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At most dialysis clinics in Japan, a central dialysis fluid delivery system (CDDS) is used primarily to provide consistent treatment to patients. We incorporated hot water disinfection to a CDDS over a 7 year period, after which we assessed the dialysis purification levels. We observed that adequate levels had been maintained. We rated the internal circuits of the device at the 7 year mark, comparing the insides of both the used and unused new Synflex tubing, silicone blades, Teflon tubing, silicone rubber tubing, and stainless steel parts. No bacteria or contamination (such as endotoxins) was detected, and no degradation or damage were observed. Even after the auto-hot water disinfection system was installed, no internal tubing degradation due to hot water or mechanical issues have occurred, and the system’s dialysis fluid purification levels have been maintained.

We describe the case of an elderly Japanese female who had experienced diabetic nephropathy since the year 20xx and had been undergoing dialysis treatment while receiving vascular access interventional therapy (VAIVT) for arteriovenous fistula (AVF) occlusion. The patient visited the clinic/hospital in 20xx+10 with the AVF occlusion; emergency VAIVT was performed but blood flow could not be resumed. The patient was not admitted and was treated as an outpatient, and thus a cuff catheter (Split stream catheter: SST28 cm, Medcomp) was inserted. An infection developed and was successfully treated with antibiotics. The dialysis treatment continued without issue. One year after the cuff catheter’s insertion, the patient was admitted due difficulty breathing. Despite continued dialysis treatment with the catheter, the patient died 15 days post-admission. The removal of the catheter proved to be difficult. An autopsy was approved, and the area around the catheter was examined. The adhesion of the catheter to the right atrium was observed, but no infection was detected in the bloodstream. This case illustrates that dialysis with the use of a cuff catheter can be effective.

Background: Minimal change disease (MCD) is characterized by a nephrotic syndrome usually steroid-sensitive and a high incidence of relapse of proteinuria. Previous cohort studies have reported conflicting results regarding the association between the time to remission and incidence of relapse. Methods: This multicenter prospective cohort study included 102 adult patients with steroid-sensitive MCD or focal segmental glomerulosclerosis from a 5-year cohort study of primary nephrotic syndrome, the Japan Nephrotic Syndrome Cohort Study, who achieved remission of proteinuria within 2 months of immunosuppressive therapy (IST). The association between the time to remission of proteinuria after immunosuppressive therapy and incidence of relapse was assessed using Cox proportional hazards models adjusted for clinically relevant factors. Results: Remission was observed at 3–7, 8–14, 15–21, 22–28, and 30–56 days after initiation of immunosuppressive therapy in 17 (16.7%), 37 (36.3%), 21 (20.6%), 13 (12.7%), and 14 (13.7%) patients, respectively. During a median observation period of 2.3 years after the end of the 2nd month after initiation of immunosuppressive therapy, 46 (45.1%) patients relapsed. The time to remission was associated with the incidence of relapse in an inverse U-shaped pattern (multivariable-adjusted hazard ratios [95% confidence intervals] of the time to remission of 3–7, 8–14, 15–21, 22–28, 30–56 days: 1.00 [reference], 1.76 [0.56, 5.51], 6.06 [1.85, 19.80], 5.46 [1.44, 20.64], and 2.19 [0.52, 9.30], respectively). Conclusion: The time to remission was identified as a significant predictor of relapse in steroid-sensitive patients.

