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Natriuretic peptides are associated with malnutrition and volume overload. Over-hydration cannot simply be explained by excess extracellular water in patients undergoing hemodialysis. We assessed the relationship between the extracellular and intracellular water (ECW/ICW) ratio, N-terminal pro-B-type natriuretic peptide (NT-proBNP), human atrial natriuretic peptide (hANP), and echocardiographic findings. Body composition was examined by segmental multi-frequency bioelectrical impedance analysis in 368 patients undergoing maintenance dialysis (261 men and 107 women; mean age, 65 ± 12 years). Patients with higher ECW/ICW ratio quartiles tended to be older, were on dialysis longer, and had higher post-dialysis blood pressure and lower body mass index, ultrafiltration volume, serum albumin, blood urea nitrogen, and creatinine levels (p < 0.05). The ECW/ICW ratio significantly increased with decreasing ICW, but not with ECW. Patients with a higher ECW/ICW ratio and lower percent fat had significantly higher natriuretic peptide levels. After adjusting for covariates, the ECW/ICW ratio remained an independent associated factor for natriuretic peptides (β = 0.34, p < 0.001 for NT-proBNP and β = 0.40, p < 0.001 for hANP) and the left ventricular mass index (β = 0.20, p = 0.002). The ICW-ECW volume imbalance regulated by decreased cell mass may explain the reserve capacity for fluid accumulation in patients undergoing hemodialysis.

BACKGROUND AND AIMS To control mineral and bone disorders in haemodialysis (HD) patients, doses of vitamin D analogues and calcimimetics are adjusted based on serum parathyroid hormone (PTH) levels. Accordingly, method-related differences in PTH results may influence the prescribed dose of those drugs and PTH-lowering treatment costs. The aim of this study was to clarify the influence of inter-method variability in PTH measurement on PTH-lowering treatment costs. METHOD We used data from 30 maintenance HD patients in our facility. The Intact-PTH measuring assay was changed from the Elecsys PTH to the Alinity Intact PTH Reagent Kit (Alinity PTH) in March 2021, following a 2-month transitional period when PTH levels were measured using both assays. We examined method-related differences in PTH levels, using the results obtained in the transitional period. Using prescription records from October to December 2020, when the Elecsys PTH assay was used, and those from March to May 2021, when assay system was fully changed to the Alinity PTH, we examined the influence of the PTH measuring method on medication cost by evaluating the monthly cost of vitamin D analogues and calcimimetics in our facility. We evaluated the mean levels of serum calcium, phosphorus and PTH in 30 patients in the corresponding period. RESULTS Inter-method variability in PTH results was evaluated using 60 specimens from 30 patients. PTH results of 60 specimens ranged from 11 to 802 pg/mL and 8.8 to 1198 pg/mL in the Elecsys PTH and in the Alinity PTH, respectively. Compared with PTH levels obtained with the Elecsys PTH, those measured with the Alinity PTH were significantly higher (P < .001). On average, results obtained with the Alinity PTH were 1.58-fold higher than those provided by the Elecsys PTH. When the Elecsys PTH assay was used, the average monthly cost of vitamin D analogues and calcimimetics was €44 and €1668, respectively. After the assay was changed to the Alinity PTH, the average monthly costs were €40 for vitamin D analogues and €2471 for calcimimetics (€1 = ¥130). There were no notable changes in the mean serum levels of calcium, phosphorus and PTH throughout the study period. CONCLUSION Inter-method variability in PTH results would have an influence on the cost-effective assessment of PTH lowering therapy. Standardization of PTH measurement is required.

Background Major symptoms of progressive chronic kidney disease (CKD) are similar to those of hypothyroidism. Hidden symptoms of hypothyroidism underlying CKD are often observed in clinical practice. This study aimed to ascertain the frequency of hypothyroidism complicated by CKD, and to analyze factors impacting thyroid function. Methods During the period from April 2012 through October 2016, 510 CKD patients at our outpatient clinic were measured thyroid and kidney function for diagnosing hypothyroidism (overt hypothyroidism, OH; subclinical hypothyroidism, SH; non-thyroidal illness, NTI) and evaluating the stage of CKD. All patients were over 15 years of age. Results There were significant differences in age, estimated glomerular filtration rate (eGFR), urinary protein (UP), and serum albumin (Alb) among patients with OH, SH, and NTI compared to the normal group in univariate and multivariate analyses. UP showed the highest odds ratio of OH, SH, and NTI but no differences were recognized in gender in each group. Frequency distribution showed that the prevalence of thyroid dysfunction was greater among more severe stage of CKD with higher amount of UP. OH and SH did not show high positive ratio of anti-thyroglobulin antibody (TgAb) and anti-thyroid peroxidase antibody (TPOAb). NTI and normal subjects showed higher positive ratio as 50.0% and 42.9% of TgAb and TPOAb than OH and SH. Conclusions Hypothyroidism complicated by CKD exhibited a high prevalence. Age, eGFR, UP, and serum Alb were related to the prevalence of hypothyroidism, whereas gender was not and this was contradicted to the prevalence of hypothyroidism in general population. The prevalence of OH and SH was higher among patients with higher stage of CKD with increased UP. Hypothyroidism complicated by CKD may involve different onset mechanisms unrelated to antithyroid antibodies (ATAb). In CKD patients, assessments of OH and SH, as well as NTI, are needed for proper diagnosis.

