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Magnesium alloys have a problem of low corrosion resistance and fatigue strength. In this study, we focused on multi-stage wet blasting (WB) as a method to improve the fatigue strength. This method is characterized by a smaller increase in surface roughness compared to ordinary WB. We compared normal WB with multistage wet blasting. Magnesium alloy AZ31 was used as the test specimen. Fatigue tests were performed by rotating bending fatigue test. In the multistage wet blasting, particles with large particle size were treated, and then particles with small particle size were used. As a result, the fatigue limit of WB125 and WB15, which are multi-stage treatments, increased by about 10% compared to the normal treatment. It was found that this was due to a 16% smaller surface roughness as well as a deeper surface modified layer. Furthermore, it was reconfirmed that the particle size used in the first stage was the dominant factor in imparting hardness and residual stress in the wet blasting process.

Objective: Dialysis patients have a higher incidence of stroke, and outcomes are often poor. Diabetic nephropathy (DN) is a stroke risk-factor, but the importance is unclear in dialysis patients. This study investigated the stroke features and risk factors in hemodialysis (HD) patients. Methods: All end-stage renal disease patients undergoing HD at Teraoka Memorial Hospital dialysis center were identified, with 195 recruited. Baseline clinical characteristics were collected, and the clinical outcomes and related factors of stroke in HD patients were retrospectively analyzed. The incidence rate of stroke and mortality were calculated using Kaplan-Meier survival analysis. Factors potentially related to stroke were analyzed by the log-rank test and Cox proportional hazards model for univariate and multivariate analysis. Results: In total, 21.0% (41 of 195) patients developed stroke. The incidence rates of stroke per 1000 patient-years were 53.6, 65.2, and 34.0 in all HD patients, DN patients, and non-DN patients, respectively. The cumulative incidence rates of stroke in all HD patients, DN patients, and non-DN patients per 5 years, and per 10 years were 22.6%, 43.5%; 28.8%, 59.6%; and 17.6%, 31.1%, respectively. The incidence rate of stroke in the DN patients was significantly higher than in the non-DN patients (P = .013). DN was the significant risk factor for stroke by multivariate analysis (hazard ratio 2.63, 95% confidence interval 1.08-7.85; P = .032). Conclusions: This study revealed the trends of stroke in HD patients at a single institution in Japan. DN was shown to be a significant risk factor for stroke in HD patients.

From the viewpoint of weight reduction in transportation equipment such as automobiles, the use of light metals is being promoted. Magnesium alloy is the lightest in practical metals, but it has the property that its strength is low. For improvement of fatigue strength, surface modification treatment such as shot peening is generally applied. Since the magnesium alloy has high reactivity with oxygen and may ignite, surface treatment in a dry environment like shot peening is difficult. In this study, we focused on wet blasting process with low probability of ignition and examined the influence of it on fatigue strength. The fatigue strength of wet blasting AZ31 showed higher results than untreated material. As this factor, improvement of hardness near the surface and application of compressive residual stress are conceivable. Also, the particles used in the wet blasting process are smaller than the particles used in the general shot peening process. Therefore, the fact that the surface roughness did not change significantly was also considered to be one factor. From the above results, we clarified that the wet blasting treatment can safely improve the fatigue strength of the magnesium alloy.

Hemoglobin (Hb) Hiroshima is an Hb variant that travels rapidly on electrophoresis and shows a fourfold increase in oxygen affinity and a decreased Bohr effect. We encountered a 40-year-old male patient with erythremia and an undetectable HbA1c level. The presence of an abnormal hemoglobin molecule was suggested by the results of high-performance liquid chromatography analysis. Subsequent gene analysis by direct sequencing confirmed Hb Hiroshima (β146 histidine → aspartic acid). Caution should be exercised when diagnosing erythremia.

症例は, 慢性腎不全のため外来維持血液透析を行っている74歳男性. 左前腕尺骨神経鞘腫切除術のため入院中であった. 術後8日目, 通常通り血液透析が施行され, その終了約2時間後に突然上腹部に帯状の疼痛が出現した. その後両下肢のしびれを自覚し次第に両下肢筋力低下を呈するようになり数時間後には両下肢弛緩性麻痺となった. 翌日には腹部の疼痛は消失したが, 両下肢弛緩性麻痺は持続しTh8レベル以下の解離性知覚障害, 直腸障害, 腱反射消失を認めた.突然の発症, 対麻痺, 解離性知覚障害から脊髄障害が疑われ, MRIでTh8-Th12レベルにT1強調画像 (T1) でiso intensity, T2強調画像 (T2) でhigh intensityの病変を認め脊髄梗塞と診断した. アルガトロバン, グリセリンの投与を開始し, 高気圧酸素療法を行った. 発症後7日よりリハビリを開始したが症状の回復には乏しく, わずかに足尖を伸展できるようになったのみで固定した. 脊髄梗塞は臨床上まれな疾患であるが, 近年MRIの普及によりその画像所見・経時変化などの報告が散見されるようになってきた. しかし, 透析患者における脊髄梗塞の合併の報告は未だ少ない. 今回われわれは, 典型的な発症様式およびMRIの経時的変化を示した脊髄梗塞の1例を経験したので報告する.

