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著者人数：20名, 資料番号: SA1000216000

Aim The aim of the present study was to evaluate the alteration in plasma immunoreactive insulin (IRI) concentrations due to hemodialysis (HD) treatment by using three types of membranes in diabetic HD patients. Method We recruited 20 outpatients on maintenance HD with diabetes for this crossover study. HD was performed using membranes made of cellulose triacetate (CTA), polyester-polymer alloy (PEPA), and polysulphone (PS). These membranes were used for 2 weeks (6 HD sessions) in each patient in a randomized order decided by drawing lots. Blood samples were obtained at the beginning and end of the HD session from the blood tubing at the arterial (A) site. At 60 min after the initiation of dialysis, blood samples were obtained from the blood tubing at both the A and venous (V) sites of the dialyzer. Results The plasma IRI levels decreased significantly at the sites an hour after initiating HD in all membranes. The clearance of IRI was significantly higher in the case of the PS membrane when compared with the CTA and PEPA membranes. Conclusions It was concluded that plasma insulin is cleared by HD, and the rate differs for each membrane. Plasma insulin clearance with the PS membrane is higher than that with the PEPA and CTA membranes.

Phase characteristics, which are systematic phase offsets across the main beam of an actual telescope, may be a problem for achieving the same-beam differential very long baseline interferometer (VLBI) technique. This technique is essential for differential phase delay measurements such as those used in the Japanese Selenological and Engineering Explorer (SELENE) project, where the phase has to be determined to an accuracy of 0.075 radians rms. Accurate measurement and correction of phase characteristics are very important. The phase characteristics at 2.2375 and 2.2807 GHz of the 20-m and 10-m telescopes at Mizusawa were measured to an error of approximately 0.04 radians rms. The phase characteristics were 0.06 radians rms for the 20-m and 0.055 radians rms for the 10-m telescopes in the main beams, and the post-fit residuals decreased to 0.03 and 0.04 radians rms, respectively, after correcting by using quadratic formulas. These results confirmed the effectiveness of the same-beam differential VLBI technique for VLBI observations of SELENE

The Japanese SELENE project consists of a main satellite, a relay sub-satellite (Rstar), and a VLBI sub-satellite (Vstar). Rstar will relay the Doppler ranging signal between the main satellite and the ground station for the world’s first direct measurement of the gravity field on the far side of the Moon. The differential VLBI radio sources onboard Rstar and Vstar will be used to determine the gravity field of the Moon precisely, especially near the rim. Rstar and Vstar only transmit three pairs of carriers in the S-band and one pair of carriers in the X-band, and the difference in phase delays of Rstar and Vstar will be obtained from the relation between correlation phase and frequency of four pairs of carriers. In particular, the difference in correlation phase at each frequency has to be estimated without the 2π ambiguity, and this imposes strict conditions; e.g., the correlation phase error must be lower than 4.3° and the error of differences in total electron content in the ionosphere must be less than 0.23 TECU. To resolve the 2π ambiguity problem, we use the same-beam differential VLBI technique, in which Rstar and Vstar are simultaneously observed by using the same beam of the receiving antenna. In this case, the influences of the atmosphere, ionosphere, and receivers can nearly be canceled in the difference in correlation phases, the difference in delay can be obtained with an accuracy of several picoseconds from the correlation phases, and the relative positions of Rstar and Vstar can be determined with a very high sensitivity (tens of cm). In this paper, we estimate the chance for same-beam differential VLBI observations in SELENE. We give a procedure and conditions for the obtaining differential phase delay, and predict the measurement errors in same-beam differential VLBI by using GPS techniques and by observing three satellites, Shuangxing, Geotail, and a geostationary satellite.

Recently, a concern has been raised about a particular kind of behaviour that is adversely affecting the quality of nursing theoretical discourse. With the behaviour being attributed to nurses' tendency to think in binary terms, it has been proposed that nurses replace their binary way of thinking with thinking that is inclusive and expansive and is based on an epistemology of contradiction. While agreeing that the behaviour of concern is indeed unscholarly, I disagree that the culprit is the binary. In this commentary, I argue that the culprit is sophistical argumentation involving a binary (real or not) and that, by not making room for legitimate binaries, we run the danger of 'throwing out the baby with the bathwater'. Further, I argue that the proffered solution is illusory. Its epistemological basis prohibits the deliverance of that which is promised.