Because of the severe shortage of suitable deceased donors, ABO-incompatible living donor kidney transplantation (ABOi LDKT) is performed even in pediatric recipients in Japan. We performed pediatric ABOi LDKT using rituximab without anti-A/B antibody removal. Thirteen pediatric recipients (mean age 7.4, range 3.4–15.7, four females) whose baseline anti-A/B IgG titers were ≤ × 64 underwent ABOi LDKT without antibody removal and splenectomy between July 2013 and April 2017 at Toho University. Mycophenolate mofetil (MMF) was initiated on day − 10. Rituximab (100 mg) was administered twice. Basiliximab and triple maintenance immunosuppression (calcineurin inhibitor, MMF, and steroids) were administered. Protocol biopsy was performed at 3 months and 1 year after transplantation. We retrospectively compared the clinical outcomes between these recipients and 37 children (mean age 9.0, range 2.6–18.9, 15 female) who underwent ABO-compatible (ABOc) LDKT during the same period. The mean follow-up periods of ABOi and ABOc groups were 31.9 ± 13.5 and 28.8 ± 14.4 months, respectively. In the ABOi group, no clinical acute rejection (AR) was noted and subclinical AR was observed in four patients without evidence of acute antibody-mediated rejection. In the ABOc group, clinical and subclinical AR developed in 3 and 10 patients, respectively. No significant difference was identified for the mean eGFR between the ABOi and ABOc groups (98.3 ± 48.8 vs. 86.9 ± 39.4, P = 0.452 at 3 months; 78.2 ± 21.2 vs. 79.7 ± 21.3, at 1 year, P = 0.830). Death-censored graft survival at follow-up was 100% in the ABOi group and 94.6% in the ABOc group. Patient survival during the follow-up period in both the groups was 100%. Late-onset neutropenia (LON) requiring granulocyte colony-stimulating factor occurred more frequently in the ABOi group than in the ABOc group (4 vs. 0 patients) (P

本研究では，大学生・大学院生の心理学教育に対するニーズを明らかにするため2つの調査を実施した。研究1では，学部学生を対象に進学動機や心理学教育に対する認識，ニーズ等に関する質問紙調査を実施した。研究2では，大学院生を対象に学部教育と大学院教育の連携に関するインタビュー調査を実施した。分析の結果，興味関心がある授業と就職のための授業を区別する対処を学生が行なっていること，早い段階で将来の見通しを学生が持てるような対応をしていくことが必要なこと（研究1），および学部学生と大学院生とでは求める学びに違いがあること，大学院では学びの捉え直しが生じること，資格取得のための受身的動機が強いこと（研究2）が明らかとなった。以上のことから，インターンシップやボランティア体験を通じ，授業で学んだ心理学を積極的に活用する機会を学びの中に設けることによる，心理学の有用性に関する理解の前倒しが心理学教育には有効であると考えられる。, In this study, two surveys were conducted to clarify the needs of undergraduate and graduate students for psychology education. In Study1, a questionnaire survey was conducted on undergraduate students’ motivations, awareness of psychology education, needs, etc. In Study2, an interview survey on collaboration between undergraduate and postgraduate education was conducted for graduate students. It was found the students took action to distinguish between classes of interest and classes for employment, and it is useful to cope with the prospects of the future at an early stage （Study1）, and that there was discrepancy between learning sought by undergraduate students and that by graduate students, they rethink learning in graduate schools, and that there is strong passive motivations for acquiring qualifications （Study2）. Therefore, it is considered effective for psychology education to accelerate understanding by providing opportunities to actively use psychology learned in class through internships and volunteer experiences.

Background Lipofuscin is an indicator of aging. We examined the clinicopathologic significance of lipofuscin deposition in the renal tubules of renal allografts. Method We analyzed allograft biopsy specimens from living kidney transplantations from January to December 2015. For controls, we analyzed native kidney biopsy specimens obtained from January 2015 to December 2016. We identified granules with a yellow-to-tan shade in renal tubules as lipofuscin. Results The donor age at transplantation was significantly older in lipofuscin deposition biopsy specimens than in those without, whereas the time after transplantation age was not different between the 2 groups with renal allografts. In native kidney biopsies, age at biopsy was significantly older in lipofuscin deposition biopsy specimens than in those without. We compared “massive lipofuscin deposition,” defined as lipofuscin deposition on both sides of 3 or more renal tubules, and donor-age matched control allograft biopsies without lipofuscin deposition. Comparing these 2 groups, recipient age at transplantation was significantly older in the massive lipofuscin deposition group. Conclusion Lipofuscin deposition on tubular epithelium is not a surrogate marker of aging of kidneys allografts, although lipofuscin deposition was significantly greater in older tissues from native kidneys. The older age of recipients may be associated with massive lipofuscin deposition in renal allografts.

BACKGROUND AND OBJECTIVES: Precise BP measurement to exclude hypertension is critical in evaluating potential living kidney donors. Ambulatory BP monitoring is considered the gold standard method for diagnosing hypertension, but it is cumbersome to perform. We sought to determine whether lower BP cutoffs using office and automated BP would reduce the rate of missed hypertension in potential living donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We measured BP in 578 prospective donors using three modalities: (1) single office BP, (2) office automated BP (average of five consecutive automated readings separated by 1 minute), and (3) ambulatory BP. Daytime ambulatory BP was considered the gold standard for diagnosing hypertension. We assessed both the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology/American Heart Association (ACC/AHA) definitions of hypertension in the cohort. Empirical thresholds of office BP and automated BP for the detection of ambulatory BP–diagnosed hypertension were derived using Youden index, which maximizes the sum of sensitivity and specificity and gives equal weight to false positive and false negative values. RESULTS: Hypertension was diagnosed in 90 (16%) prospective donors by JNC-7 criteria and 198 (34%) prospective donors by ACC/AHA criteria. Masked hypertension was found in 3% of the total cohort by JNC-7 using the combination of office or automated BP, and it was seen in 24% by ACC/AHA guidelines. Using Youden index, cutoffs were derived for both office and automated BP using JNC-7 (

Introduction: Accidental fall risk is high in patients undergoing maintenance hemodialysis. Falls are associated with fatal injury, comorbidities, and mortality. Risk assessment should be conducted as a primary intervention to prevent falls. This study investigated whether quadriceps muscle thickness measured using ultrasonography can prospectively predict fall injury among dialysis patients.Methods: Using an observational cohort study design, 180 ambulatory hemodialysis patients during the period 2015–2016 were recruited in the four dialysis clinics. The sum of the maximum quadriceps muscle thickness on both sides and the average of the maximum thigh circumference and handgrip strength after hemodialysis were calculated. Patients were stratified according to tertiles of quadriceps muscle thickness. Fall injury was surveyed according to the patient’s self-report for the one-year period.Results: Among the 180 hemodialysis patients, 42 (23.3%) had fall injury during the 12-month follow-up period. When the quadriceps muscle thickness levels were stratified into sex-specific tertile, patients in the lowest tertile (men P < 0.001). Conversely, no significant differences were found in the thigh circumference and handgrip strength between women with fall injury and those women without fall injury.Conclusions: Quadriceps muscle thickness using ultrasonography can be measured easily at the bedside and is a precise predictor of fall injury in patients undergoing maintenance hemodialysis.

