Search

Objective Although lipid disorders are a well-known risk factor for cardiovascular disease (CVD) in the general population, the optimal management with lipid-lowering therapy to reduce CVD risks and mortality in hemodialysis (HD) patients remains controversial. In the clinical setting, dyslipidemia can be diagnosed based on the detection of elevated lipid concentrations at the beginning of HD. This study investigated changes in the levels of serum lipids during a single HD session. Methods The serum total cholesterol, triglyceride and high-density lipoprotein (HDL) cholesterol levels were measured in 31 HD patients at zero, two and four hours after the beginning of a single HD session. The data were analyzed using the Wilcoxon signed-rank test, a linear mixed model and Spearman's rank correlation analysis. Results The serum total cholesterol, HDL cholesterol and non-HDL cholesterol levels increased significantly during the HD session. Even after the lipid parameters were corrected for changes in the total protein level, the total cholesterol and HDL cholesterol levels increased, whereas the non-HDL cholesterol levels did not change significantly. The percentage change in the serum levels of these lipid fractions correlated strongly with the percentage change in the ultrafiltration volume per body weight. In contrast, the serum triglyceride levels were decreased significantly at two hours compared with the levels noted at the beginning of HD and gradually increased at four hours. Conclusion The serum lipid levels are influenced significantly by HD treatment and ultrafiltration. Evaluating the degree of dyslipidemia at the beginning of a HD session may therefore underestimate the levels of serum lipids in HD patients with a large amount of weight gain, thus resulting in the use of insufficient lipid-lowering therapy.

患者は82歳男性. 高熱, 嘔気, 嘔吐とBUN 118mg/dL, 血清クレアチニン8.0mg/dL, LDH 2, 195U/Lを認めて紹介入院し, 入院後血小板4.1万/mm3と判明したため, 溶血性尿毒症症候群 (HUS)/血栓性血小板減少性紫斑病 (TTP) による急性腎不全と診断した. 血液透析と血漿交換を施行したところ著効を示し, 腎機能と血小板は改善・正常化した. しかし, その10日後にCr 2.2mg/dLと上昇し, 血小板11.0万/mm3となったのでHUS/TTPの再発と診断した. 低補体血症を伴うHCV陽性のクリオグロブリン血症を認めたため, HUS/TTPとの関連を疑った. クリオグロブリン除去目的にクリオフィルトレーション施行するとともに血漿交換と血液透析を行い再度寛解に至った. クリオグロブリン陰性化を目的にプレドニンとシクロフォスファミドの併用療法を施行したところ, クリオグロブリン陰性化と補体正常化を認め, LDH 239IU/L, 血小板16.7万/mm3, ヘマトクリット25.1%, 血清クレアチニン1.2mg/dLと改善し, その後の再発は認められなかった. クリオグロブリン血症はHUS/TTPの原因疾患として記載がないが, 本例はHCV陽性のクリオグロブリン血症に伴うHUS/TTPが疑われる. クリオグロブリン血症関連HUB/TTPにおいても血漿交換は非常に有効な治療法と考えられた. 初回治療後も短期間で再発し, 副腎皮質ステロイドとシクロフォスファミドの併用によりクリオグロブリン陰性化し血清補体も正常化し, その後の再発を予防できた.

Aldosterone-salt treatment induces not only hypertension but also extensive inflammation that contributes to fibrosis in the rat kidney. However, the mechanism underlying aldosterone-salt-induced renal inflammation remains unclear. Pyroptosis has recently been identified as a new type of cell death that is accompanied by the activation of inflammatory cytokines. We hypothesized that aldosterone-salt treatment could induce inflammation through pyroptosis and that mizoribine, an effective immunosuppressant, would ameliorate the renal inflammation that would otherwise cause renal fibrosis. Ten days after recovery from left uninephrectomy, rats were given drinking water with 1% sodium chloride. The animals were divided into three groups (n = 7 per group): (1) vehicle infusion group, (2) aldosterone infusion group, or (3) aldosterone infusion plus oral mizoribine group. Aldosterone-salt treatment increased the expression of the nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain containing 3 and caspase-1, and also increased the number of terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells. However, the oral administration of mizoribine attenuated these alterations. Furthermore, mizoribine inhibited hypertension and renal fibrosis, and also attenuated the aldosterone-induced expression of serum/glucocorticoid-regulated kinase and α epithelial sodium channel. These results suggest that caspase-1 activation plays an important role in the development of inflammation induced by aldosterone-salt treatment and that it functions as an anti-inflammatory strategy that protects against renal injury and hypertension.