This paper reports on a new method of measuring the phase characteristics of an antenna using the Doppler frequency measurement technique. With this method, the antenna being tested is rotated at a rate of f/sub sp/ around an axis through its geometrical center, and the phase characteristics of the antenna are calculated from the harmonic components of f/sub sp/ during time variations in the Doppler frequency of radio waves emitted from the antenna. Using this, we obtained three-dimensional phase characteristics of a patch antenna with a root-mean-square error of about 0.5/spl deg/, and confirmed its efficacy through experimental results.

The impact of crosstalk on the delay was examined by measuring a test chip manufactured with a 0.13-/spl mu/m-node technology. This examination revealed three requirements for precise and fast gate-level simulation technology: (1) consideration of degradation change dependent on relative-signal-arrival-time over a wide range, (2) static timing analysis (STA) based operation, and (3) quantitative estimation of the degradation accumulation caused by multiple aggressors. A candidate for such simulation technology is provided. and its highly precise characteristic is demonstrated through measurements and simulations. In a test structure with a two-aggressor crosstalk, the maximum error between the measured and simulated degradations was reduced to less than one sixth of that with a conventional method.

In an attempt to improve the Li insertion/extraction rates of a low-temperature disordered carbon having a very high Li loading capacity, several surface modification methods were examined for a mesophase carbon fiber prepared at 800 °C. The electrochemical reaction rates were evaluated by cyclic voltammetry and potential step chronoamperometry (PSCA) in an electrolyte of propylene carbonate (PC) containing 1 M LiClO 4 at an ambient temperature in a glove box filled with dried argon. In contrast to a well-graphitized carbon fiber, the vacuum deposition of a silver film on the 800 °C fiber surface revealed no appreciable rate-enhancing effect except at the lowest potential limit. Successive heating of the silver-deposited fiber in low-pressure oxygen, however, resulted in a remarkable rate enhancement. Using a single carbon fiber (10 μm in diameter), the chemical diffusion coefficient ( D chem ) was evaluated by PSCA. The D chem value was found to be increased up to one order of magnitude after the treatment, by which we could show that the low-temperature carbon has a capability to be put to practical use for the next generation of Li-ion batteries having enhanced capacity and power.

If nurses are to make the kind of contribution they are capable of making to the betterment of human health, then they must critically examine the moral injunctions and tenets of multicultural ethics that are being widely promulgated in nursing education. Such an examination, undertaken in this article, shows that responsible nursing practice cannot be realized under multicultural ethics. An alternate ethical basis for practice, a transcultural ethics grounded in moderate realism, is described and recommended because it provides principles that permit the realization of responsible practice.

Polycrystalline bulk crystals of MnSb were prepared by the normal freezing method, while single crystals of MnSb and bulk crystals of Pt-doped MnSb were prepared by the Bridgman technique. The magneto-optical (MO) spectra of these samples were measured between 1.24 and 6.35 eV. The Kerr rotation spectra of polycrystalline MnSb showed a new peak around 6 eV, which is larger than for lower energies. The spectra of single crystals of MnSb were strongly dependence on their crystal orientation. XRD measurement and an area analysis of EPMA revealed that Pt-doped MnSb grown in the equilibrium condition was characterized by a phase separation into MnSb and PtMnSb. The shape of the MO spectra of Pt-doped MnSb was slightly different from that of undoped MnSb.