Background Accidental fall risk is high in patients undergoing maintenance hemodialysis. Falls are associated with fatal injury, comorbidities, and mortality. Risk assessment should be a primary component of fall prevention. This study investigated whether quadriceps muscle thickness measured using ultrasonography can predict fall injury among dialysis patients. Methods Using an observational cohort study design, 180 ambulatory hemodialysis patients were recruited from 2015 to 2016 from four dialysis clinics. The sum of the maximum quadriceps muscle thickness on both sides and the average of the maximum thigh circumference and handgrip strength after hemodialysis were calculated. Patients were stratified according to tertiles of quadriceps muscle thickness. Fall injury was surveyed according to the patient’s self-report during the one-year period. Results Among the 180 hemodialysis patients, 44 (24.4%) had fall injuries during the 12-month follow-up period. When the quadriceps muscle thickness levels were stratified into sex-specific tertiles, patients in the lowest tertile were more likely to have a higher incidence of fall injury than those in the higher two tertiles (0.52 vs. 0.19 and 0.17 fall injuries/person-year). After adjusting for covariates, lower quadriceps muscle thickness was found to be an independent predictor of fall injury (hazard ratio [95% confidence interval], 2.33 [1.22–4.52], P Conclusions Quadriceps muscle thickness can be measured easily at the bedside using ultrasonography and is a precise predictor of fall injury in patients undergoing maintenance hemodialysis.

Despite the advances in management, acute decompensated heart failure (ADHF) continues to be associated with poor clinical outcomes. Renal dysfunction, especially acute kidney injury (AKI), is one of the strongest predictors of adverse outcomes in ADHF. The association between the heart and the kidney in patients with ADHF is complex, and a complete understanding of this bidirectional interaction has not been elucidated. There are two big issues in this field. First is that many different definitions for renal dysfunction have been used conventionally. This would create different interpretations of renal failure in ADHF. Another problem is that the timing of WRF/AKI onset during hospitalization varies. To reconsider the future direction of AKI, this review focused on the current perspectives on AKI in ADHF patients.

Background We investigated whether serum uric acid (SUA) levels before kidney transplantation predict new-onset diabetes after kidney transplantation (NODAT) and compared SUA levels with known risk factors for NODAT by prospective cohort study. Methods A total of 151 adult kidney recipients without diabetes (84 men, 67 women) who underwent living-donor kidney transplantation between 2001 and 2011 were followed in this study. The Cox proportional hazards model was used to analyse the risk of NODAT. Results During the follow-up period (median 3.3 years, range 0–10 years), 32 (21.2%) adult kidney recipients without diabetes developed NODAT, and an incidence rate was 5.6 per 100 person-years and a 10-year cumulative incidence of 26.9%. When subjects were stratified by SUA levels into tertiles, the patients in the highest tertile (> 8.6 mg/dl for men, > 7.7 mg/dl for women) had a significantly higher risk of NODAT than the patients in the lower 2 tertiles (log-rank test, P = 0.03). In the univariate analysis, increased level of SUA was associated with NODAT (hazard ratio 1.27 [95% CI 1.04–1.55], P = 0.01). In the multivariate analysis, increased level of SUA was significantly associated with NODAT after correction by any factors, e.g. (age, sex, family history of diabetes, BMI, HbA1c, serum creatinine, tacrolimus, HCV) factors directly affecting the SUA value (1.26 [1.02–1.56], P = 0.03), risk factors for T2DM onset (1.34 [1.10–1.64], P = 0.03), and factors previously reported risk factors for NODAT (1.36 [1.11–1.66], P = 0.003). Conclusion SUA independently predicts NODAT in living-donor kidney transplantation patients.

AIM The present study was performed to examine the clinicopathological significance of hyaline deposits in the smooth muscle of the interlobular artery (interlobular hyaline arteriopathy [IHA]) in renal allografts. METHODS Tissue specimens that included the interlobular artery from biopsies performed from January 2012 to December 2015, as well as specimens from biopsies performed ≥1 year after living kidney transplantation were analyzed. Biopsies of recipients with new-onset diabetes mellitus after transplantation were excluded, as well as those of recipients who had undergone transplantation because of diabetic nephropathy. Arteriolopathy was evaluated using the aah score determined by the Banff 2007 classification. RESULTS In total, 51 specimens with IHA lesions were identified among 381 biopsies obtained from 243 recipients performed ≥1 year after kidney transplantation. Among these 51 biopsies, 18 specimens had a score of aah3, 29 had a score of aah2, and four had a score of aah1. The incidence of IHA lesions was 3.6% at ≥1 to

Fluid volume overload is common and is associated with adverse outcomes in hemodialysis patients. Practicing physicians individually manage fluid volume balance in their dialysis patients according to blood pressure, interdialytic weight gain, cardiac function, nutritional status, and other comorbidities. However, accurate assessment of fluid volume status remains a concern. Indicators of dry weight target have been explored further with newer concepts and technologies. In general, total body water comprises approximately 50%-60% of adult body weight (range, 45%-75%), and water comprises 73.3% of lean body mass. The standard hydration status between intracellular water and extracellular water is maintained at a ratio of 62:38 in healthy adults, which, however, is influenced universally by body cell volume driven by age and muscle mass. Fluid volume imbalance in dialysis patients also is characterized primarily by decreased body cell mass associated with aging and muscle attenuation, as well as excess extracellular water content associated with sodium retention, which may be associated with the reserve capacity for volume overload. Indeed, dialysis patients with a leaner body mass have a higher prevalence of hypertension, poorer hypertension control, and greater left ventricular hypertrophy. Understanding of these body composition changes by aging and sarcopenia can aid clinical decision making in the dry weight assessments in dialysis patients. Advising patients with consistently high interdialytic weight gain to practice salt restriction and providing appropriate nutritional support for malnourished patients with downward trajectory in their dry weight would be of great help to achieve optimal fluid volume status.