When stomach cancer cells have spread into the abdominal cavity, the results are usually fatal within one year. Numerous attempts have been made to improve survival, with little success. Recently a new device has been constructed which eases the treatment of peritoneal dissemination of gastric cancers using hot water in conjunction with chemotherapeutic agents. The device, called a peritoneal cavity expander, or PCE, is an acrylic cylinder, with both ends open and both ends flanged. The flange at one end is attached to the open surgical incision of the patient. The patient, then, literally has an extension of his peritoneal cavity extending up and out of his abdomen. Hot saline solution, to which the chemotherapeutic drugs cisplatin and mitomycin C have been added, is pumped into the cylinder. Although the water is heated to 52 degrees Centigrade, the temperature has dropped to 41-43 degrees by the time the mixture enters the abdomen. The added volume of the cylinder allows the small intestines to float upwards, permitting the hot chemotherapeutic perfusate to enter all the peritoneal nooks and crannies into which it would otherwise diffuse too slowly. The operation using this device was performed on 31 patients, 12 of whom underwent a second-look operation to determine the extent of tumor destruction. Of these 12, 4 had complete response, 1 had partial response, 3 had no change and 4 showed progressive disease. The complete and partial responders had a two-year survival rate of 50 percent, which compares favorably with the zero percent of the non-responding patients. One complication observed was renal (kidney) failure, which is believed to have resulted from the reuptake of peritoneal liquids after the operation, causing excessive edema. The appropriate use of diuretics is crucial at this time. The use of hyperthermic peritoneal perfusion probably has both direct effects of the tumor cells themselves and an enhancement of the activity of the chemotherapeutic agents, and more widespread use of the technique is suggested. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background: We investigated the effects of sodium–glucose cotransporter 2 inhibitor (SGLT2i) administration focusing on its involvement in tubulo-interstitial disorders in diabetic kidney. Methods: Enrolled patients with diabetic kidney disease received a mean dose of 52.3 mg of an SGLT2i (ipragliflozin) daily. Blood and urine were sampled at 0, 1, and 12 months (M). Results: Non-renal-dysfunction patients (NRD: baseline eGFR ≥ 60 mL/min/1.73 m2, n= 12) and renal-dysfunction patients (RD: baseline eGFR < 60 mL/min/1.73 m2, n= 9) were analyzed separately. The median urine albumin-to-Cr ratio (ACR) was significantly decreased at 1 M in both groups (NRD: 163.1 at 0 M vs 118.5 mg/g Cr at 1 M, RD: 325.2 at 0 M vs 136.0 mg/g Cr at 1 M). In the RD, but not the NRD group, reduction of urine monocyte chemotactic protein-1 (MCP-1) by SGLT2i showed a significant difference between high-responders (HR: − 25.7 ± 11.4%) and low-responders (LR: 59.2 ± 17.0%), defined by ACR reduction at 1 M. Univariate analysis showed a significant correlation between the reduction of ACR and MCP-1 (R= 0.683, p= 0.042) in RD. Conclusion: SGLT2i exerted an anti-albuminuric effect regardless of the presence/absence of renal dysfunction. However, the anti-albuminuric effect of SGLT2i in patients with renal dysfunction appears more closely associated with amelioration of tubulo-interstitial disorders compared to patients without renal dysfunction.

We assessed the expression profile of Mg2+-transporting molecules in obese diabetic rats as a cause of hypermagnesiuric hypomagnesemia, which is involved in the development of insulin resistance, hypertension, and coronary diseases. Kidneys were obtained from male Otsuka Long-Evans Tokushima fatty (OLETF) and Long-Evans Tokushima Otsuka (LETO) obese diabetic rats at the ages of 16, 24, and 34 wk. Expression profiles were studied by real-time PCR and immunohistochemistry together with measurements of urine Mg2+excretion. Urine Mg2+excretion was increased in 24-wk-old OLETF rats and hypomagnesemia was apparent in 34-wk-old OLETF rats but not in LETO rats (urine Mg2+excretion: 0.16 ± 0.01 μg·min−1·g body wt−1in 24-wk-old LETO rats and 0.28 ± 0.01 μg·min−1·g body wt−1in 24-wk-old OLETF rats). Gene expression of transient receptor potential (TRP)M6 was downregulated (85.5 ± 5.6% in 34-wk-old LETO rats and 63.0 ± 3.5% in 34-wk-old OLETF rats) concomitant with Na+-Cl−cotransporter downregulation, whereas the expression of claudin-16 in tight junctions of the thick ascending limb of Henle was not different. The results of the semiquantitative analysis of immunohistochemistry were consistent with these findings (TRPM6: 0.49 ± 0.04% in 16-wk-old LETO rats, 0.10 ± 0.01% in 16-wk-old OLETF rats, 0.52 ± 0.03% in 24-wk-old LETO rats, 0.10 ± 0.01% in 24-wk-old OLETF rats, 0.48 ± 0.02% in 34-wk-old LETO rats, and 0.12 ± 0.02% in 34-wk-old OLETF rats). Gene expression of fibrosis-related proinflammatory cytokines as well as histological changes showed that the hypermagnesiuria-related molecular changes and tubulointerstitial nephropathy developed independently. TRPM6, located principally in distal convoluted tubules, appears to be a susceptible molecule that causes hypermagnesiuric hypomagnesemia as a tubulointerstitial nephropathy-independent altered tubular function in diabetic nephropathy.

