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1.
RNA ; 2022 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-36283829

RESUMEN

Each transfer RNA (tRNA) is aminoacylated (charged) with a genetic codon-specific amino acid at its 3' end. Charged tRNAs are primarily used for translation, whereas fluctuations in charged tRNA fractions are known to reflect cellular response to stress. Here we report the development of individual tRNA-acylation using PCR (i-tRAP), a convenient PCR-based method that can specifically quantify individual tRNA charging ratio. In this i-tRAP method, demethylases remove base methylations which are problematic for reverse transcription reaction, and ß-elimination reaction specifically removes the 3' end of adenine residue in uncharged tRNA. Subsequent TaqMan MGB qRT-PCR can distinguish between cDNA of charged tRNA and uncharged tRNA. By using this method, we revealed that the charging ratio of tRNAGln(CUG) was changed in response to amino acid starvation and also the charging ratio of tRNAGln(CUG) in senescent cells was lower than in young cells under starvation conditions. i-tRAP can be applicable to the quantification of charging ratio of various tRNAs, and provides a simple and convenient method for analyzing tRNA charging.

2.
Acta Neuropathol ; 147(1): 77, 2024 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-38687393

RESUMEN

Influenza-associated encephalopathy (IAE) is extremely acute in onset, with high lethality and morbidity within a few days, while the direct pathogenesis by influenza virus in this acute phase in the brain is largely unknown. Here we show that influenza virus enters into the cerebral endothelium and thereby induces IAE. Three-weeks-old young mice were inoculated with influenza A virus (IAV). Physical and neurological scores were recorded and temporal-spatial analyses of histopathology and viral studies were performed up to 72 h post inoculation. Histopathological examinations were also performed using IAE human autopsy brains. Viral infection, proliferation and pathogenesis were analyzed in cell lines of endothelium and astrocyte. The effects of anti-influenza viral drugs were tested in the cell lines and animal models. Upon intravenous inoculation of IAV in mice, the mice developed encephalopathy with brain edema and pathological lesions represented by micro bleeding and injured astrocytic process (clasmatodendrosis) within 72 h. Histologically, massive deposits of viral nucleoprotein were observed as early as 24 h post infection in the brain endothelial cells of mouse models and the IAE patients. IAV inoculated endothelial cell lines showed deposition of viral proteins and provoked cell death, while IAV scarcely amplified. Inhibition of viral transcription and translation suppressed the endothelial cell death and the lethality of mouse models. These data suggest that the onset of encephalopathy should be induced by cerebral endothelial infection with IAV. Thus, IAV entry into the endothelium, and transcription and/or translation of viral RNA, but not viral proliferation, should be the key pathogenesis of IAE.


Asunto(s)
Encéfalo , Infecciones por Orthomyxoviridae , Animales , Humanos , Ratones , Encéfalo/patología , Encéfalo/virología , Infecciones por Orthomyxoviridae/patología , Infecciones por Orthomyxoviridae/virología , Infecciones por Orthomyxoviridae/complicaciones , Internalización del Virus , Virus de la Influenza A/patogenicidad , Células Endoteliales/virología , Células Endoteliales/patología , Gripe Humana/patología , Gripe Humana/complicaciones , Encefalopatías/virología , Encefalopatías/patología , Masculino , Modelos Animales de Enfermedad , Femenino , Endotelio/patología , Endotelio/virología , Ratones Endogámicos C57BL
3.
Kidney Int ; 104(3): 441-454, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37290600

RESUMEN

Individuals with kidney failure undergoing maintenance dialysis frequently report a high symptom burden that can interfere with functioning and diminish life satisfaction. Until recently, the focus of nephrology care for dialysis patients has been related primarily to numerical targets for laboratory measures, and outcomes such as cardiovascular disease and mortality. Routine symptom assessment is not universal or standardized in dialysis care. Even when symptoms are identified, treatment options are limited and are initiated infrequently, in part because of a paucity of evidence in the dialysis population and the complexities of medication interactions in kidney failure. In May of 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference-Symptom-Based Complications in Dialysis-to identify the optimal means for diagnosing and managing symptom-based complications in patients undergoing maintenance dialysis. Participants included patients, physicians, behavioral therapists, nurses, pharmacists, and clinical researchers. They outlined foundational principles and consensus points related to identifying and addressing symptoms experienced by patients undergoing dialysis and described gaps in the knowledge base and priorities for research. Healthcare delivery and education systems have a responsibility to provide individualized symptom assessment and management. Nephrology teams should take the lead in symptom management, although this does not necessarily mean taking ownership of all aspects of care. Even when options for clinical response are limited, clinicians should focus on acknowledging, prioritizing, and managing symptoms that are most important to individual patients. A recognized factor in the initiation and implementation of improvements in symptom assessment and management is that they will be based on locally existing needs and resources.


