Efficacy of a moisturizer for pruritus accompanied by xerosis in patients undergoing dialysis: A multicenter, open-label, randomized verification study.

Xerosis and pruritus are common in patients undergoing dialysis. These symptoms are treated with moisturizers, but limited evidence supports the efficacy of such treatment. Our exploratory study suggested the effectiveness of a heparinoid-containing product for xerosis in dialysis patients. We conducted a multicenter, open-label, randomized, before-after, parallel-group comparative study to verify the exploratory study results (Clinical Trial Registry: UMIN000029360). Seventy-one Japanese patients undergoing dialysis with chronic kidney disease and xerosis were randomly assigned to receive a heparinoid-containing product for 2 weeks (group A [n = 36]) or 8 weeks (group B [n = 35]). Patients were instructed to apply the study product based on the fingertip unit method. The efficacy endpoints were the water content of the stratum corneum (WCSC), skin dryness score, pruritus visual analog scale score, and Dermatology Life Quality Index. Safety was assessed by monitoring adverse events. The mean WCSC (arbitrary units) was 26.0 ± 9.6 in group A and 25.2 ± 10.0 in group B at the start of treatment (week 0), significantly increased to 39.0±12.5 in group A and 38.5 ± 11.0 in group B (P < 0.0001 for both vs week 0) by week 2, and then decreased only in group A. Thus, the WCSC at week 4 (the primary endpoint) remained significantly higher in group B (36.4 ± 12.2 vs 28.8 ± 10.4; P = 0.0068). Other endpoints improved during treatment with the study product. One patient developed a rash and erythema as treatment-related adverse events. In conclusion, 8 weeks' application of a heparinoid-containing product was effective for xerosis in patients undergoing dialysis.

Efficacy of a Moisturizer for Pruritus Accompanied With Asteatosis in Dialysis Patients: An Open-Label, Randomized, Exploratory Study.

BACKGROUND: In dialysis patients, skin disorders (dryness and itching) are frequently observed and treated with a moisturizer, in the absence of clear evidence of efficacy. STUDY DESIGN: An open-label, randomized, before/after, parallel-group, comparative/exploratory study. SETTING & PARTICIPANTS: 12 Japanese patients with chronic kidney failure undergoing maintenance hemodialysis who presented with dry skin and itching. INTERVENTION: Patients received a topical heparinoid moisturizer as the study drug for 2 weeks from the first day of the study treatment, followed by either a 2-week washout (group A: 6 participants) or further 2-week treatment (group B: 6 participants). OUTCOMES: The primary end point was change in water content in the stratum corneum in the hypochondrium. Secondary end points included change in visual analogue scale itching score and subjective evaluations of symptoms. To evaluate safety, adverse events were also investigated. MEASUREMENTS: Water content of the stratum corneum, dryness/itching improvement rating, itching visual analogue scale/duration of itching, photographic evaluation of skin symptoms, principal investigator's overall assessment of study drug, and adverse events. RESULTS: Mean water content of the stratum corneum in the combined groups significantly increased at week 2 (51.2 arbitrary units [AU] vs treatment start day, 31.6 AU; P<0.001), but significantly decreased at week 4 in group A, in which patients discontinued treatment with the study drug (39.4 AU; P = 0.005). Other efficacy end points, including the visual analogue scale itching score, were also improved by treatment with the study drug, but such improvement was not sustained after discontinuation of treatment. There were no adverse events related to the study treatment. LIMITATIONS: Only Japanese patients were included in the study, with a small sample size. CONCLUSIONS: Continuous application of the topical heparinoid moisturizer increased water content in the stratum corneum and lessened itching in dialysis patients. FUNDING: Maruho Co, Ltd. TRIAL REGISTRATION: Registered at the University Hospital Medical Information Network Clinical Trials Registry with study number UMIN000017016.

Oral Rehabilitation of Oral Cancer Patients Using Zygomatic Implant-Supported Maxillary Prostheses with Magnetic Attachment: Three Case Reports.

Maxillectomy for malignant tumor often results in a maxillary defect and serious oral dysfunction. A prosthesis is usually provided for postoperative oral rehabilitation of such patients with maxillary defects. However, the further the resected region extends, the less stable the prosthesis becomes, due to insufficient bone and tooth support. Therefore, in many cases, conventional resection dentures may not be adequate to restore the oral function. Effective utilization of dental and zygomatic implants may help to restore oral function in patients with severe maxillary defects. This clinical report describes the management of three patients with severe maxillary defects following cancer ablative surgery who were rehabilitated using maxillary prostheses with magnetic attachments supported by dental and zygomatic implants. Occlusal reconstruction was performed with removable prostheses supported with two or four implants and magnetic attachment. The oral function was evaluated before and after prosthodontic treatment with implants using the Oral Health Impact Profile (OHIP-14) and functional chewing score. Results indicated improvement in all cases. These findings show that quality of life (QOL) and oral function were improved.

A Case of Anti-Glomerular Basement Membrane Antibody-Positive Systemic Lupus Erythematosus with Pulmonary Hemorrhage Successfully Treated at an Early Stage of the Disease.