The Japanese lunar mission, Selenological and Engineering Explorer (Kaguya), which was successfully launched on 14 September 2007, consists of a main satellite and two small satellites, Rstar and Vstar. Same-beam very long baseline interferometry (VLBI) observations of Rstar and Vstar were performed for 15.4 months from November 2007 to February 2009 using eight VLBI stations. In 2008, S band same-beam VLBI observations totaling 476 h on 179 days were undertaken. The differential phase delays were successfully estimated for most ( about 85%) of the same-beam VLBI observation periods. The high success rate was mainly due to the continuous data series measuring the differential correlation phase between Rstar and Vstar. The intrinsic measurement error in the differential phase delay was less than 1 mm RMS for small separation angles and increased to approximately 2.5 mm RMS for the largest separation angles ( up to 0.56 deg). The long-term atmospheric and ionospheric delays along the line of sight were reduced to a low level ( several tens of milimeters) using the same-beam VLBI observations, and further improved through application of GPS techniques. Combining the eight-station ( four Japanese telescopes of VLBI Exploration of Radio Astrometry and four international telescopes) S band same-beam VLBI data with Doppler and range data, the accuracy of the orbit determination was improved from a level of several tens of meters when only using Doppler and range data to a level of 10 m. As a preliminary test of the technique, the coefficient sigma degree variance of the lunar gravity field was compared with and without 4 months of VLBI data included. A significant reduction below around 10 deg ( especially for the second degree) was observed when the VLBI data were included. These observations confirm that the VLBI data contribute to improvements in the accuracy of the orbit determination and through this to the lunar gravity field model.

A quarter of a century ago, the nursing profession in Canada took a bold step: to establish baccalaureate preparation in nursing as the standard for practice as a registered nurse in Canada. Towards that end, hospital schools of nursing gave way to collaborative programs designed to help hospital and college diploma nursing students make the transition into baccalaureate nursing programs. It is thus paradoxical that, today, the nursing profession in Canada should do anything to jeopardize its goal to have RNs prepared at the baccalaureate level. The purpose of this paper is to focus Canadian nurse leaders' attention on that very possibility, given that some professional nursing organizations in Canada have conceptualized a future RN practice that could result in the emergence of a new kind of healthcare professional and a return to diploma preparation of RNs.

Background: Though different high-flux dialyzers are available, there are no comparative studies on their glycemic control effects on diabetic hemodialysis (HD) patients. In this crossover study, we compared the effects of polysulfone (PS) and polyester-polymer alloy (PEPA) dialyzers. Methods: We recruited 47 diabetic HD patients. The conventional dialyzers were replaced with PS or PEPA dialyzers and the patients were treated for 16 weeks. Subsequently, after interchanging the PS and PEPA dialyzers, the treatment continued for another 16 weeks. For each dialyzer, we analyzed the glycemic control effect and measured their clearance and reduction rates of insulin. Results: The PEPA dialyzer lowered the glycated albumin (GA) levels more significantly than the PS dialyzer. While the groups exhibited no differences in metabolic parameters, the clearance and reduction rates of insulin were more significant in the PS. A significant decrease was observed in the levels of GA, fasting plasma glucose, and glycated hemoglobin in patients with lower fasting C-peptide levels (< 6.0 ng/ml). Conclusion: Glycemic control in diabetic HD patients is affected by the type of dialyzer used. Our results indicate that the PEPA dialyzer is more potent in controlling glycemia than the PS dialyzer in diabetic HD patients.

This paper proposes a new 9-node degenerated shell element based on a nonlinear mixed formulation. To avoid locking phenomena, we present a mixed formulation based on a three-field Hu-Washizu principle in which displacements, the Green strain tensors, and the second Piola-Kirchhoff stress tensors are independently assumed. In approximating strain and stress fields, covariant components of the strains and stresses measured in the element curvilinear coordinate system are interpolated by the common polynomial functions over an element. Parameter vectors of stress and strain interpolants are elementwise eliminated so that we may obtain an element stiffness matrix similar to that of the displacement model. This formulation is mathematically clear in the variational context, and can include geometrical and material nonlinearities without spoiling such clearness. Numerical results based on our approach are illustrated with satisfactory behavior of the element observed.

