren and youth in Japan is rocuronium (careful administration is indicated for use in neonates, infants, and young and older children) (Table 47). More details are available in “Guidelines for Use of Anesthetics and Anesthesia-Related Drugs, 3rd revised edition (2012. 10. 31), Chapter X. Pediatric Anesthesia Drugs,” by the Japanese Society of Anesthesiologists.68As for medical products used in the field of pediatric cardio-vascular diseases, data from well-designed clinical studies have been limited. Instead, evidence is restricted to experts’ opinions. Consideration for risk/benefit and informed consent are important, and it is necessary to refer severe cases to insti-tutions where pediatric cardiologists are available.Table 49 shows the doses of major drugs used for pediatric cardiovascular diseases described in a representative textbook (Anderson RH, et al. Pediatric Cardiology, third edition, 2009).69I. List of Cardiovascular Drugs for Children69ConclusionClinical studies of new drugs for pediatric use have been lim-ited, and there have been few established guidelines for clini-cal evaluation of drugs of this kind worldwide, resulting in a lack of high-quality evidence in this field. Therefore, many drugs that are indicated for adult diseases remain to be devel-oped for pediatric use. Table 49 shows a list of cardiovascular drugs used for children around the world.69 This list includes a number of globally recognized drugs, although some have yet to be approved for pediatric use in Japan. This table has been cited from Anderson’s basic textbook of pediatric cardi-ology. The dosing basically covers neonates to 10-year-old children. However, this table provides rough standards, and the doses should be chosen appropriately by the doctor in charge who considers the risk/benefit based on the physical development, immaturity, race difference, renal and hepatic function, dehydration status, presence/absence of fever, sever-ity of the disease, complications, and concomitant medicationsin individual patients and other factors.(Table 49 continued the next page.)。
Japan, an island nation in East Asia, is a fascinating blend of modernity and tradition. The country is known for its technological advancements and cuttingedge innovations, yet it also holds onto its rich cultural heritage and customs that have been passed down through generations.In the modern aspect, Japan is a global leader in technology and innovation. The country is home to numerous multinational corporations such as Sony, Toyota, and Panasonic, which have revolutionized industries like electronics, automobiles, and telecommunications. Japanese cities, particularly Tokyo, are known for their sleek skyscrapers, bustling streets, and vibrant nightlife. The Shinkansen, or bullet train, is a marvel of modern engineering that connects the major cities of Japan at lightningfast speeds.Despite its modern achievements, Japan has not forgotten its roots. The country is deeply connected to its traditions and takes great pride in preserving its cultural heritage. Traditional Japanese arts such as tea ceremonies, calligraphy, and flower arranging are still practiced and appreciated by many. The kimono, a traditional Japanese garment, is worn on special occasions and is considered a symbol of elegance and refinement.Japanese cuisine is another area where the blend of modern and traditional is evident. While sushi and ramen are enjoyed worldwide, there are also regional dishes that showcase the unique flavors and ingredients of different parts of Japan. Modern Japanese cuisine has also evolved to incorporate international flavors and cooking techniques, creating a fusion of tastes that is uniquely Japanese.In terms of architecture, Japan has managed to strike a balance between the old and the new. Ancient temples and shrines coexist with modern skyscrapers, creating a visually stunning contrast. Traditional Japanese architecture, with its emphasis on harmony with nature, is still evident in the design of many buildings and public spaces.The Japanese language itself is a testament to the countrys blend of modern and traditional. While the use of English has increased in recent years, especially in the business world, the Japanese language remains an integral part of the countrys identity. The use of kanji, or Chinese characters, alongside hiragana and katakana, reflects the influence of both Chinese and Western cultures.In conclusion, Japan is a country that has successfully integrated modernity and tradition. Its technological advancements and modern lifestyle coexist with a deep respect for its cultural heritage and traditions. This unique blend is what makes Japan such a fascinating and dynamic country to explore and experience.。
关于长颈鹿的英语作文长颈鹿是世界上现存最高的动物，站得高望得远，视力不凡，在动物界号称“千里眼”。
那么关于长颈鹿的英语作文有哪些呢?下面是橙子为大家精心挑选的描写长颈鹿的英语作文，希望对大家有所帮助。
描写长颈鹿的英语作文篇一 Giraffes are one of the world's tallest mammals. They are well known for their long necks, long legs, and spotted patterns.Giraffes have small "horns" or knobs on top of their heads that grow to be about five inches long.These knobs are used to protect the head in fights. Male giraffes are larger than females.Males weigh between 2,400 and 3,000 pounds and stand up to 19 feet tall! Female giraffes weigh between 1,600 and 2,600 pounds and grow to be 16 feet tall.Giraffes live in the savannas of Africa, where they roam freely among the tall trees, arid land, dense forests and open plains.Their long necks help giraffes eat leaves from tall trees, typically acacia trees. If they need to, giraffes can go for several days without water. Instead of drinking, giraffes stay hydrated by the moisture 1 / 4from leaves.描写长颈鹿的英语作文篇二 The Medici giraffe was a giraffe presented to Lorenzo de Medici in 1486 possibly by al-Ashraf Qaitbay,the Burji Mamluke sultan of Egypt,in an attempt to win the support of the Medici.It caused a great stir on its arrival in Florence:although the Medici maintained a large menagerie,and had previously featured a giant mannequin of a giraffe in the animal entertainments they provided to the citizenry,this was the first time a living example had been seen in the city.It was also reputedly the first living giraffe to be seen in Italy since the days of Ancient Rome.It did not survive for long and another giraffe was not seen in Europe for almost 300 years.描写长颈鹿的英语作文篇三 Morning, we waited eagerly for a giraffe, to see the Japanese city of Nagoya to the city of Nanjing. The giraffe, a call A Guo, a call hill.They are in a special room and spacious lawn leisurely paced, greedily eating fresh leaves.The giraffe was pale yellow, covered with different size and shape of brown reticular markings. If they stand in the 2 / 4trees, it is difficult to be found.The giraffe is the highest in the world of animal, they are not only a long neck, face is long. The giraffe's head like a lookout, eyes are big and bright, is expected to be far away. As long as the giraffe straight legs, neck, head can effortlessly to eat seven or eight feet out of the leaves. But to eat on the water and grass will be hauled the two legs splayed, lower the head to eat. Had little trouble!Giraffe have no vocal cords, is a mute. Its skin is very thick, not afraid of thorn.The giraffe runs is also quite interesting: before and after the legs while swinging, up and down, just like a pendulum, when run fast.The giraffe's head a diagonal is a very rare herbs, it is said that, although the giraffe's neck is very long, low the head but not to have hypertension.To this point, has aroused strong interest in the medical community. Now, there are many medical workers are studying this subject, then the future for mankind.Friendly messenger giraffe -- Nagoya, how I want to visit you often!3 / 44 / 4。