Background: Renal osteodystrophy is one of the major complications in patients with chronic renal failure. Large C-PTH fragments are secreted from the parathyroid glands and exert antagonistic actions against PTH-(1–84). The PTH-(1–84)/large C-PTH fragments ratio reflects both biosynthesis and processing of PTH; however the alteration of the ratio under vitamin D therapy has not been investigated. Methods: Seventeen hemodialysis patients with intact PTH levels of >300 pg/ml were enrolled. Calcitriol or maxacalcitol were administered intravenously for 78 weeks. Intact PTH, PTH-(1–84), and the PTH-(1–84)/large C-PTH fragments ratio were measured at 0, 13, 26, 52 and 78 weeks. Results: Intact PTH and PTH-(1–84) levels, which were 492.0 ± 115.7 and 303.4 ± 105.4 pg/ml, respectively, at baseline, significantly decreased at the end of the study to 268.9 ± 121.9 (p < 0.0001) and 190.7 ± 106.9 pg/ml (p = 0.0008), respectively. In contrast, large C-PTH fragments, which were 152.7 ± 53.5 pg/ml at baseline, did not significantly change at 78 weeks (144.5 ± 72.2 pg/ml, p = 0.7612). Consequently, the PTH-(1–84)/large C-PTH fragments ratio was significantly reduced from 2.25 ± 1.31 to 1.47 ± 0.89 (p = 0.0004). Conclusion: The PTH-(1–84)/large C-PTH fragments ratio reflects the change of PTH biosynthesis, processing and secretion from the parathyroid glands, and it may be a beneficial marker to evaluate the overall biological PTH action and predict bone turnover status in hemodialysis patients under intravenous vitamin D therapy.

Glomerular hyperfiltration plays a pathogenic role in the early stages of diabetic nephropathy. Experimental studies in laboratory animals suggest that nitric oxide (NO) might be involved in the pathogenesis of glomerular hyperfiltration. We performed a cross-sectional study to determine the relationship between diabetic glomerular hyperfiltration and the NO system. Normoalbuminuric (n=41), microalbuminuric (n=25), and macroalbuminuric (n=16) patients with type 2 diabetes were recruited in this study and compared with age-matched 84 non-diabetic control subjects. Creatinine clearance and urinary NO(2)(-)/NO(3)(-) excretion (urinary NOx) were measured, and the expression of endothelial cell nitric oxide synthase (ecNOS) was evaluated in human renal tissues. Glomerular hyperfiltration was present in 19 (37.5%) and nine (36.6%) of normoalbuminuric and microalbuminuric type 2 diabetic patients, respectively. The urinary NOx was significantly higher in normoalbuminuric patients compared with normal subjects. Creatinine clearance correlated significantly with urinary NOx in normoalbuminuric and microalbuminuric patients. Immunohistochemical staining intensities for ecNOS were significantly increased in glomerular endothelial cells of microalbuminuric type 2 diabetic patients as compared with the control subjects. These results suggest that NO may contribute to the pathogenesis of glomerular hyperfiltration in Japanese type 2 diabetic patients.

The necklace vortex excitation, one of the longitudinal vortex excitations, appeared on the upstream cylinder in a crisscross circular cylinder system in uniform flow. The influence of the diameter ratio, gap-to-diameter ratio s/d and the logarithmic damping factor on the oscillation behavior caused by the necklace vortex excitation was investigated using a wind tunnel. The amplitude of the oscillation increases with increasing diameter ratio. The substantial fluctuating lift coefficient of the necklace vortex was introduced based on the spanwise dimension of the vortex, (CLR)'rms, and it was evaluated using the measurement of the oscillation amplitude. In the necklace vortex excitation region, the relationship between (CLR)'rms and the gap-to-diameter ratio collapses on a single curve irrespective of the diameter ratio of the two cylinders, and (CLR)'rms decreases with increasing gap-to-diameter ratio.