The fluid volume balance between intracellular water (ICW) and extracellular water (ECW) gradually changes with age and various medical conditions. Comprehension of these physiological changes would aid in clinical decision-making related to body fluid assessments. A total of 1,992 individuals (753 men and 1,239 women) aged ≥15 yr included in this study had their body composition measurements performed at training gyms in 2014. We developed a regression formula to assess the association of age with the ratio of ECW to ICW in these subjects. The mean ages of male and female subjects were 51.2 ± 15.2 and 57.4 ± 15.2 yr, and their mean body mass indexes were 23.4 ± 3.3 and 21.1 ± 2.8 kg/m2, respectively. The total fluid volumes of male and female subjects were 39.6 ± 4.9 and 27.7 ± 3.0 liters, whereas the percent body fat mass per kilogram of body weight were 19 and 26%, respectively. The ECW-to-ICW ratio increased with age because of the steeper decrease in the ICW content than in the ECW content, especially after the age of 70 yr. The regression formulas used for calculating the age-adjusted ECW/ICW ratio were as follows: 0.5857 + 7.4334 × 10−6 × (age)2 in men and 0.6062 + 5.5775 × 10−6 × (age)2 in women. In conclusion, the fluid imbalance between ICW and ECW contents is driven by decreased cell volume associated with aging and muscle attenuation. Therefore, our proposed formula may serve as a useful assessment tool for the calculation of body fluid composition.

Despite restoration of fertility after kidney transplantation, the benefit is limited in female kidney recipients. Our objective is to determine the reasons for this discrepancy.We evaluated 315 women who underwent kidney transplantation from 1983 to 2015 (a median of age at transplantation [10th-90th percentile] of 32 years [7-55 years]); 230 recipients between the ages of 15 to 49 years old as of March 2016 were observed.We experienced 10 abortions and 21 live births from our 23 recipients and 2 abortions and 7 live births in 7 recipients from other transplant center. The live birth rate was 8.9 per 1000 female transplant recipients of childbearing age. Seven recipients received either treatments of artificial insemination or in vitro fertilization. Average age at pregnancy was 33.2 ± 3.2 years old, and the fertile period post-transplantation was longer in recipients with live births than those without live births (14.1 ± 7.1 vs 9.9 ± 7.3 years, P .05). In 42.9% of recipients with live birth, pregnancy-induced hypertension was observed in the last trimester. The gestational age and the average birth weight were 32.8 ± 5.0 months and 2184 ± 632 g, respectively. During follow-up of 14.5 years, there was one case of graft loss, which is a rate of 2.5 per 1000 female recipients.Although pregnancy complications are often observed in kidney recipients, graft survival is less influenced by pregnancy. Importantly, kidney disease at childbearing age disrupts pregnancy even after kidney transplantation.

Background Transplant recipients are supposedly in a more anemic, catabolic, and even inflammatory state at re-entering hemodialysis due to chronic rejection. The goal of this study was to clarify how transplant recipients can re-enter dialysis safely by focusing on control of anemia. Methods From 2012 to 2014, a total of 29 transplant recipients re-entered hemodialysis because of chronic rejection (ie, the chronic kidney disease with transplant [CKDT] group). At the same time, in 2014, a total of 30 patients with chronic kidney disease without transplantation entered dialysis as the control group (ie, the CKD group). CKDT recipients (mean ± standard deviation age, 41.9 ± 11.8 years; 18 male subjects, 10 female subjects; frequency of diabetes, 10%; duration of graft survival, 12.5 ± 4.3 years) were younger and fewer had diabetes compared with the CKD group (age, 53.2 ± 10.5 years; 21 male subjects, 9 female subjects; frequency of diabetes, 36%). Patient characteristics at entering dialysis in both groups were analyzed according to retrospective chart review. Results At entering dialysis, there were no significant differences between the CKD and CKDT groups in terms of the following: dose of darbepoetin; concentrations of hemoglobin, albumin, and C-reactive protein; cardiothoracic ratio; blood urea nitrogen and creatinine levels; estimated glomerular filtration rate; initial ultrafiltration; and duration of hospitalization for initiation of dialysis. The only difference between groups was mean weight at entry to dialysis (CKDT group, 58.5 ± 15.1 kg; CKD group, 67.1 ± 14.8 kg; P = .03). The darbepoetin dose per kilogram of weight did not differ between groups (CKDT, 2.28 ± 2.03 μg/kg; CKD, 2.12 ± 1.6 μg/kg; P = .95) in the final month before entry to dialysis. Conclusions Safe re-initiation of dialysis is important for recipient survival. Although anemia is supposedly higher in transplant recipients due to immunosuppression, this single-center analysis found no difference in anemia in CKD with or without transplantation, caused by good use of erythropoietin-stimulating agents in both groups.

