Association of aortic valve calcification with carotid artery lesions and peripheral artery disease in patients with chronic kidney disease: a cross-sectional study.

BACKGROUND: Patients with chronic kidney disease (CKD) reportedly have a high prevalence of aortic valve calcification (AVC). In population-based studies, AVC is considered a manifestation of systemic atherosclerosis. The association of AVC with atherosclerotic lesions has not been fully investigated in predialysis patients. The present study was performed to determine whether carotid artery lesions and peripheral artery disease (PAD) are associated with AVC in patients with CKD not on dialysis. METHODS: In total, 749 patients were included in this cross-sectional study. AVC was evaluated using echocardiography. Carotid artery lesions including carotid artery plaque (CAP) and PAD were simultaneously examined in each patient. A logistic regression analysis was applied to determine the factors associated with AVC. RESULTS: AVC, CAP, and PAD were found in 201, 583, and 123 patients, respectively. In the multivariable analyses adjusted for covariates including the estimated glomerular filtration rate and makers of mineral metabolism (serum calcium, serum phosphorus, parathyroid hormone, 1,25-dihydroxyvitamin D, and fibroblast growth factor 23), AVC was significantly associated with the presence of CAP [odds ratio (OR), 3.37; 95% confidence interval (CI), 1.43-7.95], the presence of PAD (OR, 1.76; 95% CI, 1.10-2.81), the CAP score (per 1.0-point increase) (OR, 1.06; 95% CI, 1.02-1.11), and the ankle-brachial blood pressure index (per 0.1-point increase) (OR, 0.83; 95% CI, 0.72-0.95). CONCLUSIONS: AVC was associated with atherosclerotic lesions independent of kidney function and mineral metabolism. We consider that this association between AVC and atherosclerosis might reflect the burden of shared atherosclerotic risk factors.

Administration of Corticosteroids for Prompt Suppression of Cytokine Storm in Severe Cases of Japanese Spotted Fever.

Japanese spotted fever (JSF) is a tick-borne disease caused by Rickettsia japonicaand primarily affects the warmer coastal areas of Japan. Early treatment with tetracycline antibiotics is crucial to prevent severe complications, such as pneumonia, meningitis, disseminated intravascular coagulation (DIC), and systemic inflammatory response syndrome. An 83-year-old man with hypertension, chronic kidney disease, and hyperuricemia presented with DIC and subsequently developed septic shock. Polymerase chain reaction confirmed JSF caused by R. japonica. Initial treatment with ceftriaxone was ineffective, leading to a switch to intravenous minocycline and levofloxacin. Considering the high levels of C-reactive protein, procalcitonin, ferritin, and soluble interleukin-2 receptor, intravenous hydrocortisone (200 mg/day) was administered to control the cytokine storm. On day 4, the patient's condition improved significantly, with increased blood pressure, reduced DIC markers, and decreased levels of inflammatory cytokines, including interleukin-6 and tumor necrosis factor-α. The patient's recovery continued, and he was transferred to a chronic care hospital. Severe JSF cases are primarily driven by a cytokine storm caused by an excessive immune response. Early administration of corticosteroids along with antibiotics effectively suppressed the cytokine storm in this case. Reports have shown mixed results, indicating the need for further research to determine the optimal type, dosage, and duration of corticosteroid treatment.

Prediction of bortezomib-induced peripheral neuropathy with the R-R interval variation of the electrocardiogram in plasma cell myeloma: a retrospective study.

Bortezomib-induced peripheral neuropathy (BIPN) is a key dose-limiting toxicity in patients with plasma cell myeloma (PCM). This study examined 56 patients with PCM treated with bortezomib to determine the possible predisposing factors to BIPN with the R-R interval variation (RRIV) of the electrocardiogram (ECG). Of all, 17 patients developed Clinically obvious BIPN, grades 2-4 or grade worsening from the baseline neuropathy per the National Cancer Institute's Common Terminology Criteria for Adverse Events (v5.0). In the receiver operating characteristic curve analysis, the optimal RRIV cutoff value to distinguish patients with and without risk to develop BIPN was 1.391. A lower RRIV before bortezomib treatment independently correlated with the onset of Clinically obvious BIPN (p = .002) and the time to the onset of Clinically obvious BIPN (p < 0.001). A lower RRIV of the ECG before the bortezomib treatment is a predictive factor for BIPN in PCM.