Background. The parameters of the urea kinetic model (UKM) [product of dialyzer urea clearance and treatment time divided by body urea volume (Kt/V), protein catabolic rate (PCR), percent creatinine generation rate (%CGR)] are predictors of prognosis in patients on hemodialysis. In addition, adequate nutritional status has been recently recognized to be important for patient survival. We examined the relationship between serum amino acid levels and the parameters of the UKM, and investigated whether they could be predictors of patients' prognosis.

The present report describes a case of primary aorto-enteric fistula (PAEF) in an 81-year-old man with no previous abdominal surgery. The patient was admitted to Teraoka Memorial Hospital in shock with repeated episodes of melena and hematemesis. We performed emergency endoscopy to establish a diagnosis and identified a ruptured aortic aneurysm visualized through a fistula in the second portion of the duodenum. As most PAEF cause massive gastrointestinal hemorrhage, prompt diagnosis is critical to ensure a successful outcome. Although the patient and his family refused surgery and the patient died, we were able to make the diagnosis at an early stage by endoscopy. While PAEF is usually very difficult to diagnose by a single modality, endoscopy can be one of the modalities to identify the source of gastrointestinal hemorrhages, even in cases of PAEF.

Modules are an important part of the CPV system. By pursing, in our objective of a 35% efficiency module, we need to look forward a significant improvement in the state of the art of CPV modules since no commercial module is capable of achieving that efficiency. Achieving this efficiency will require high efficiency cells, progress in the optics lenses that are implemented in these modules, and also integration into module. Basic design of 35 % CPV module is presented considering for practical and rapid industry application. The output is 385 W while its weight is only 18 kg. In spite of its high concentration ratio reaching 1,000 X, it acceptance angle is as high as 1.1 degree.

The mesangium is centrally located in the glomerulus and plays an important role in the microcirculation within the glomerulus. In order to reveal the role of the mesangial matrix in the microcirculat

維持透析導入半年後に胸腺癌を発症した非常に稀な1例を経験した. 患者は80歳男性で, 78歳時に胃癌の摘出術を施行された. 糖尿病の治療を17年間続けていたが, 腎機能が悪化したため1992年7月に血液透析へ導入した. 同年10月から前縦隔の腫瘤を認め悪性腫瘍を強く疑ったが, 患者と家族の希望により経過を観察していた. 食欲低下や咳嗽, 胸水の貯留などが出現したため, 1993年4月に当科へ入院したが入院第22日目に死亡した. Necropsyを施行したところ病理組織検査で胸腺癌と診断した. 我々が検索した限りでは, 透析導入後に胸腺癌が発生した報告はなく, わずかに胸腺癌の摘出後7か月目に悪性高血圧のため急激に腎機能が悪化し, 最終的に維持血液透析を施行された全身性進行性硬化症の1例が報告されているだけである. しかも, 本症例では透析導入2年前に胃癌の摘出術を受けており, 透析患者の悪性腫瘍の発生要因や発生時期を考えるうえで興味深い症例と思われたため報告した.

Hemoglobin (Hb) Hiroshima is an Hb variant that travels rapidly on electrophoresis and shows a fourfold increase in oxygen affinity and a decreased Bohr effect. We encountered a 40-year-old male patient with erythremia and an undetectable HbA(1c) level. The presence of an abnormal hemoglobin molecule was suggested by the results of high-performance liquid chromatography analysis. Subsequent gene analysis by direct sequencing confirmed Hb Hiroshima (β146 histidine → aspartic acid). Caution should be exercised when diagnosing erythremia.

This paper describes the results of the lightning test for CPV system. The CPV system is provided with a tracking device. For 14kW system, the entire aperture area is 75 m2 and its height is approximately 10 m. This is relatively tall structure and subject to receive lightning damage. The IEC62305 standard describes the durability of CPV modules against lightning strike effect. Our test revealed that lightning current passed through the module's aluminum chassis and flowed directly into the ground. Module IV measurement was performed, and no degradation or change was observer before and after the lightning test.

The output characteristics of tracking type concentrator photovoltaic (CPV), tracking type silicon solar cell, and fixed silicon solar cell were compared in Japanese meteorological condition. At first, the module characteristics were evaluated. In the noon, output power of the CPV module was twice the crystalline silicon modules. In the morning and evening, tracked modules generated higher power due to the tracking. Next, the characteristics of 14 kW CPV system and 50 kW multi‐crystalline silicon PV system were evaluated and compared. The output of CPV system was high but unstable because the CPV system was susceptible to meteorological conditions. The CPV system runs ahead of the crystalline silicon PV system under the conditions that the global irradiance per a day is more than 5 kWh/m2 and the direct normal irradiance per a day is more than 4 kWh/m2.