We report here a case of systemic lupus erythematosus (SLE) with pulmonary hemorrhage and anti-glomerular basement membrane (anti-GBM) antibodies. A 42-year-old woman was admitted to our hospital with complaints of exanthema, arthralgia, shortness of breath, and hemoptysis. Plain chest computed tomography (CT) scan revealed pericardial effusion, bilateral pleural effusions, and pulmonary hemorrhage. Laboratory findings on admission revealed proteinuria, microscopic hematuria, anemia, leukopenia, hypoalbuminemia, hypocomplementemia, and slightly elevated levels of serum creatinine. Serological tests revealed elevated titers of serum anti-GBM antibodies, proteinase 3-antineutrophil cytoplasmic antibodies (PR3-ANCA), and anti-double stranded deoxyribonucleic acid (dsDNA)-immunoglobulin G (IgG) antibodies. Early treatment with steroid pulse therapy combined with plasma exchange resolved the patient's pulmonary hemorrhage and renal dysfunction. Renal biopsy carried out after the treatment revealed a recovery phase of acute tubular injury with minor glomerular abnormalities without linear IgG deposition along the GBMs. For a good prognosis, it is necessary to start treatment immediately in patients with anti-GBM antibody-positive SLE associated with pulmonary hemorrhage.

[Case of acute generalized exanthematous pustulosis caused by Kerorin].

A 78-year-old woman visited a local clinic because of cough and fever, and was prescribed levofloxacin, carbocisteine, and cold medicine (salicylamide, acetaminophen, anhydrous caffeine, promethazine methylene disalicylate). The following day, erythema appeared on the trunk, and spread. Multiple pustules independent of hair follicles developed on the erythema mainly in the skin folds. Histopathological examination revealed subcorneal pustular dermatosis. The clinical course and characteristics of the rashes led to a diagnosis of acute generalized exanthematous pustulosis (AGEP). Although the administration on levofloxacin, carbocisteine, and cold medicine were discontinued, the rashes recurred. We reviewed the patient's history, and found that she had a history of taking the over-the-counter drug Kerorin, and had taken a dose of Kerorin on the day before the first examination and before the recurrence. The ingestion of Kerorin was regarded as an incidental oral administration test, which was positive. Thus, oral administration tests with Kerorin and its ingredients acetylsalicylic acid and anhydrous caffeine were positive, leading to a diagnosis of AGEP caused by Kerorin.

Circulating miR-223 in Oral Cancer: Its Potential as a Novel Diagnostic Biomarker and Therapeutic Target.

Circulating microRNAs (miRNAs) have been detected in various types of cancer and have been proposed as novel biomarkers for diagnosis and treatment. Until recently, however, no studies had comprehensively examined circulating miRNAs in oral cancer. The current study used an ultra-sensitive genome-wide miRNA array to investigate changes in circulating miRNAs in plasma from five patients with oral cancer and ten healthy individuals. Results indicated that there were only a few circulating miRNAs, including miR-223, miR-26a, miR-126, and miR-21, that were up-regulated in patients with oral cancer. A subsequent validation test indicated that circulating miR-223 levels were significantly higher (~2-fold, P< 0.05) in patients with oral cancer (n = 31) than in those without cancer (n = 31). Moreover, miR-223 was found to be up-regulated in tumor-adjacent normal tissue compared to tumor tissue from patients with oral cancer. A gain-of-function assay was performed to explore the potential roles of circulating miR-223 in the development of oral cancer. Results revealed that miR-223 functions as a tumor suppressor by inhibiting cell proliferation and inducing apoptosis. In conclusion, this study suggested that circulating miR-223 may serve as a potential biomarker for diagnosis and that it may represent a novel therapeutic target for treatment of oral cancer.

Functional characterization of the type III secretion ATPase SsaN encoded by Salmonella pathogenicity island 2.

A type III secretion system (T3SS) is utilized by a large number of gram-negative bacteria to deliver effectors directly into the cytosol of eukaryotic host cells. One essential component of a T3SS is an ATPase that catalyzes the unfolding of proteins, which is followed by the translocation of effectors through an injectisome. Here we demonstrate a functional role of the ATPase SsaN, a component of Salmonella pathogenicity island 2 T3SS (T3SS-2) in Salmonella enterica serovar Typhimurium. SsaN hydrolyzed ATP in vitro and was essential for T3SS function and Salmonella virulence in vivo. Protein-protein interaction analyses revealed that SsaN interacted with SsaK and SsaQ to form the C ring complex. SsaN and its complex co-localized to the membrane fraction under T3SS-2 inducing conditions. In addition, SsaN bound to Salmonella pathogenicity island 2 (SPI-2) specific chaperones, including SsaE, SseA, SscA, and SscB that facilitated translocator/effector secretion. Using an in vitro chaperone release assay, we demonstrated that SsaN dissociated a chaperone-effector complex, SsaE and SseB, in an ATP-dependent manner. Effector release was dependent on a conserved arginine residue at position 192 of SsaN, and this was essential for its enzymatic activity. These results strongly suggest that the T3SS-2-associated ATPase SsaN contributes to T3SS-2 effector translocation efficiency.

An epidemiological study on relationship between the hours of sleep and life style factors in Japanese factory workers.

To prevent "life style-related diseases", it is necessary to evaluate not only the factors directly related to sleep but also the relationship between sleep and other life style-related factors (such as smoking, alcohol drinking, food habits, and exercise routines). There have been no extensive studies conducted on these relationships. A survey was conducted on 2,000 employees of a large plant over a 6-year period to provide data that would allow one to analyze correlation between hours of sleep and other life style factors, such as smoking, alcohol drinking, dietary habit, and exercise. It focused on a serial evaluation, with special reference to the correlation between sleep and smoking and drinking habits, exercise, and food habits. In relation to smoking or an alcohol drinking habit, no significant correlation was found between those who did not get enough sleep and those who got adequate sleep. For the dietary habits, the group with insufficient hours of sleep was related to a less than satisfactory frequency of meal taking, irregularity of eating, snacking habits, excessive seasoning of food, and consumption of insufficient quantities of vegetables. Conversely, it was recognized that those who have satisfactory food habits are more likely to enjoy an appropriate amount of sleep. Those who fail to get sufficient sleep engage in food habits that are more likely to cause life style-related diseases.