Most dialysis clinics in Japan have mainly adopted the central dialysis fluid delivery system (CDDS) to provide constant treatment to many patients. Chemical disinfection is the major maintenance method of the CDDS. Our clinic introduced an automated hot water disinfection system that used the heat conduction effect to disinfect a reverse osmosis (RO) device and dialysis fluid supply equipment. Endotoxin level and the amount of viable bacteria often showed abnormal values before introduction of this system. After its introduction, weekly disinfection resulted in endotoxin levels and the amount of viable bacteria lower than measurement sensitivity. In hot water disinfection, water heated to 90°C in the RO tank flows into the dialysis fluid supply equipment. The maximum temperature inside the tank of the supply equipment is 86.3°C. (We confirmed that the temperature was maintained at 80°C or more for 10 minutes or more during the monitoring.) Dialysate purification was maintained even after introduction of the automated hot water disinfection system and the dialysate could be supplied stably by the CDDS. Therefore, this disinfection system might be very useful in terms of both cost and safety, and can be used for dialysis treatment of multiple patients.

Crystal structure of Ca1.1Co1.9(PO4)2was successfully determined from laboratory X-ray powder diffraction data (Co K?) using direct methods and the Rietveld refinement. The crystal structure was found to be monoclinic (space group P21?n, Z=4) with lattice dimensions of a=1.452 67(5) nm, b=0.494 34(1) nm, c=0.867 50(3) nm, ?=92.316(1)?, and V=0.622 45(3) nm3. The final reliability indices calculated from the Rietveld refinement were Rwp=3.93%, Rp=3.02%, RB=4.10%, and S=1.48. Both Co and Ca atoms were distributed over the 2aand 2dsites with a preference of Ca at the 2dsite. The coexistence of Co and Ca on the 2aand 2dsites is indispensable for stabilizing Ca1.1Co1.9(PO4)2in the Ca3(PO4)2-Co3(PO4)2system.

Abstract: In order to elucidate the nature of the heterogeneous nucleation, a differential scanning calorimetry (DSC) thermal analysis of pure Fe and Fe-Ni alloys (Ni content: 1.0 to 29.3 mass pct) containing TiN, Al2O3, and Ti2O3 was conducted. Then, special attention was paid to the difference in the phase of the primary crystal nucleated by the triggering effect of a catalyst (nucleating agent). The solidification and transformation mode appearing during cooling in these alloys is classified into three cases: F mode, FA mode, and A mode. The change of modes and the critical undercooling (ΔT) depend on the kind of catalyst used as well as the chemical composition (Ni content). In addition, in spite of the kind of primary crystal, the value of ΔT is always small in the order of TiN, Al2O3, and Ti2O3. As a matter of fact, only TiN has a practical effect as a catalyst on the triggered nucleation of the primary crystal of the δ phase. None of them has a practical effect on the nucleation of the primary crystal of the γ phase.