慢性透析患者の合併症の一つである皮膚掻痒症は, いまだに原因は十分に解明されておらず, そのため治療法も確立していない.そこで, 今回我々は, 脂肪乳剤の投与条件を設定し, その条件を満たす難治性の皮膚掻痒症を有する慢性血液透析患者7名に対し, 脂肪乳剤の投与を行った. その結果, 皮膚乾燥に対しても, 掻痒感に対しても, 同じ5名 (71.4%) の有効性を認めた. また脂肪乳剤投与前後における検査値で有意差を認めた検査項目はなく, 副作用は認めなかった. しかし投与終了4週後には, 脂肪乳剤の有効性を認めた5名のうち4名が増悪し, 再投与により, 再び改善を認めた.このように, 適応を十分に考慮すれば, 脂肪乳剤が慢性透析患者の難治性皮膚掻痒症に対して有効かつ安全な薬剤であることが確認された. 今後, この脂肪乳剤の皮膚掻痒に対する有効性の機序が明らかにされれば, より有効で安全な薬剤の開発や, あるいは新たな透析方法の開発が期待できるものと考えられる.

血漿vetronectin (VN) 値は, 血液透析患者では低値を示すが, 透析歴が長くなるほど, より低値を示すことが知られている. そこで, 今回我々は, 同一患者に対し, regenerated cellulose (RC膜), cellulose triacetate膜 (CTA膜), polysulfone膜 (PS膜) の3種類の透析膜を順次変えて血液透析を施行し, その際の血漿VN値の変動を測定することにより, これらの透析膜で血漿VN値の変動に有意な変化があるか否かを検討した. また, 抗凝固剤としてのheparinの影響の有無を検討するため, 抗凝固剤として, heparinを使用した時とnafamostat mesilate (NM) を使用した時の, 血漿VN値の変動を比較検討した.その結果, すべての膜において, 透析開始前の血漿VN値は, 正常値より低値を示した. 血漿VN値の変動では, RC膜のみ有意な変化を認め, 透析開始後15分の血漿VN値が, 開始前に比べ有意に低値を示したが, CTA膜, PS膜には, 有意な変動を認めなかった. 従って, 使用している透析膜の種類により補体活性化の程度が異なり, VNの消費の程度が異なってくることが示唆された. また, 抗凝固剤による検討では, すべての膜において, heparin使用時とNM使用時とでは, 血漿VN値の変動に関し有意差を認めなかったため, VNがheparinと結合することによりVNが消費されるという説を支持する結果は得られなかった.

This paper discusses optical impact to the cultivation area with comparison of flat-plate PV and tracking PV - typically HCPV. Sometimes the PV area is covered by concrete, asphalt or graves for suppression of weeds. In this case, the atmosphere may be better but the PV owner will have to pay additional land cost preparation. Another aspect is the land utilization. This complies that massive unused land space is required. In this situation, it is reasonable to think of utilizing PV-uncovered area for agriculture. This paper discusses the space factor of the PV field by comparison of measured and calculated results as well as possibility of utilizing the land underneath PV array by agriculture. The farmland equipped with high-pole CPV has about 2 times more cultivated land, and the minimum illumination level of the cultivated land is around 2 times, the total sunlight energy to the farming land is almost 3 times. The PV output per lost cultivated land is about 2 times.

重篤な心不全のため血液透析 (HD) の施行は困難と判断しCAPDを施行したところ, 良好に尿毒症をコントロールし得た慢性関節リウマチ (RA) に続発したアミロイドーシスの腎不全患者を2例経験したので報告する.症例1は75歳, 女性. 昭和56年にRAと診断され, 昭和58年に蛋白尿が出現した. 昭和62年より腎機能が低下し, 平成元年7月より腎機能が増悪した. 心不全が高度なためHDの施行は困難と判断し, 8月にCAPDへ導入した. 以後, 良好に尿毒症や浮腫, 心不全症状はコントロールし得た. 平成2年3月に胃生検でアミロイドの沈着を認めたが, その頃より心不全が再び増悪し血圧が低下した. 5月1日には徐脈傾向となり7日に死亡した. 剖検の結果, AA型のアミロイドが心臓, 腎臓, 甲状腺, 膵臓, 消化管, 全身の中小動脈に高度に認められた.症例2は72歳, 女性. 昭和57年にRAと診断され, 昭和63年に蛋白尿, 腎機能低下を認めた. 平成元年9月に小唾液腺生検と甲状腺生検でAA型のアミロイドの沈着を認め, 続発性アミロイドーシスと診断した. DMSO (dimethylsulfoxide) の投与によりやや改善傾向を認めたが, 本人が服用を拒否した平成2年2月末より急激に腎機能が悪化した. 重篤な心不全を伴ったため, HDの施行は困難と判断し3月にCAPDへ導入したところ尿毒症や心不全は良好にコントロールし得た. しかし7月より再び心不全が悪化し, 8月より血圧の低下を認め, 9月12日に死亡した.2例共に重篤な心不全が存在したが, CAPDにより良好に尿毒症をコントロールし得た. しかし心不全の悪化のため, 導入後それぞれ8か月と6か月で死亡した. その心不全の主因として心アミロイドーシスの悪化が考えられた. CAPDへ導入した後も, 心アミロイドーシスの進展を予防するための治療を継続して行う必要があると考えられた.