Optical waveguides consisting of a SiOxNy (0≤x,y≤1) core and SiO2 cladding layers have been fabricated using Si LSI technologies. Low‐pressure chemical vapor deposition (CVD) at 750 °C and remote‐plasma CVD at 300 °C have been employed for the deposition of core materials. The propagation loss of ridge type waveguides depends on the size (thickness and width), refractive index and surface roughness of the core. A minimum loss of 1.5 dB/cm has been obtained. Micromirrors made from substrate‐Si, poly‐Si or Al, which change the light propagation direction, have been fabricated using wet‐chemical or chemical dry etching. The light bending efficiency ranges from 60% to 80% depending on the material. Simulations and measurements of the propagation losses of branched and curved waveguides have been carried out. It is shown that the simulated results are in good qualitative agreement with the experimental data for both branched and curved waveguides. Single‐chip integration of light emitting diodes (LEDs), microm...

We investigated whether or not N-terminal pro brain natriuretic peptide (NT-proBNP) could predict hospitalization for cardiovascular disease (CVD) among Japanese hemodialysis patients. A total of 104 patients on maintenance dialysis 3 times per week were enrolled. We followed the patients for 23.9 +/- 4.2 months and 19 hospitalizations for CVD occurring during this period. The area under the curve (AUC) for the risk of CVD hospitalization was calculated after drawing a receiver operating characteristic curve. Predialysis NT-proBNP showed a larger AUC value than both postdialysis NT-proBNP and brain natriuretic peptide. The optimal cut-off value of predialysis NT-proBNP for predicting CVD hospitalization was 5,894 pg/mL, (sensitivity of 60 % and specificity of 76 %). Diabetes mellitus, a history of CVD, and the predialysis NT-proBNP level were significant determinants of CVD hospitalization according to Cox proportional hazards analysis. In conclusion, predialysis NT-proBNP is useful for predicting CVD hospitalization in hemodialysis patients.

To evaluate the pharmacological effects of ibudilast on cerebral circulation, we examined 5 ischaemic stroke patients, using positron emission tomography, and we measured cerebral blood flow (CBF). Ibudilast loading per os led to a remarkable increase in CBF after 30 min. This CBF elevation was observed in the lesion side as well as in the nonlesion hemisphere. Therefore, we can confirm that ibudilast ameliorates the chronic low perfusion state of CBF in the ischaemic stroke patient.

Tight blood pressure (BP) control is important for the prevention of cardiovascular disease in hypertensive patients. A cross-sectional study of 2339 patients from 101 clinics and hospitals in Ibaraki Prefecture was performed to evaluate BP control with the patients' current antihypertensive medication. Group A (n=892) included high-risk hypertensive patients with at least one of the following risk factors: diabetes mellitus, chronic kidney disease or a history of myocardial infarction. Group B (n=586) included patients

Spontaneous dehiscence of the aortic wall at the aortic commissure is not recognized as one of the usual pathological causes of aortic regurgitation. We describe the case of a 56-year-old man with hypertension, who experienced acutely progressive congestive heart failure due to massive aortic regurgitation. Local layer dehiscence around the commissure was noted with partial detachment of the commissure resulting in the loss of commissural support with secondary rupture of a non-coronary cusp, which led to massive aortic regurgitation.

Thiazolidinediones (TZDs), synthetic peroxisome proliferator-activated receptor (PPAR)-gamma ligands, have a central role in insulin sensitization and adipogenesis. It has been reported that TZDs exert protective effects in both diabetic and nondiabetic models of renal disease, although the exact mechanism is not well understood. In particular, only a few studies have reported the renoprotective effects of TZDs in nondiabetic models of tubulointerstitial fibrosis and inflammation. Therefore, we investigated the anti-fibrotic and anti-inflammatory effects of the TZD troglitazone in the mouse model of unilateral ureteral obstruction (UUO). C57BL/6J mice underwent UUO and were studied after 3 and 7 days. Animals were divided into three groups and received control vehicle, troglitazone (150 mg/kg per day) or troglitazone (300 mg/kg per day) by gavage. Kidneys were harvested for morphological, mRNA and protein analysis. Reverse-transcriptase-PCR was used to assess the expression of transforming growth factor-beta1 (TGF-beta1) and the TGF-beta1 type I receptor (TGF beta R-I). Protein expression was assessed by western blotting (TGF beta R-I) and immunostaining (TGF beta R-I, alpha-smooth muscle actin (alpha-SMA), type I collagen (collagen I), F4/80, and proliferating cell nuclear antigen (PCNA)). The expression of alpha-SMA, collagen I, and F4/80 was decreased in mice treated with troglitazone compared with the control group. The numbers of PCNA-positive interstitial cells were decreased in mice treated with troglitazone. TGF-beta1 mRNA and TGF beta R-I mRNA and protein expression were decreased in the group treated with troglitazone compared with the control group. The beneficial effects of troglitazone treatment were also dose dependent. PPAR-gamma agonist significantly reduced TGF-beta and attenuated renal interstitial fibrosis and inflammation in the model of UUO.