Aim Changes in plasma immunoreactive insulin (IRI) and connecting-peptide immunoreactivity (CPR) concentrations during hemodialysis (HD) were evaluated in diabetic HD patients with 3 different high-flux membranes. The removal properties of the membranes were compared. Method In this prospective controlled study, 15 stable diabetic patients on HD were randomly selected for 6 HD sessions with 3 different membranes: polysulfone (PS), cellulose triacetate (CTA), and polymethylmethacrylate (PMMA). Blood samples were obtained from the blood tubing at the arterial (A) site at the beginning and end of the sixth HD session. At 60 minutes after dialysis initiation, blood samples were obtained from both the A and venous (V) sites of the dialyzer to investigate the clearance and removal properties of the membranes. Results The plasma IRI and CPR levels decreased significantly at each time point with all 3 membranes. IRI clearance with the PS membrane was significantly higher than that with the CTA and PMMA membranes. No difference was observed in the IRI reduction rate between the 3 membranes. CPR clearance and reduction rate with the PMMA membrane were lower than with the PS and CTA membranes. No significant difference was observed in serum creatinine clearance and reduction rates between the 3 membranes; however, serum urea nitrogen clearance was significantly lower with the PMMA membrane compared with the PS and CTA membranes. A significantly high β2-microglobulin clearance and reduction rate was achieved in the order PS > CTA > PMMA. Conclusion Plasma IRI and CPR are cleared by HD; their clearance rates differ with the dialyzer membranes. Plasma IRI clearance with the PS membrane is higher than that with the CTA and PMMA membranes. (Int J Artif Organs 2008; 31: 898–904)

Aims Type 2 diabetes is characterized by a combination of insulin resistance, dyslipidemia, and increased blood pressure. In this study, we evaluated the clinical efficacy of pioglitazone in the treatment of diabetic patients with hypertension undergoing hemodialysis (HD). Methods An open-label, randomized study was performed using 40 subjects assigned to two groups: one group (pioglitazone group) was administered an add-on pioglitazone therapy (fixed dose, 30 mg) plus conventional oral antidiabetic agents, and the other group (control group) was administered conventional oral agents alone. The treatment efficacy was determined by monitoring the glycemic control and insulin resistance, which were assessed based on the homeostasis model assessment for insulin resistance (HOMA-IR). The safety of and tolerance to the drug were determined by monitoring clinical and laboratory parameters. Results Pioglitazone was effective in reducing the plasma glucose and hemoglobin A1c levels from the baseline values, beginning at 4 weeks of treatment. It was also effective in reducing the triglyceride levels. The HOMA-IR decreased significantly in the pioglitazone group, and this decrease was maintained until the last measurement, which was at 24 weeks. The systolic and diastolic blood pressure values were statistically lower in the pioglitazone group than in the control group. No serious adverse effects were observed in any of the patients. Conclusions Pioglitazone is safe and effective for the treatment of Type 2-diabetic patients undergoing HD therapy. A daily dose of 30 mg pioglitazone is sufficient for treating HD patients, regardless of whether or not they are obese. Furthermore, pioglitazone reduced the systolic and diastolic blood pressure in our patients, and this effect requires further investigation.

The authors demonstrate the effectiveness of a method which uses Nedelec's tetrahedral elements for finite-element approximations of the mixed formulations of three-dimensional magnetostatic problems. The fundamental unknown function can be the magnetic field intensity (H-method) as well as the vector potential (A-method). A verification problem established by the Institute of Electrical Engineers of Japan is solved with these methods. Also, a practical test with the H-method is shown. It is shown that the H-method produces fairly good results within a reasonable computation time. >

Aims Unfortunately, clinicians are diagnosing a growing number of patients on hemodialysis (HD) with insulin-resistant, Type 2 diabetes in Japan. While alpha-glucosidase inhibitors (alpha-GI) such as oral antidiabetic agents are indicated for Japanese diabetics on HD, pioglitazone and other PPARgamma agonists are now contraindicated. No prospective study has evaluated the use of thiazolidinediones in diabetics with end-stage renal disease (ESRD) in combination with alpha-GI. In this study we evaluated the efficacy and safety of pioglitazone in Japanese diabetics on HD. Methods An open-label randomized study was performed on 31 Type 2 diabetics on HD with unstable glycemic control receiving constant doses of voglibose. The patients were randomly assigned to two groups: a combination therapy group (pioglitazone group) administered pioglitazone (fixed dose 30 mg) plus voglibose, and a monotherapy group (control group) administered voglibose alone. The efficacy of the treatments was determined by monitoring glycemic control (plasma glucose and HbA1c) and insulin resistance. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-R). Safety and tolerance were determined by monitoring clinical and laboratory parameters. Results The pioglitazone was effective in reducing plasma glucose and HbA1c from the baseline levels from Week 4 onward. It was also effective in reducing triglycerides. HOMA-R decreased significantly at 4 weeks in the pioglitazone group, and the decrease continued up to the last measurement at Week 12. Systolic and diastolic blood pressures at 4 weeks were statistically lower in the pioglitazone group than in the control group. No serious adverse effects such as hypoglycemia, liver impairment or rhabdomyolysis were observed in any of the patients. Conclusions Pioglitazone was safe and effective as a treatment for diabetics on dialysis therapy. The 30 mg daily dose of pioglitazone was sufficient for Japanese HD patients, obese and nonobese alike. The combination therapy of pioglitazone with voglibose will add to the list of first-line drug treatments for glycemic control in uremic Type 2 diabetes.