Hematuria in patients with glomerulonephritis seems to result from the passage of red blood cells through anatomical gaps in the glomerular basement membrane. However, such morphological evidence has rarely been demonstrated. A patient with mixed connective tissue disease associated with membranous glomerulonephritis is described in whom the renal biopsy specimen showed an escape of red blood cells through a gap in the basement membrane. These findings support the morphological basis of hematuria in glomerulonephritis.

A 29-year-old diabetic woman who developed severe anaemia, nephrotic syndrome, and hypertension before the 28th week of gestation, had residual evidence of toxaemia and renal dysfunction more than 1 month following delivery. The histopathological findings of renal biopsy specimens were considered most consistent with toxaemia of pregnancy complicated by diabetic glomerulosclerosis. We consider that rapid acceleration of renal dysfunction may have been induced by: (1) poor control of diabetes before pregnancy; (2) glomerular hyperfiltration of the remnant nephrons throughout pregnancy; (3) hypercoagulopathy associated with pregnancy; (4) appearance of hypertension following these three conditions.

The effect of serine protease inhibitor Camostat Mesilate on nephrotic syndrome with diabetic nephropathy was evaluated. Eight patients with nephrotic syndrome associated with diabetic nephropathy were orally administered 600 mg of Camostat Mesilate per day. Three patients showed a reduction of urinary protein excretion promptly at 4 weeks. Serum protein and degree of edema improved significantly at 4 weeks. Camostat Mesilate had no effect on renal function assessed by creatinine clearance. During the observation period there were no significant changes in blood pressure, level of blood sugar, or HbA1c. Camostat Mesilate would be beneficial for the treatment of diabetic nephropathy.

We measured serum and urinary concentrations of type IV collagen by radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) in diabetics. Serum and urinary concentrations of type IV collagen measured by RIA and ELISA were increased compared to those of control subjects. In diabetics with macroproteinuria or with renal insufficiency, serum and urinary concentrations of type IV collagen were higher than in diabetics without nephropathy or with early renal damage as determined by the presence of microproteinuria. These results suggest that serum and urinary concentrations of type IV collagen are increased in patients with advanced diabetic nephropathy. These increases may indicate that alteration of basement membrane metabolism has occurred in diabetics.

The changes in glomerular extracellular matrices components in diabetic nephropathy were investigated. Indirect immunofluorescence staining, using polyclonal antibodies to heparan sulfate proteoglycan (HS-PG), laminin, type IV collagen, and fibronectin was carried out on renal specimens obtained by needle biopsy. Immunofluorescence intensity and distribution were observed. HS-PG and laminin decreased in the capillary walls; on the other hand, type IV collagen and fibronectin tended to increase in the mesangial area. HS-PG and laminin decreased in inverse proportion to sclerosis grades and proteinuria. These changes seemed to play an important role in progression of diabetic glomerulosclerosis.

We retrospectively assessd the response to methylprednisolone pulse therapy in 120 biopsy proven lupus nephritis patients according to WHO morphologic classification. With regard to faster improvement of serological activities and the decrease in urinary protein, the patients with class III and IV-b lupus nephritis are good indications for pulse therapy.

Serine protease inhibitor camostat mesilate was administered for 8 weeks to 19 patients with nephrotic syndrome due to primary glomerulonephritis and diabetic nephropathy. There was a significant decrease in urinary protein and increase in serum total protein without change in renal function. Proteinase inhibitors might be beneficial in treating patients with nephrotic syndrome.

The ion exchange membrane (IEM) process is now accepted as superior to both mercury and diaphragm processes in energy efficiency as well as environmental impact. The number of membrane cell plants has been steadily increasing in recent years.