A 24-year-old woman with focal segmental glomerulosclerosis was referred to our hospital for treatment of nephrotic syndrome. Though she experienced partial remission following treatment with prednisone and cyclosporine, she had a relapse of nephrotic syndrome when her prednisone was tapered off to 30 mg/day. The prednisone could not be tapered to less than 30 mg/day due to repeated relapses. After introduction of oral mizoribine (MZR) pulse therapy, the patient's prednisone was tapered to 15 mg/day and she had no signs of relapse for more than 1 year. This case suggests that oral MZR pulse therapy is a good therapeutic option for patients with steroid-dependent nephrotic syndrome.

Background and Purpose— [ 11 C]flumazenil (FMZ), a ligand that selectively binds to the central benzodiazepine receptor in the neuronal membrane, is useful for evaluating neuronal viability in a positron emission tomography (PET) scan. Using this ligand, we investigated whether there was a correlation between neuronal integrity in various brain structures and dementia in patients with leukoaraiosis. Methods— Twelve patients with extensive leukoaraiosis on magnetic resonance imaging were divided into groups of patients with or without dementia. Based on a 2-compartment, 2-parameter model that included metabolite-corrected arterial input and PET-measured cerebral radioactivity, the distribution volume of FMZ (FMZ-V d ) was calculated in various regions of interest by nonlinear curve fitting. Additionally, tracer kinetic analysis was applied for voxel-by-voxel quantification of FMZ-V d , and data analysis was performed by statistical parametric mapping. Results— The presence of dementia was associated with a reduced FMZ-V d in widespread areas of the cerebral cortex, including the bilateral frontopolar and frontal/insular areas, the left temporo-occipital border areas, and the left marginal cortical areas. Conclusions— Differences in neuronal integrity in the cerebral cortex might determine whether patients with leukoaraiosis become symptomatic or not.

We have previously reported the marked increase in plasma levels of endothelin-1 in patients with acute myocardial infarction (AMI). To investigate the effects of severe myocardial ischemia on the production of endothelin-1, plasma concentrations of endothelin-1 were measured by a sandwich-type enzyme immunoassay that we developed recently in both the coronary sinus and the aorta of dogs with artificially induced AMI. Dogs were anesthetized and chests were opened. The proximal left anterior descending coronary artery was completely occluded by ligation for 1 h and then was reperfused for 1 h. Throughout the experiment (at the end of occlusion for 1 h, at the beginning of reperfusion, at the end of reperfusion for 1 h), plasma endothelin-1 levels were not significantly altered either in the coronary sinus or in the aorta. The present findings indicate that severe myocardial ischemia itself does not affect the production of endothelin-1 in the coronary circulation of dogs.

At aortic regurgitation state, 2D synchrotron radiation (SR) coronary arteriography (CAG) with aortographic contrast injection was examined theoretically and animal experiments were performed to confirm its diagnostic ability. This system consisted of a silicon monocrystal, fluorescent plate, avalanche-type pickup tube camera, and image acquisition system. The experiment was performed at synchrotron sources in the Photon Factory of Tsukuba. The x- ray energy was adjusted to just above the iodine K-edge. Theoretical calculation described that the coronary arteries overlapping on left ventricle could not be demonstrated well with a high signal-to-noise ratio by using the aortographic CAG with SR. The canine coronary arteries without overlap over the left ventricle were demonstrated clearly, however, the image quality appear to be reduced. The coronary artery overlapping over left ventricle could not be demonstrated well, however the transient reduction of left ventricular wall motion was revealed by transient stenotic procedure of left anterior descending coronary artery.

Two-dimensional synchrotron radiation (SR) coronary arteriography (CAG) with aortographic contrast injection was considered theoretically and animal experiments were performed to examine its diagnostic ability. This system consisted of a silicon monocrystal, fluorescent plate, avalanche-type pickup tube camera, and image acquisition system. The experiment was performed at synchrotron sources in the Photon Factory in Tsukuba. The x-ray energy was adjusted to just above the iodine K-edge.