We examined the clinicopathologic significance of hyalinosis in the vasa recta in the medulla of allograft kidney biopsies. We analyzed biopsy specimens from January 2010 to December 2015, obtained from both the cortex and medulla (including the vasa recta) ≥ 1 year after living-donor kidney transplantation. We excluded biopsy specimens from recipients who had undergone transplantation due to diabetic nephropathy or who had diabetes mellitus after transplantation. We evaluated hyaline arteriolopathy in the cortex using the aah score determined by the Banff 2007 classification. Among 381 biopsy specimens obtained from 248 transplant recipients ≥ 1 year after transplantation, 36 specimens obtained from 34 recipients showed vasa recta hyalinosis (VRH) in the medulla. Among these 36 specimens, 17 had a score of aah3, 16 had a score of aah2, and 3 had a score of aah1. The incidence of VRH was 1.9% at ≥ 1 to

The present study was performed to examine the clinicopathological significance of hyaline deposits in the smooth muscle of the interlobular artery (interlobular hyaline arteriopathy [IHA]) in renal allografts.Tissue specimens that included the interlobular artery from biopsies performed from January 2012 to December 2015, as well as specimens from biopsies performed ≥1 year after living kidney transplantation were analyzed. Biopsies of recipients with new-onset diabetes mellitus after transplantation were excluded, as well as those of recipients who had undergone transplantation because of diabetic nephropathy. Arteriolopathy was evaluated using the aah score determined by the Banff 2007 classification.In total, 51 specimens with IHA lesions were identified among 381 biopsies obtained from 243 recipients performed ≥1 year after kidney transplantation. Among these 51 biopsies, 18 specimens had a score of aah3, 29 had a score of aah2, and four had a score of aah1. The incidence of IHA lesions was 3.6% at ≥1 to4 years, 18.5% at ≥4 to8 years, and 54.1% at ≥8 years. Older kidney grafts exhibited more IHA lesions. Among the biopsy specimens obtained ≥8 years after transplantation, no significant differences in the recipient or donor age, duration after transplantation, or prevalence of hypertension were observed between the IHA and non-IHA groups. The aah scores were significantly higher in the IHA group ≥8 years after transplantation as determined by the mean score test (P0.01).IHA in renal allografts is associated with severe arteriolopathy.

This article examines communicative practices in Japanese and UK English accounts of extraordinary experiences. We compare the way in which specific narrative features are handled: description of the actual experience, and the completion of the narrative. We also examine some ways in which the accounts are rhetorically designed to address skeptical alternatives. The perspective is informed by an ethnomethodological focus on communicative competences in description. This comparison identifies differences between Japanese and UK English narratives. This focus on interactional features of the data is contrasted to macro cultural or psychological perspectives on the relationship between national culture and language.

Objective Body mass index (BMI) is commonly used for assessment of nutritional status. However, changes in BMI in chronic kidney disease (CKD) patients are affected not only by muscle and fat but also by fluid volume. The ratio of extracellular water (ECW BIA ) to total body water (TBW BIA ) in multifrequency bioelectrical impedance analysis is commonly used for assessing abnormal fluid status. This study reexamines ECW BIA /TBW BIA and evaluates the reliability of TBW BIA /TBW watson and dry mass index (DMI) in the assessment of fluid and nutritional status. Design, Setting, and Subjects TBW BIA , intracellular water (ICW BIA ), and ECW BIA were measured in 45 randomly selected CKD patients. Participants were surveyed for age, gender, BMI, blood pressure, serum albumin, estimated glomerular filtration rate, and proteinuria. DMI was calculated by the formula ([weight − TBW BIA ]/height 2 ) and TBW BIA /TBW watson using an anthropometric formula (Watson). Fluid and nutritional status were assessed using ECW BIA /TBW BIA , TBW BIA /TBW watson , and DMI. Results TBW BIA /TBW watson positively correlated with weight, BMI, and diastolic blood pressure and negatively correlated with age and serum albumin level. In contrast, ECW BIA /TBW BIA correlated with ICW deficit, aging, and body weight loss. On the basis of DMI and TBW BIA /TBW watson , participants were categorized as follows: 1 obese patient with hypovolemia and 2 with euvolemia; 17 overweight patients with hypovolemia (n = 6), euvolemia (n = 8), or hypervolemia (n = 3); 24 patients of optimal weight with hypovolemia (n = 10), euvolemia (n = 9), or hypervolemia (n = 5); and 1 underweight patient with euvolemia. Conclusions A combination of DMI, BMI, and TBW BIA /TBW watson makes it possible to include assessment of fluid volume to the physique index. In addition, ECW BIA /TBW BIA is not a reliable marker of edematous state in CKD patients.

Reduced dietary protein intake in malnourished patients with chronic kidney disease (CKD) may be associated with adverse clinical outcomes, which may mask any efficacy of a low-protein diet. The study included 126 patients with CKD who attended a dedicated dietary counseling clinic in 2005–2009 and were systematically followed until January 2015. Of these patients, 20 (15.9%) had moderate or severe nutrition-related risk of geriatric nutritional risk index (GNRI) < 92; these patients were more likely to be older, have a greater proteinuria, and have lower body mass index and serum albumin concentration. Dietary protein intake was significantly lower in older patients (r = −0.33, p < 0.001) and those with lower glomerular filtration rate (r = 0.47, p < 0.001). The non-protein to nitrogen calorie ratio was independently associated with GNRI. Reduced GNRI was significantly associated with mortality (hazard ratio (HR) = 4.94; 95% confidence interval (CI) = 1.61–15.42, p = 0.012) and cardiovascular events (HR = 9.37; 95% CI = 2.49–37.34, p = 0.006), but not with adverse renal outcomes. Restricting protein intake may be harmful to patients with any nutrition-related risk, suggesting that improvement of nutritional status should be a high priority.

Recently, measurement of surface temperature with thermocouples has become difficult because of the advanced downsizing of electronic components.