Asunto(s)
Enfermedades Renales , Nefrología , Diálisis Renal , Humanos , Riñón , Enfermedades Renales/etiología , Fallo Renal Crónico/terapia , Diálisis Renal/efectos adversos
4.
Clin Nephrol ; 88(8): 112-116, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28372632

RESUMEN

A 38-year-old Japanese man who had undergone clipping surgery for a ruptured aneurysm of the anterior communicating artery 2 days prior, suddenly developed refractory hypernatremia (serum sodium (Na) 156 - 162 mmol/L). Symptoms included low plasma vasopressin, fluctuating urine osmolality (120 - 710 mOsm/kg) and lack of thirst, all suggesting adipsic diabetes insipidus (ADI). Hypernatremia was corrected by scheduled water intake with desmopressin administration. During 1-year follow-up after the surgery, his serum Na level normalized despite the suspension of desmopressin, but neither thirst nor osmolality-dependent vasopressin release recovered. Meanwhile, his urine osmolality shifted to a constant high level. The present case suggests that renal compensatory adaptation, apparently independent of the circulating vasopressin level, plays a major role in water handling in longitudinal ADI.
.


Asunto(s)
Adaptación Fisiológica , Aneurisma Roto/fisiopatología , Agua Corporal/metabolismo , Diabetes Insípida/fisiopatología , Aneurisma Intracraneal/complicaciones , Riñón/fisiopatología , Adulto , Humanos , Masculino , Vasopresinas/fisiología
5.
Phys Chem Chem Phys ; 18(39): 27422-27431, 2016 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-27711434

RESUMEN

An efficient computational method to evaluate the binding energies of many protons in large systems was developed. Proton binding energy is calculated as a corrected nuclear orbital energy using the second-order proton propagator method, which is based on nuclear orbital plus molecular orbital theory. In the present scheme, the divide-and-conquer technique was applied to utilize local molecular orbitals. This use relies on the locality of electronic relaxation after deprotonation and the electron-nucleus correlation. Numerical assessment showed reduction in computational cost without the loss of accuracy. An initial application to model a protein resulted in reasonable binding energies that were in accordance with the electrostatic environment and solvent effects.

6.
Clin Calcium ; 26(9): 1295-300, 2016 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-27561344

RESUMEN

Routine examination of bone mineral density(BMD)by DXA(dual energy X-ray absorptiometry)is useful to predict bone fracture in both CKD nondialysis and dialysis patients. The cutoff value of BMD to predict bone fracture is different between genders and its predictive power is better in patients with lower serum PTH levels than higher counterpart. Increase in serum bone specific alkaline phosphatase is a better predictor of the bone fracture than serum PTH levels.


Asunto(s)
Fracturas Óseas/etiología , Insuficiencia Renal Crónica/complicaciones , Fosfatasa Alcalina/sangre , Biomarcadores/sangre , Densidad Ósea , Fracturas Óseas/fisiopatología , Humanos , Hormona Paratiroidea/sangre , Factores de Riesgo
7.
J Comput Chem ; 36(5): 303-11, 2015 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-25487530

RESUMEN

We report the implementation of the local response dispersion (LRD) method in an electronic structure program package aimed at periodic systems and an assessment combined with the Perdew-Burke-Ernzerhof (PBE) functional and its revised version (revPBE). The real-space numerical integration was implemented and performed exploiting the electron distribution given by the plane-wave basis set. The dispersion-corrected density functionals revPBE+LRD was found to be suitable for reproducing energetics, structures, and electron distributions in simple substances, molecular crystals, and physical adsorptions.

8.
Nephrology (Carlton) ; 19(12): 777-83, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25142830

RESUMEN

AIM: Estimating fluid balance in haemodialysis patients is essential when determining dry weight, but limited methods are currently available. B-type natriuretic peptide (BNP) is a useful surrogate marker in patients with congestive heart failure (CHF), but whether its validity could be generalized to haemodialysis patients has not been studied well. METHODS: A total of 457 haemodialysis patients at a dialysis centre were analyzed. Determinants of BNP were assessed in connection with ultrasound cardiography (UCG) records, Kt/V, ultrafiltration rate (UFR), and demographic factors. All-cause death and cardiovascular (CV) events were recorded as the main outcome. RESULTS: Among the UCG records, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), were determinants of log-transformed (ln) BNP; UFR, age and sex were also significant. There was a positive correlation between BNP and LAD (r = 0.285, P < 0.001). Receiver operating characteristic (ROC) analysis revealed that BNP had 90% and 80% sensitivity to predict the presence of LA enlargement of 77.9 pg/mL and 133.2 pg/mL, respectively. Higher BNP and lower LVEF were associated with higher risk for developing all-cause death and CVD. In the adjusted model, patients with BNP higher than 471 pg/mL had hazard ratio of 2.18 (95% confidence interval (CI) 1.20-3.96, P = 0.01), compared to those with BNP <109 pg/mL. CONCLUSION: B-type natriuretic peptide was determined by LAD, LVEF, UFR, age and sex. BNP and LAD had positive correlation and BNP could become a useful tool for estimating the presence of LA enlargement. BNP and LVEF was a strong risk factor for predicting all-cause death and CV events among patients undergoing haemodialysis.