Rationale and Objectives. The diagnostic potential of two-dimensional aortographic coronary arteriography with synchrotron radiation was examined in dogs. Methods. The experiment was performed at a wiggler beam line by using a silicon monocrystal, fluorescent plate, and avalanche-type camera. The x-ray energy was adjusted to just above the iodine K-edge to obtain the highest contrast. Quantitative densitometry was used to compare intravenous coronary arteriography with aortographic coronary arteriography. Results. Aortographic coronary arteriography clearly depicted the branches of the coronary arteries such as the left anterior descending coronary artery, circumferential coronary artery, and right coronary artery to sizes of less than 0.2 mm without major overlap of coronary arteries. Intravenous coronary arteriography depicted only the branches of the left anterior descending coronary artery and right coronary artery with poor image quality. The ratio of contrast material dilution was about 2.4 to 3.4 in aortographic procedures, whereas in intravenous procedures it ranged widely from 7.7 to 15.6. Conclusion. These preliminary investigations indicate that two-dimensional aortographic coronary arteriography with synchrotron radiation promises to be a minimally invasive and easily repeatable method of clearly imaging the coronary arteries.

Light propagation loss of the micron size optical waveguides is found to be improved from 1.8 to 0.6 dB/cm by capping waveguides by Al film. Al micromirrors for changing the light propagation direction in the vertical and horizontal planes were fabricated. Various shapes of Al corner mirrors to change the light direction in the horizontal plane were investigated. The straight simple mirror at an angle of 45 degree(s) against the incident light has the largest reflectivity of 50%. Branched waveguides were also fabricated by using Al corner mirrors and resulted in the almost equal distribution of the light for three branches. Light emitting diodes (LEDs), micromirrors, waveguides and photodetectors have been integrated on a single chip and the signal transfer from the LED to the photodetector has been verified.© (1995) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A method for correlating positron emission tomography with magnetic resonance (MR) imaging enabled the authors to examine the high intensity white matter areas in T2-weighted images in patients with internal carotid artery occlusion. The high intensity areas showed increased cerebral blood volume compared with the ipsilateral and contralateral normal intensity white matter. This observation may have relevance in explaining some of the patchy white matter lesions seen in MR images.

Study objective – The aim was to examine whether regional myocardial dysfunction has a significant effect on the wall motion and blood flow in remote non-ischaemic regions. Design – Two different severities of regional dysfunction were produced by occluding the left anterior descending coronary artery and perfusing it with a hypoxic solution. Haemodynamic variables were otherwise identical in the two conditions. The relationship of regional dysfunction in the left anterior descending artery region to regional wall motion and regional myocardial blood flow in the left circumflex artery region were examined. Experimental material – 22 anaesthetised mongrel dogs, 9-16 kg, were used for the studies: 14 for the regional wall motion studies, and eight for the regional myocardial blood flow studies. Measurements and main results – Segment shortening in the left anterior descending artery region was impaired differently in the two conditions: arterial occlusion caused a bulge, while hypoxic perfusion caused only mild hypokinesis. Segment shortening and the myocardial blood flow in the left circumflex artery region were augmented similarly in the two conditions. Left ventricular end diastolic pressure and end diastolic segment length in the left circumflex region were increased and aortic pressure was slightly decreased by left anterior descending artery occlusion and hypoxic perfusion, but there was no significant difference between the two conditions. Heart rate was not affected. Conclusion – The augmentation of wall motion and blood flow of the remote myocardium does not depend on the magnitude of acutely induced regional dysfunction per se. The augmented wall motion in the remote region is unlikely to be due to mechanical unloading of the remote myocardium due to an intraventricular regional interaction, but rather to the Frank-Starling mechanism and left ventricular afterload reduction following acute ischaemia.

Alternating polyampholytes (MA-VA) containing two acidic groups and one basic group were prepared by the copolymerization of maleic anhydride (M1) and N-vinylsuccinimide (M2) at 60°C with AIBN as the initiator, followed by acid hydrolysis with 1N hydrochloric acid at 140°C for 24 hr. The monomer reactivity ratios r1 and r2 are 0.025 and 0.06, respectively. The structure of polymers was discussed on the basis of the data of their elementary, infrared (IR), and thermal analyses and the binding ability of heavy metal ion. Polyampholytes were soluble in strong acidic and basic media but were precipitated in the pH range 3–4. An isoelectric point at pH 3 was determined by potentiometric titration and the turbidimetric method. By thermal treatment above 205°C the polyampholyte turned quantitatively into a cyclized lactam. This suggests that the polyampholyte MA–VA has an intramolecular hydrogen bond between the amino and γ-carboxyl groups. The binding of Cu2+ and Hg2+ by the polyelectrolyte was evaluated by equilibrium dialysis.