Background/Aim: Fluid volume overload occurs in chronic kidney disease (CKD), leading to the compensatory release of natriuretic peptides. However, the elevated cardiac peptides may also be associated with malnutrition as well as volume overload. Methods: Body fluid composition was measured in 147 patients with CKD between 2009 and 2015, and its relationship to brain natriuretic peptide (BNP) levels was examined. Body fluid composition was separated into three components: (a) a water-free mass consisting of muscle, fat, and minerals; (b) intracellular water (ICW) content, and (c) extracellular water (ECW) content. Excess fluid mass was calculated using Chamney's formula. Results: The measured BNP levels in the tertile groups were 10.9 ± 5.4, 36.3 ± 12.5, and 393 ± 542 pg/ml, respectively. Patients in a higher log-transformed BNP level tertile were more likely to be older, to have a higher frequency of cardiac comorbidities, pulse pressure, C-reactive protein levels, and proteinuria, and to have lower serum sodium, kidney function, and serum albumin (p < 0.05). In body fluid composition, decreased body mass was significantly associated with the ECW-to-ICW ratio in relation to the downward ICW slope (r = -0.235, p = 0.004) and was strongly correlated with excess fluid mass (r = -0.701, p < 0.001). The ECW-to-ICW ratio and excess fluid mass was independently associated with the BNP levels. Conclusion: Fluid volume imbalance between intra- and extracellular water regulated by decreased cell mass was independently associated with BNP levels, which may explain the reserve capacity for fluid accumulation in patients with CKD.

症例は34歳，男性．非IgAメサンギウム増殖性糸球体腎炎による末期腎不全のため，2006年3月（31歳）に当院で腹膜透析（PD）を導入した．既往歴として1990年（15歳）より貧血を指摘されていたが原因不明であった．透析導入後も高度の貧血が遷延し，頻回の赤血球輸血を必要としたため，精査目的で2006年8月に再入院した．骨髄所見に基づき骨髄異形成症候群（myelodysplastic syndrome：MDS）と診断，病型は不応性貧血（refractory anemia：RA），重症度分類は低リスク群であった．輸血，エポエチンβ 12,000IU/2週投与に加え，蛋白同化ステロイドの投与，さらに十分な透析量確保のためにPD/血液透析（HD）併用療法を開始したが，貧血の改善は得られなかった．しかし，赤血球造血刺激因子製剤（erythropoiesis stimulating agents：ESA）をダルべポエチン（darbepoetin alfa：DA）に変更し180μg/週まで増量したところ，貧血の改善と輸血量の軽減が得られ，生活の質（quality of life：QOL）は向上した．DAを用いた十分量のESA投与がRAに対して有効であることを示す症例と思われ，今後，MDSの治療においてESAが広く使用可能になることが期待される．

A girl and her mother were diagnosed as having membranoproliferative glomerulonephritis (MPGN) type I. Microscopic hematuria and proteinuria presented at 9 years of age in the mother and at 14 years in the daughter. Both had persistent hypocomplementemia and were treated with steroids. When the mother was 40 years old, proteinuria was still continuing and creatinine clearance was 64.4 ml/min per 1.73 m(2). When the daughter was 15 years old, microscopic hematuria was still continuing. To our knowledge, familial cases of MPGN in two generations have not been reported in Japan.

Angiotensin-converting enzyme (ACE) 2 (ACE2) is expressed mainly in the heart and kidney and forms angiotensin-1-7 from angiotensin II. ACE2 might act in a counterregulatory manner to ACE. There is little information about renal ACE and ACE2 expression in human diabetic nephropathy.Cross-sectional study.Kidney tissue from 20 patients with type 2 diabetes and overt nephropathy and 20 healthy kidney donors.Diabetes status.Renal expression of ACE and ACE2 assessed by means of immunohistochemistry and in situ hybridization. Correlation between ACE and ACE2 expression and levels of various biochemical parameters.Decreased ACE2 and increased ACE expression in both the tubulointerstitium and glomeruli resulted in a significant (P0.001) increase in ACE/ACE2 ratio in patients with diabetes with overt nephropathy compared with controls, although ACE messenger RNA in the tubulointerstitium did not significantly increase. ACE/ACE2 ratio correlated positively with values for mean blood pressure, fasting blood glucose, serum creatinine, proteinuria, and hemoglobin A(1c) and inversely with estimated glomerular filtration rate (P0.001).Inclusion of small number of human renal biopsy specimens with structural distortion of cortical tissue.The high ACE/ACE2 ratio in kidneys of patients with type 2 diabetes with overt nephropathy may contribute to renal injury.

Fluid imbalance due to sodium retention and malnutrition can be characterized by the ratio of extracellular water (ECW) to intracellular water (ICW). We investigated whether the ECW/ICW ratio is a risk factor for adverse outcomes.Retrospective cohort study.149 patients with chronic kidney disease from 2005 to 2009, who were followed until August 2013.Body fluid composition was measured by bioelectrical impedance analysis. Patients were categorized according to the ECW/ICW ratio tertile. Daily nutrient intake was estimated from 24-h dietary recall and analyzed using standard food composition tables. The main outcomes were adverse renal outcomes, as defined by a decline of 50% or more from the baseline glomerular filtration rate or initiation of renal replacement therapy, cardiovascular events, and all-cause mortality.The ECW/ICW ratio increased with downward ICW slope with age and renal dysfunction besides ECW excess with massive proteinuria. Sodium intake, protein intake, and calorie intake were negatively correlated with the ECW/ICW ratios due to the steeper decreasing ICW content with the decreased dietary intake than the decreasing ECW content. During a median 4.9-year follow up, patients in the highest tertile had the worst adverse renal outcomes (15.9 vs. 5.1 per 100 patient-years, P0.001), cardiovascular events (4.1 vs. 0.3 per 100 patient-years, P = 0.002), and mortality (11.2 vs. 1.3 per 100 patient-years, P0.001). The adjusted hazard ratio (95% confidence intervals) for adverse renal outcomes, cardiovascular events, and mortality were 1.15 (1.03 - 1.26), 1.12 (0.93 - 1.31), and 1.29 (1.11 - 1.50), respectively.Fluid imbalance between ICW and ECW occurring in malnourished and elderly patients with chronic kidney disease may explain the reserve capacity for volume overload and is associated with adverse renal outcomes and all-cause mortality.