Purpose: To present an alternative to the recent proposal that the extant theories of nursing be replaced with culture-specific theories of nursing in order to have theories of nursing that are culturally responsive. Method: A philosophical analysis of the implications for nursing practice of adopting the proposal serves as the basis for recommending a different philosophically based theoretical solution. Anticipated probable objections to that recommendation are considered. Conclusion: Culture-specific theories of nursing might allow nurses to be culturally sensitive. However, because nurses must be humanly responsive to the needs of people as human beings and not just as cultural beings, cultural theories of nursing should be developed within the precepts of a transcultural theory of nursing grounded in a conception of objective human needs and values.

Four-way Doppler measurements and differential VLBI will be executed by SELENE to obtain highly accurate global mapping and improve the model of lunar gravity. Two small sub-satellites: Relay Satellite (Rstar) and VLBI Radio Satellite (Vstar), which are separated from SELENE Main Orbiter, perform these selenodetic observation using Relay Satellite Transponder (RAST) and VLBI Radio Sources (VRAD). These sub-satellites have no thrusters to control orbits and attitude to yield precise measurements of orbits perturbed by gravity anomaly. Lack of thrusters, however, causes the instability of attitude that interfere the selenodesy observation. The tip off at the separation and the solar radiation pressure torque dominantly affect the attitude, hence, we evaluated them in the critical design phase of the sub-satellite development. Properties of the newly developed release mechanism were obtained by ground tests, and the satellite attitude inclination by disturbances was analyzed. These results show that the design of the sub-satellites has enough properties to produce selenodesy data.

This paper proposes a new walking and jumping robot, that is expected to get over large debris in the disaster area which is difficult to move around by ordinary walking robot and to find out the victims efficiently as the rescue operation. To acquire stability on uneven terrain in landing, the robot is designed by legs which widely spread like spiders. The legs are consists of 4-bar linkage and driven by a pair of pneumatic cylinders which momentarily produce high power and speed. At this time, basic performance of the pneumatic cylinder is verified for the jumping use. Moreover the one leg model is developed and examined its jumping and landing performances.

Over the past few decades, nurse scholars have widely embraced the idea of worldviews and of worldviews serving as the bases of conceptions of nursing. Today, worldviews are so much taken for granted as the starting point of nursing inquiry that nurse scholars are continually seeking solutions to epistemological problems within the idea of worldviews. This article argues that, as long as we persist in doing so, the nursing discipline’s aim to develop an organized body of nursing knowledge for nursing practice will remain unrealized. I propose that conceptions of nursing and of nursing inquiry be grounded in the philosophy of moderate realism, which eschews the idea of worldviews.

Under the influence of idealist mainstream thinking that reality is mind-dependent, many nurses are dismissing the possibility of attaining objectively true judgments. A worrisome trend that has emerged from such thinking is to recommend that nursing practice decisions ultimately be based solely on subjective judgments. We present a conception of practical nursing judgment based on the common-sense philosophy of moderate realism, which has the potential to help offset the trend. It allows for nursing decision making in which nursing principles and rules are modified in light of the contingent circumstances of a nursing situation, resulting in decisions which have both a subjective and an objective aspect to them. This feature, plus the fact that the nursing principles are grounded in common natural needs, rights, and obligations, provides nurses with a basis for nursing care which is individualized, just, benevolent, and sensible, a means requisite to making our lives good.

