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N-terminal-pro-B-type-natriuretic peptide (NT-proBNP) was a predictive marker of cardiovascular disease (CVD)-related death in chronic dialysis patients. NT-proBNP was also correlated with markers of inflammation, malnutrition and protein-energy wasting. We hypothesized whether NT-proBNP was also associated with non-CVD death in chronic dialysis patients. A prospective observational study for incidence of death in chronic dialysis patients was conducted. Prevalent chronic dialysis patients (n = 1310) were enrolled and followed for 24 months. One hundred forty-four deaths were recorded. Area under the curve using ROC analysis for NT-proBNP showed: all causes of death (0.761), CVD-related (0.750), infection and malignancy-related (0.702) and others and unknown (0.745). After adjusting for age, sex, hemodialysis vintage, cardiothoracic ratio, mean pre-dialysis systolic blood pressure, dry weight and basal kidney disease, the hazard ratios (95% confidence intervals) per 1-log NT-proBNP calculated using multivariate Cox analysis were: all causes of death, 3.83 (2.51–5.85); CVD-related, 4.30 (2.12–8.75); infection and malignancy-related, 2.41 (1.17-4.93); and others and unknown origin, 5.63 (2.57–12.37). NT-proBNP was significantly associated not only with CVD-relate but also with non-CVD-related deaths in this population of prevalent chronic dialysis patients.

AIM Although infection is the second leading cause of death in maintenance haemodialysis patients, the effects of glycaemic control on infection in diabetic haemodialysis patients have not yet been examined in detail. We examined the relationship between diabetes or glycemic control and infection-related hospitalization (IRH) in haemodialysis patients. METHODS Patients receiving maintenance haemodialysis (n = 1551, 493 diabetic patients) were enrolled in this prospective cohort study in December 2009 and followed-up for 3 years. IRH during the follow-up period was abstracted from medical records. Kaplan-Meier and Cox regression analyses were used to investigate the relationship between diabetes or glycaemic control and IRH. RESULTS The Kaplan-Meier analysis revealed that the risk of IRH was significantly higher in haemodialysis patients with diabetes, particularly in those with poorly controlled HbA1c levels (HbA1c ≥ 7.0%), than in haemodialysis patients without diabetes. When patients with ≥HbA1c 7.0% were divided into two groups using a median value of HbA1c, the risk of IRH was significantly higher in those with the poorest glycaemic control (HbA1c ≥ 7.4%), an older age, or lower albumin levels. The multivariable-adjusted hazard ratio for the risk of IRH was not higher in the second criteria of HbA1c (HbA1c 7.0-7.3%), but was significantly higher in the group with the poorest glycaemic control (HbA1c ≥ 7.4%) than in those in the good control criterion (HbA1c

Background/Aims: Predictors including the preventive effects of antiplatelet and anticoagulant drugs on cerebral infarction (CI) events have not yet been clarified in dialysis patients. The aim of the present study was to examine the risk of CI and preventive effects of these drugs in Japanese hemodialysis patients., Methods: Patients receiving maintenance hemodialysis (n=1,551, median age (interquartile range), 69.0 (59.0-78.0) years; 41.5% female) were enrolled in the Miyazaki Dialysis Cohort Study and prospectively followed-up for 3 years. Kaplan-Meier and Cox's regression analyses were used to clarify the risk of CI., Results: Eighty-four patients developed CI at an incidence of 21.5/1000 patients per year. The presence of a previous history of CI, atrial fibrillation (AF), and diabetes mellitus in addition to age were also identified as predictive factors for new CI, whereas no relationship was observed between antiplatelet and/or anticoagulant usage and CI. Furthermore, no significant difference was noted in the frequency of CI events between patients with AF who received warfarin and those who did not., Conclusions: The incidence of CI was higher in dialysis patients with a previous history of CI and AF; however, the preventive effects of antiplatelet/anticoagulant drugs on the development of CI were not evident.

Background The use of a new bio-impedance spectroscopy device (Body Composition Monitor, BCM) in the field of dialysis became possible in Japan. However, it is unknown whether the data obtained using this apparatus are indicative for Japanese dialysis patients. Objective To compare individual fluid status in healthy Japanese using the BCM device with the data obtained from healthy Caucasians. Methods A total of 219 volunteers (female vs. male, 150 vs. 69; mean age, 68.8 ± 8.4 years; mean BMI, 22.6 ± 2.9 kg/m2) were enrolled. The measurement was performed by the end of the morning before exercise. Results Mean over-hydration (OH) level was 0.7 ± 0.8 L. Nearly 80% of subjects had values equivalent to the standard values of healthy Caucasians (-1.1∼1.1 L). Age had a weak positive correlation to OH. The fat tissue index levels were slightly lower in Japanese than in Caucasians. On the other hand, the levels of lean tissue index and ECW/ICW (E/I) ratio did not differ between Japanese and Caucasians. E/I ratio showed a good correlation with OH level. Conclusion Fluid status of healthy Japanese was equivalent to the standard value of Caucasians. Although validity of using parameters from healthy Caucasians in healthy Japanese population was considered to be confirmed, validity of use in Japanese dialysis patients should be evaluated further using the parameters from healthy Caucasians.