Cognitive function as measured by the Hebb-Williams maze task was examined in Fischer 344 male rats that had been exposed to an enriched environment for periods of variable duration and at different starting ages. In one experiment, rats were exposed to environmental enrichment from weaning until the age of 2.5, 15, or 25 months. The results of 12 problems of the Hebb-Williams maze task showed that the enriched rearing condition improved the learning ability in all the age groups; however, factor analysis and ANOVA demonstrated that four of the 12 maze problems were not suitable for detecting the effect of age under different environmental conditions. Reanalysis of the results obtained with the other eight maze problems more clearly revealed both the effects of rearing condition and aging. The latter analysis demonstrated that the learning rate of rats reared under enriched conditions was faster than that of rats reared under standard social conditions. Short-term (3-month) exposure also had positive effects on cognitive function in both adult (11-month-old) and aged (22-month-old) animals. The effect of long-term exposure to an enriched environment starting at weaning was much greater than that of short-term exposure in aged rats, whereas the effects of both long-term and short-term exposure were almost the same in adult rats. These results show that aged animals still have appreciable plasticity in cognitive function, and suggest that environmental stimulation could benefit aging humans as well. © 2002 Wiley-Liss, Inc.

Eyewitness testimony is generated through communication between the examiner and non-examiner (eyewitness) in interrogation rooms or public courts. In this analysis, the authors have studied the ‘fact-generating’ process microscopically, and the issue of credibility in testifying from one's experience. Specifically, they examined the Kabutoyama case, in which it took more than 20 years to render a final verdict of not guilty. They closely examined the credibility of testimony made by a key witness in the case. After analysing the testimony both qualitatively and quantitatively, they observed several characteristics in the witness-examiner exchanges and consider that non-empirical eyewitness testimony is a product of witness-examiner interactions. This paper is based on a research project carried out to report on expert opinion regarding credibility of eyewitness testimony. Part of the results of this project have already been published by Mori and Ohashi (1997).

Background Excess extracellular volume is a major clinical problem in patients with chronic kidney disease (CKD). However, whether the extracellular volume status is associated with disease progression is unclear. We investigated the association between the extracellular volume status and renal outcomes. Methods We performed a retrospective cohort study of 149 patients with CKD who underwent bioelectrical impedance analysis (BIA) from 2005 to 2009. Patients were categorized according to tertiles of extracellular volume status. The extracellular volume status was assessed by examining the ratio of extracellular water measured by BIA (ECWBIA) to the total body water calculated using the Watson formula (TBWWatson). The main outcomes were adverse renal outcomes as defined by a decline of ≥50% from the baseline glomerular filtration rate or initiation of renal replacement therapy. Results A higher %ECWBIA/TBWWatson ratio tended to be associated with older age, male sex, diabetes mellitus, resistant hypertension, lower renal function, lower serum albumin levels, higher proteinuria levels, and a higher frequency of furosemide use. In the multivariate analysis, proteinuria remained independently associated with the %ECWBIA/TBWWatson ratio. Both the intracellular and extracellular water volumes decreased with age (correlation between ICW and age, r = -0.30, P < 0.001; correlation between ECW and age, r = -0.17, P = 0.03). Consequently, the %ECWBIA in the body fluid composition increased with age. During a median follow-up of 4.9 years, patients in the highest tertile of the %ECWBIA/TBWWatson ratio were at greater risk of adverse renal outcomes (16.6 per 100.0 patient years) than were those in the lowest tertile (8.1 per 100.0 patient years) or second tertile (5.6 per 100.0 patient years) (log-rank P = 0.005). After adjustment for covariates, the %ECWBIA/TBWWatson ratio was significantly associated with adverse renal outcomes (hazard ratio, 1.21; 95 % confidence interval, 1.10–1.34; P < 0.001). Conclusions The ECWBIA/TBWWatson ratio was independently associated with adverse renal outcomes. Proteinuria was independently associated with the extracellular volume status. The balance between ICW and ECW changes with age in that the percentage of ECW content in the body fluid composition increases. Elderly patients with CKD may thus be susceptible to volume overload. Electronic supplementary material The online version of this article (doi:10.1186/1471-2369-15-189) contains supplementary material, which is available to authorized users.

Juxtaglomerular cell tumor is a rare renal neoplasm. Secondary hypertension with juxtaglomerular cell tumor can be seen in females in their 20s and 30s. We present a case of juxtaglomerular cell tumor during pregnancy. A 32-year-old female was hospitalized for refractory hypertension and nephrotic syndrome in the 23rd gestational week. One year before admission, she had been diagnosed with hypertension; plasma renin activity at that time had been 2.3 ng/ml/h. Her blood pressure was uncontrolled during pregnancy, and proteinuria was detected in the 12th gestational week despite the administration of antihypertensive medications. Laboratory data showed proteinuria, hypokalemia, and hypoalbuminemia. In the 25th gestational week, she underwent surgical termination of the pregnancy because of congestive heart failure and acute renal injury. After the termination of the pregnancy and the delivery of a viable fetus, her hypertension and nephrotic syndrome were found to persist with a high plasma renin activity (13 ng/ml/h). Ultrasonography showed a 5.5-cm left renal cystic mass with a partially solid component at the lower renal pole. The left kidney with the renal mass was excised by laparoscopic nephrectomy. Plasma renin activity normalized the next day, with a decrease in blood pressure to 120-130/80-90 mm Hg; however, proteinuria remained at ≥3.5 g/day. On the basis of histopathological findings, the patient was diagnosed with a juxtaglomerular cell tumor and focal segmental glomerulosclerosis. Juxtaglomerular cell tumor is a rare renin-secreting tumor associated with refractory hypertension in young females and is a possible cause of hypertension during pregnancy.