The objective of this study was to describe one aspect of the reported quality of life (QOL) (according to the Aristotelian-Thomistic philosophical theory of the good life) of a selected group of children and adolescents whose parents were being treated by dialysis therapy for renal failure.An exploratory descriptive design was used.Twenty-five children and adolescents ranging in age from 8 to 16 years, selected on a convenience basis, participated in the study. The setting was a major renal treatment program in Western Canada.Semi-structured interviews were held with children and adolescents privately, in their homes, once a week for two to three weeks. The interview data were subjected to content analysis.Generally, the children and adolescents seemed to possess the real goods necessary for a good life. However, they appeared to need more goods of the mind: (a) an intellective good--more information about how their various family members were feeling, and (b) decreased fear in relation to their parents' condition and treatments. Also, they discussed the need for carefree family vacations, an instrumental means to sensory pleasure--a bodily good.Overall, the QOL of this group of children and adolescents seemed to be good. The parents' renal disease and dialysis therapy had an impact on the children's lives in that sometimes it interfered with and sometimes it facilitated attainment of real goods. Further study is required to examine the effects on the QOL of children and adolescents regarding dialysis modality, age/gender of the child or adolescent, and stage of treatment.

Seven patients undergoing chronic hemodialysis three times a week and whose plasma bicarbonate concentration on predialysis was consistently under 18 mmol/l due to bicarbonate dialysis (BCD), were treated with BCD for 2 weeks, then switched to acetate-free biofiltration (AFB) for 8 weeks. In both periods, the same high flux dialyzer (AN69HF) was used. The treatment time, dialysate flow rate and blood flow rate were kept constant in each patient during both periods. Plasma bicarbonate concentration (HCO3-), serum urea nitrogen (SUN), serum creatinine (Cr) and plasma amino acids concentrations (AA) were measured before dialysis and KT/V was calculated on the 2nd days of the last week in both periods. HCO3- on AFB was significantly higher than that on BCD (16.4 +/- 0.9 vs 19.9 +/- 1.8 mmol/l; p0.05). SUN on AFB was significantly lower than that on BCD even though the dialysis schedule and dietary content were not changed (84.7 +/- 3.7 vs 76.6 +/- 3.8 mg/dl; p0.05). TP, Cr and KT/V were not significantly different. Plasma total amino acid concentration (TAA) and plasma essential amino acid concentration (EAA) were not significantly different in both periods. In contrast, plasma branched-chain amino acid concentrations (BCAA) on AFB were significantly higher than that on BCD (313.5 +/- 44.3 vs 390.3 +/- 50.7 mumol/l; p0.05). Plasma BCAA concentrations, valine (VAL), leucine (LEU) and isoleucine (ILE), were significantly higher on AFB than that on BCD, respectively (p0.05). These findings suggest that optimal correction of the metabolic acidosis in chronic hemodialysis patients by AFB leads to a significant increase in plasma BCAA concentration.

This discipline of nursing is at a crucial point in its development. Conceptualizations about nursing are being developed and tested without benefit of a clear conception as to their nature. Consequently, the nursing literature on the topic tends to confuse rather than clarify thought. The purpose of this philosophic treatise is to show that greater clarity could be achieved by acknowledging the fact that questions addressed in conceptions about nursing are philosophic in nature. The influential thought of Jacqueline Fawcett is critiqued with reference to how acknowledging and acting in terms of this fact would also lend parsimony to thought on the matter.

We have recently observed reactivity of primary biliary cirrhosis (PBC) sera with several proteins bearing N-acetylglucosamine residues from rat liver nuclear envelopes. The aim of this study was to characterize the reactive antigens. Sera from 31 patients with PBC, 30 with rheumatoid arthritis (RA) and 30 with Sjögren's syndrome (SS) were examined. Rim-like immunofluorescence staining was observed in 15 of 31 (48%) sera from patients with PBC, in 1 of 30 with RA and in 1 of 30 with SS. Upon immunoblotting using preparations of whole rat liver nuclear envelopes and their Triton X 100-KCl extract as antigen sources, a 200 kDa protein band was observed in 9 of sera with PBC. Furthermore, upon immunoblotting using the wheat germ aggulutinin-bound fraction of rat liver envelope as antigen, 62, 60 and 54 kDa protein bands corresponding to components of the p62 complex in the nuclear pore complex (Kita et al. Biochem. 113, 377-382) were observed in 7, 5 and 6 samples respectively, of the 31 PBC sera. Our data suggest that PBC sera recognize not only the 210 kDa protein but also the p62 complex proteins.