Asunto(s)
Cardiomegalia/sangre , Péptido Natriurético Encefálico/sangre , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/terapia , Factores de Edad , Anciano , Área Bajo la Curva , Biomarcadores/sangre , Cardiomegalia/diagnóstico , Cardiomegalia/mortalidad , Cardiomegalia/fisiopatología , Causas de Muerte , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Japón , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Diálisis Renal/mortalidad , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/fisiopatología , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Volumen Sistólico , Resultado del Tratamiento , Ultrasonografía , Función Ventricular Izquierda , Equilibrio Hidroelectrolítico
9.
Clin Calcium ; 24(12): 1757-61, 2014 Dec.
Artículo en Japonés | MEDLINE | ID: mdl-25423919

RESUMEN

"Thinking Global! Acting Local" has been used to express a principle in implementing global guidelines in local. In case of KDIGO 2009 CKD-MBD guideline, Japanese Society of Dialysis Therapy followed the principal part of its global one and published 2012 CKD-MBD guideline for Japanese users. In this guideline, JSDT recommended very different PTH target from the KDIGO and emphasized the parathyroid interventions in their recommendation. Is it a right recommendation as for "Acting Local" ? We should be very careful to implement an opinion-base or low-level evidence-base recommendation to increase a clinical usefulness of guideline.


Asunto(s)
Enfermedades Óseas Metabólicas , Insuficiencia Renal Crónica/metabolismo , Enfermedades Óseas Metabólicas/tratamiento farmacológico , Enfermedades Óseas Metabólicas/etiología , Enfermedades Óseas Metabólicas/metabolismo , Enfermedades Óseas Metabólicas/fisiopatología , Calcio/metabolismo , Humanos , Hormona Paratiroidea/metabolismo , Guías de Práctica Clínica como Asunto , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/fisiopatología
10.
Clin Exp Nephrol ; 17(1): 106-14, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22752396

RESUMEN

BACKGROUND: Hyporesponsiveness to a large dose of erythropoietin-stimulating agents (ESA) could increase mortality risk among chronic kidney disease patients. This study aimed to assess a safe dose of ESA and the impact of hyporesponsiveness to ESA on mortality risk among hemodialyzed patients. METHODS: Patients on hemodialysis were enrolled in this cohort study. The first year was used to assess the longitudinal dialysis status of patients; the subsequent 2 years were used to assess the time-dependent risk of mortality. RESULTS: Of the 349 subjects enrolled, 40 died within 2 years. When subjects were stratified by epoetin dose and hemoglobin level into four groups, those who had low hemoglobin despite a high dose of epoetin were associated with the highest risk of mortality among the four groups (adjusted hazard ratio 2.73; 95 % confidence interval 1.20-6.24). These highest-risk subjects had lower serum albumin and higher serum ferritin than any of the other subjects. The impact of serum albumin and serum ferritin on mortality risk in an unadjusted Cox proportional hazards model was attenuated in an adjusted model which included factors of low hemoglobin and higher ESA. A dose of epoetin up to 9000 U/week had no impact on mortality risk as long as hemoglobin levels stayed above 10 g/dL. CONCLUSIONS: Hyporesponsiveness to ESA was associated with an increased risk of mortality. There was no sign of increased mortality risk associated with epoetin itself up to a total dose of 9000 U/week.