Background/Aims: How dialysis affects the survival of patients with biopsy-proven IgA nephropathy (IgAN) is not fully understood. The present long-term cohort study quantifies the survival rates and incidence of cardio-cerebrovascular diseases (CCVDs) among such patients in Japan. Methods: Fifty-two of 433 patients with IgAN who had reached end-stage kidney disease underwent renal replacement therapy (RRT) between 1981 and 2010. The overall survival rate and incidence of CCVDs in these patients were evaluated during follow-up for 11.3 ± 6.4 years. Results: The mean age at starting RRT was 42.8 ± 13.3 years. Only seven patients died during follow-up (mortality rate, 1.2/100 person-years) and Kaplan-Meier analysis revealed favorable survival rates of 93.3% and 65.1% at 10 and 20 years, respectively, compared with that of patients with glomerulonephritis in the registry of the Japanese Society for Dialysis Therapy who required RRT. Malignancy and CCVDs were causes of death at 13.6 ± 4.8 and 3.9 ± 1.3 years, respectively, after starting RRT. Fatal and non-fatal CCVDs developed in 15 (incidence, 2.7/100 person-years) patients and acute coronary syndrome and cerebral hemorrhage developed relatively soon after starting RRT. Cox proportional hazards models revealed that age at the time of starting RRT was a significant factor affecting the onset of CCVDs. Meanwhile, a history of having had corticosteroid as an initial treatment did not affect the onset of events. Conclusion: Although the survival of patients with IgAN is favorable after dialysis, the onset of CCVDs during the early phase of dialysis should be carefully monitored.

e18843Background: Improvements of treatment have reduced cancer-related mortality. However, managements of complications are important. Morbidities are key factors to manage treatments. This study ...

A case of recurrent gfastric carcinoma (endocrine cell type) successfully treated with combination chemotherapy with divided low-dose FP therapy is reported. The patient was a 47-year-old man who underwent total gastrectomy and combined distal pancreatectomy and splenectomy in June 1995 after receiving a diagnosis of Borrmann type 2 gastric carcinoma. The overall degree of advancement was as follows: H0, P0, se, n2, and stage IIIb. The histologic diagnosis was endocrine cell carcinoma. The patient initially presented with loss of appetite and a palpable abdominal mass 18 months later. Abdominal computed tomography showed metastatic lesions in both lobes of the liver, a metastatic abdominal wall mass 3cm in diameter and located directly below the umbilicus, and a pelvic mass 4cm in diameter. The patient underwent divided low-dose FP therapy, and by the 10th course, the hepatic metastases showed complete responses, and the abdominal wall and pelvic masses showed partial responses. The patient was still in good health 2 year and 6 months after initiation of therapy. These results suggest that combination chemotherapy with divided low-dose FP therapy may be useful for the treatment of highly proliferative cancers such as endocrine cell carcinoma, which exhibits a highmalignant potential, and should be actively employed in the treatment of such cancers.

A case of cancer of the sigmoid colon in which the carcinoma prolapsed from the anus due to intussusception is reported. A 62-year-old woman was seen at the hospital because she noticed of anal bleeding and a prolapsed intestine through the anus by about 20cm after evacuation. A Borrmann type 2 type 2 tumor was noted at the head of prolapsed intestine, and was diagnosed as adenocarcinoma on biopsy. Barium enema study revealed a claw like image and a pelvic CT scan presented target sign, indicating intussusception of the intestine. An iperation was performed with a diagnosis of intussusception of the intestine headed by the sigmoid cancer. During operation, we found difficulty in repositioning the intussusception completely due to severe adhasion, and performed a sigmoydectomy with lymph node dissection (group 3) in the state of invaginated intestine. The resected material revealed a 3.5×2.5cm Borrmann type 2 tumor with the invasion depth of mp that was a moderately differentiated adenocarcinoma of n0, Ly1, V0, ow (-), aw (-), and Stage I. So far another 20 cases of cancer of the sigmoid colon prolapsed through the anus due to intussusception have been seen in the Japanese literature. These redlatively rare 21 cases including ours are discussed in terms of clinical characteristics here.

遺伝子組換え大腸菌を用いて, 体積1.4dm3規模のファーメンタ培養実験を行った.用いた組換え菌は, λファージ由来のPRプロモータ, およびその下流にlac Z構造遺伝子を組込んだプラスミドpRZを, 温度感受性リプレッサーcI 857を有する大腸菌N4830-1に組込んである.二段階培養を行い, 培養開始後8時間まではpH7.0, 温度30℃として菌体増殖を促進させた。その後温度を37～42℃の範囲に上昇させて, 遺伝子発現の誘導を行わせると同時に, 誘導後のpHを変化させて, 遺伝子産物 (β-galactosidase) 生成への影響を検討した.その結果, 培養温度が高ければ発現効率が高いかわりに菌体の比死滅速度も高くなり, また逆に培養温度が低ければそれとは逆のことがおこることがわかった.また以上の実験データを用いて, プラスミド保持生菌濃度および遺伝子産物活性を状態変数とする数式によるモデル化を行った.このモデルに遺伝的アルゴリズムを適用し, 最適温度, pH変化パターンを導出した.導出した変化パターンで実験を行った結果, 今までに行った実験の中で最高の遺伝子産物の生産性が得られた.

Enol and vinyl esters were successfully synthesized by the use of an iridium complex as a catalyst. The reaction of carboxylic acids with terminal alkynes in the presence of catalytic amounts of [Ir(cod)Cl]2 and Na2CO3 gave the corresponding 1-alkenyl esters. The addition of carboxylic acids to alkynes principally took place in the Markovnikov fashion. In addition, by the use of an Ir complex combined with NaOAc various vinyl esters were prepared through the transvinylation between carboxylic acids and vinyl acetate.