The effects of a carnitine derivative, acetyl-L-carnitine (ALCAR), on the cognitive and cholinergic activities of aging rats were examined. Rats were given ALCAR (100 mg/kg) per os for 3 months and were subjected to the Hebb-Williams tasks and a new maze task, AKON-1, to assess their learning capacity. The learning capacity of the ALCAR-treated group was superior to that of the control. Cholinergic activities were determined with synaptosomes isolated from the cortices. The high-affinity choline uptake by synaptosomes, acetylcholine synthesis in synaptosomes, and acetylcholine release from synaptosomes on membrane depolarization were all enhanced in the ALCAR group. This study indicates that chronic administration of ALCAR increases cholinergic synaptic transmission and consequently enhances learning capacity as a cognitive function in aging rats.

We retrospectively investigated the clinical findings and treatment of cleft lip, cleft palate, or both associated with chromosomal karyotype aberration. The patients were examined at the Second Department of Oral and Maxillofacial Surgery, Niigata University Dental Hospital between April 1982 and March 1998.The findings obtained were as follows:1. Twelve of 806 patients with cleft lip, cleft palate, or both (1.5%) had chromosomal aberrations. Four of these patients had bilateral cleft lip, alveolus, and palate, and 8 had cleft palate. In 10 primary cases, the incidence of chromosomal aberrations was 4.4%(3/68) in patients with bilateral cleft lip, alveolus, and palate and 5.1%(7/138) in patients with cleft palate.2. Various types of chromosomal aberrations (No.13, 15, 21 numerical abnormalities and No.1, 2, 4, 5, 6, 7, 9, 13, 18, 21 structural abnormalities) were found, but there was no evidence of an association between the type of chromosomal aberration and the type of cleft lip or palate.3. A history of spontaneous abortion was confirmed in the mothers of five patients, and similar chromosomal aberrations in blood relatives were confirmed in two patients.4. Eight patients had major anomalies, and all 12 had minor anomalies. Mental retardation was confirmed in all patients.5. Among 10 patients with primary cleft lip, cleft palate, or both, 1 underwent cheiloplasty and 5 underwent palatoplasty under general anesthesia. After the physical condition of the patient had stabilized, cheiloplasty was carried out at about 1 year of age and palatoplasty at 2 to 3 years of age in close cooperation with pediatricians and anesthesiologists. To minimize trauma, surgery should be done in one step.

Numerical synaptic density and synaptic vesicle density in rat frontal cortex were examined by electron microscopy as a function of age. The density of axospinous synapses, a major population of synapses, was found to peak at age 1 month, and to gradually decrease with aging. The synaptic vesicle density in axospinous synapses was shown to rapidly increase to a peak during the first 3 weeks and then decrease to the adult level, which remained unchanged in senescence. The time course of synaptic changes in aging is presented in this study. In a previous report (Saito et al. [1994] J. Neurosci. Res. 39:57-62), we showed that enriched rearing conditions restored the age-related decrease of synaptophysin contents. This might be due to increased numerical synaptic density or enhanced packing density of synaptic vesicles in synapses. The results of the present study support the latter explanation; that is, synaptic vesicle contents were increased without changes in synaptic density. Synaptic plasticity induced by environmental stimulation is shown to relate with synaptic strengthening, but not with the formation of new synapses.

Twenty cases of upper gingival carcinoma and 13 cases of hard palate carcinoma were evaluated clinicopathologically. In addition, the relationship between surgical intervention and outcome was also studied.All upper gingival carcinomas were identified as squamous cell carcinoma histologically. In the hard palate, there were various kinds of carcinomas arising mainly from the salivary glands (10/13 cases). Furthermore, almost all cases in the hard palate were welldifferentiated mucoepidermoid carcinomas, classified into the early stages of T 1 or T 2.The 5-year cumulative survival rate of the patients with hard palate carcinoma was 100%. In contrast, the 5-year cumulative survival rate of patients with upper gingival carcinoma was 50.2% among all cases, 66.7% among 9 stage II+III cases, and 32.3% among 11 stage IV cases.Surgical intervention involving tooth extraction in the tumorous area had been done in eight patients with upper gingival carcinoma before their first visit to our institute. Of these patients, seven (87.5%) were classified as T 4, and cervical lymph node metastases were confirmed histologically in five (62.5%). Careful follow-up in thus necessary in such patients.

Obwegeser II method was applied to an 18-year-old male patient with severe progenia and open bite.The reasons for selecting this method were as follows;1. His lateral cephalometric analysis revealed only excessive mandibular protrusion without any maxillary abnormality.2. It was necessary for the mandible to be set back 14 mm posteriorly to obtain the ideal intermaxillary occlusion.3. The anteroposterior width of his mandibular ramus was bilaterally narrow.4. Furthermore, severe open bite still remained at the end of pre-surgical orthodontic treatment.Postoperative cephalometric analysis revealed both skeletal stability and harmonious balance.One of the advantages of this method is that a bigger contact area can be obtained between the two separated bone segments compared with that of sagittal split ramus osteotomy when the width of the mandibular ramus is narrow. In addition, it was suggested that a longer distance between the mandibular second molar and the anterior edge of the mandibular ramus could be a good indication for this operation.

歯肉癌におけるT分類はT4の基準に問題があり, 解釈が分かれる。本論文ではUICC分類, 頭頸部分類, 下顎管分類, 洞底分類についてその妥当性を比較検討した。対象は下顎歯肉癌は24施設から集積した1187例で, 上顎歯肉および硬口蓋癌は単一施設の37例で, T別症例分布, 生存率, 多変量解析, 治療法選択などとの関係で解析した。結果はUICC分類では大多数がT4になり, あまりT分類の意味をなさない。頭頸部分類では分布や生存率で多少是正されるが不十分であり, 下顎管分類や洞底分類で大いに改善された。下顎歯肉癌の多変量解析から下顎管分類が表面的な腫瘍の拡がりがTを規定するというUICC分類の原則をよく反映しており, 骨吸収様式と程度の分析から下顎管分類が治療法選択上よい基準を示した。これら検索から下顎歯肉については下顎管分類が, 上顎歯肉, 硬口蓋では洞底分類がT分類法としてもっとも妥当なものと結論される。