Background The number of dialysis patients in Japan has amounted to approximately 310,000. Most of the patients undergo hemodialysis. The reason why they can undergo hemodialysis is because maintaining and managing vascular access (VA) has improved. Recently, thanks to the progress of medical equipment, a variety of monitoring systems have been developed. It is important to make good use of these monitoring systems.Results In our hospital, we have been monitoring with an ultrasonic device and HD02. We measure blood flow of brachial artery with an ultrasonic device during nondialysis treatment. We examine real blood flow and blood recirculation with HD02 and evaluate the function of VA during dialysis.Conclusions In order to provide good dialysis care, good use of monitoring devices of VA is significant.

Methyl 4,5-epoxy-3-methoxycarbonyl-4-methyl-trans-2-pentenoate gave dimethyl 4-methyl-2,5-dihydrofuran-2,3-dicarboxylate on being heated with acetylenic compounds, while methyl 4,5-epoxy-3-methoxycarbonyl-4-methyl-cis-2-pentenoate gave methyl 3-methoxycarbonyl-4-oxo-2-pentenoate as a main product.

Summary Male Wistar rats were subjected to one of three types of operative reflux procedure that allowed part or all of the duodenal contents to flow back into the stomach through the pylorus, thus producing models of bile reflux alone, pancreaticoduodenal reflux alone, and combined reflux. All surviving animals were killed 50 weeks after surgery and the development of gastric cancer was assessed. No cancer was seen in 16 animals with pancreaticoduodenal reflux or in 32 control animals with gastrotomy, whereas 2/8 animals with bile reflux and 11/29 animals with combined reflux had gastric carcinoma. Compared with the control group, the incidence of carcinoma in animals with bile or combined reflux was significantly higher (P<0.05 andP<0.01 respectively). All carcinomas developed in the antral area near the pylorus. Adenomas were observed only in the groups of animals developing carcinoma and occurred in the same region of the stomach. These results suggest that bile, and not pancreaticoduodenal secretions, is the component of the duodenal contents responsible for the development of gastric carcinoma.

Abstract: Two cases of postmastectomy lymphangiosarcoma seen at our department are reported. One case, treated by amputation, died 1 year 4 months later and the other case, treated by local excision followed by amputation, died 7 months later. Twenty cases from the Japanese literature, including our 2 cases, are reviewed herein. The initial treatment for the other 18 cases was as follows: amputation in 8 cases, local excision in 2, radiotherapy in 4 and chemotherapy in 4. Fifteen of 16 cases eligible for follow up were dead within 20 months after treatment. Although the knowledge available as to the results of the treatment of postmastectomy lymphangiosarcoma is still insufficient to indicate the optimal therapeutic approach, early recognition of the lesion and prompt radical ablative surgery seem to offer the best chance for survival.

We carried out a fundamental research for synthesizing high polymers of aromatic acetoxy carboxylic acid, and observed the influence of the position of the acetoxy group, and found that m-acetoxy benzoic acid, 3, 5-diacetoxy benzoic acid and 2, 4-diacetoxy benzoic acid, are superior as the monomer for the preparation of high polymers of aromatic acetoxy carboxylic acid.

The reaction of α-keto-β-alkyl-β-allyloxycarbonyl-γ-butyrolactones with ammonium formate in the presence of palladium catalyst gave α-hydroxybutenolides in good yields. When the reaction was carried out without ammonium formate, decarboxylation-allylation took place to give allyl enol ethers of α-hydroxybutenolides, which were converted to α-keto-β-allyl-γ-butyrolactones by the thermal Claisen rearrangement.

The diabetes patients are known to be easy to present with salt sensitive hypertension. On the other hand, there is GLP-1 receptor to renal proximal tubule, and acts on sodium diuresis through NHE3. However, the effect to sodium diuresis and the blood pressure with the DPP-4 inhibitors were unknown.