This is a case report of 56-year-old man complaining of dysphasia. Upon admission, his chest X-ray film revealed medium amount of fluid accumulation in the right pleural space. Cytological examination of the aspirated fluid revealed nothing particular. Preoperative radiological examination including esophagogram, CT and MRI demonstrated cystic appearance of mass lesion, measuring approximately 5 cm in size located in posterior aspect of the lower portion of the mediastinum. Upon operation, it was found that a tumor with pedunculated connection to the esophageal muscle layer, suspecting diagnosis of leiomyoma of the esophagus. Then, tumor was removed together with the part of esophageal muscle. Postoperative pathology reported leiomyosarcoma of the esophagus with low grade malignancy. We added no esophagectomy. He made uneventful recovery without no sign of recurrence of the malignancy, 4 years after the surgery.

There have been proposed a variety of finite elements for the Reissner- Mindlin plates [1], [2], but we do not yet have fully reasonable ones mainly due to the difficulty of avoiding shear locking. As a trial to overcome such difficulty, we propose a Reissner-Mindlin type triangular element, which is based on the mixed method and free from locking. Thus, the element behaves nicely for wide ranges including the thin plate limit (i.e., the Kirchhoff range).

To investigate whether the nutritional improvement achieved by recombinant human erythropoietin (rHuEPO) treatment is the result of anemia correction with rHuEPO or the direct anabolic effects of rHuEPO per se, nutritional assessment was performed in 2 studies (study I and II) on hemodialysis (HD) patients. Nutritional assessment included blood biochemistry determinations, anthropometric measurements, daily protein intake (DPI) and dialysis efficiency. In study I, 5 HD patients who had not been given rHuEPO and had a hematocrit (Hct) ofor = 25%, were administered rHuEPO at the initial dose of 96.2 U/kgBW. Nutritional assessment of these patients was performed before rHuEPO treatment and every 4 weeks until the 24th week after rHuEPO treatment. In study II, the same nutritional assessment as in study I except for DPI, was performed in 2 groups with the same Hct level and dialysis regimen; an EPO group (n = 8) previously given rHuEPO (88.2 +/- 13.7 U/kgBW, 25.8 +/- 2.5 mos) and a non-EPO group (n = 8) not given rHuEPO. In study I, the mean Hct level was significantly increased 4 weeks after rHuEPO treatment (23.3 +/- 0.6 to 26.9 +/- 0.9%). However, the nutritional parameters and dialysis efficiency were nearly constant over 24 weeks, suggesting either the absence of a short-term direct anabolic effect of rHuEPO or masking of such an effect due to general condition improvement by anemia correction with rHuEPO. In study II, no significant differences in nutritional assessment were confirmed between the groups, suggesting that a long-term direct anabolic effect of rHuEPO may not exist and nutritional improvement may result from correction of anemia with rHuEPO.(ABSTRACT TRUNCATED AT 250 WORDS)

A 40-year-old woman suffered from toxemia of pregnancy in 1977 and was admitted to hospital. Thereafter, she developed nephrotic syndrome, underwent a renal biopsy, and a diagnosis of membranoproliferative glomerulonephritis (MPGN) was made. She received steroid therapy, immunosuppressive drug and anticoagulant therapy, and recovered sufficiently to be discharged from hospital in April, 1979. During subsequent ambulatory treatment at our outpatient department, her renal function deteriorated gradually, and maintenance hemodialysis was started from June, 1990. In July, 1991, she was admitted to our hospital with pleurisy and pericarditis. There was no improvement despite antibiotic treatments. Laboratory data revealed leukopenia and lymphopenia. Under suspicion of systemic lupus erythematosus (SLE), relevant tests were carried out. Immunological abnormalities such as positive LE cells and the presence of various autoantibodies, together with clinical signs of hypersensitivity to sunlight, stomatitis and serositis, satisfied the diagnostic criteria of the ARA and a diagnosis of SLE was made. This case did not exhibit any clinical or serological abnormalities except for the renal disorder for a 10-year period after the histological diagnosis of MPGN, but was eventually diagnosed as SLE as a result of the manifestation of SLE symptoms for the first time after one year of maintenance hemodialysis. Immunological abnormalities and SLE during maintenance hemodialysis are discussed in relation to other reports.