Asunto(s)
Anemia/tratamiento farmacológico , Eritropoyetina/administración & dosificación , Hematínicos/administración & dosificación , Diálisis Renal/mortalidad , Insuficiencia Renal Crónica/terapia , Anciano , Anemia/sangre , Anemia/diagnóstico , Anemia/etiología , Anemia/mortalidad , Biomarcadores/sangre , Relación Dosis-Respuesta a Droga , Eritropoyetina/efectos adversos , Femenino , Ferritinas/sangre , Hematínicos/efectos adversos , Hemoglobinas/metabolismo , Humanos , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/mortalidad , Medición de Riesgo , Factores de Riesgo , Albúmina Sérica/metabolismo , Albúmina Sérica Humana , Factores de Tiempo , Resultado del Tratamiento
11.
FEBS Lett ; 597(12): 1638-1650, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-37079003

RESUMEN

Each tRNA is aminoacylated (charged) with a genetic codon-specific amino acid. It remains unclear what factors are associated with tRNA charging and how tRNA charging is maintained. By using the individual tRNA acylation PCR method, we found that the charging ratio of tRNAGln (CUG) reflects cellular glutamine level. When uncharged tRNAGln (CUG) increased under amino acid starvation, the kinase GCN2, which is a key stimulator of the integrated stress response, was activated. Activation of GCN2 led to the upregulation of ubiquitin C (UBC) expression. Upregulated UBC, in turn, suppressed the further reduction in tRNAGln (CUG) charging levels. Thus, tRNA charging is sensitive to intracellular nutrient status and is an important initiator of intracellular signaling.


Asunto(s)
Aminoácidos , Proteínas de Saccharomyces cerevisiae , Aminoácidos/metabolismo , Glutamina/metabolismo , Proteínas Serina-Treonina Quinasas/metabolismo , ARN de Transferencia de Glutamina/metabolismo , Ubiquitina C/genética , Ubiquitina C/metabolismo , Proteínas de Saccharomyces cerevisiae/metabolismo , Saccharomyces cerevisiae/metabolismo , Regulación hacia Arriba
12.
Ther Apher Dial ; 27(6): 1010-1016, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37605563

RESUMEN

INTRODUCTION: With population aging and lifestyle changes, the number of patients with chronic limb-threatening ischemia (CLTI) is increasing, and refractory or recurrent lesions are more common, especially in chronic dialysis patients. In March 2021, a new type of adsorptive cellulose bead column immobilized with dextran sulfate and L-tryptophan for direct hemoperfusion (DHP) was approved by Japan's medical insurance system as a treatment for CLTI. METHODS: We retrospectively analyzed 17 cases of CLTI in dialysis patients treated with DHP using the novel column (Rheocarna) (DHP-R) at our hospital from May 2021 to October 2022. The short-term of efficacy of DHP-R was judged qualitatively by the foot care team every 2 weeks based on the assessment of skin color, warmth, ulcer epithelialization or shrinkage of the ulcer area, and foot pain. The final judgment of efficacy was made after the final DHP-R session. RESULTS: The median age of patients was 66 years, the median dialysis duration was 10 years, 15 cases (88%) were male, and 15 cases (88%) had diabetes. The median total number of sessions was eight. In comparing the groups in which DHP-R was effective and ineffective, there was no significant difference in any factors including patient background data (i.e., age, diabetes, low-density lipoprotein cholesterol, hemoglobin, dialysis duration, etc.), type of anticoagulants, and presence of episodes of blood pressure drop or circuit clotting during session. Three cases with symptomatic hypotension during the session and two cases with circuit clotting that did not improve with increased heparin dose all resolved immediately after changing the anticoagulant from heparin to nafamostat mesylate (NM). CONCLUSION: Identification of patients' characteristics in which DHP-R is favorable and some reliable index that allow a rapid decision to continue DHP-R are needed. In addition, validating whether the use of NM as anticoagulant affects the efficacy of DHP-R for CTLI treatment remains a challenge to resolve.


Asunto(s)
Diabetes Mellitus , Hemoperfusión , Humanos , Masculino , Anciano , Femenino , Polimixina B , Antibacterianos/uso terapéutico , Isquemia Crónica que Amenaza las Extremidades , Estudios Retrospectivos , Úlcera/tratamiento farmacológico , Úlcera/etiología , Diálisis Renal , Anticoagulantes/uso terapéutico , Heparina , Diabetes Mellitus/tratamiento farmacológico , Resultado del Tratamiento
13.
Intern Med ; 62(17): 2565-2569, 2023 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-37316277

RESUMEN

Multisystem inflammatory syndrome in adults (MIS-A) is a life-threatening disease that can develop weeks after coronavirus disease 2019 (COVID-19). MIS-A symptoms include multiorgan involvement, especially gastrointestinal tract and heart involvement, and Kawasaki disease-like symptoms. We herein report a 44-year-old Japanese man with MIS-A who had contracted COVID-19 five weeks ago and went into shock after acute gastroenteritis, acute kidney injury, and Kawasaki disease-like symptoms. Methylprednisone pulse and high-dose intravenous immunoglobulin resulted in recovery of shock and his renal function, but diffuse ST-segment elevation on electrocardiography and pericardial effusion with a fever emerged after therapy. Additional granulocyte-monocyte adsorptive apheresis successfully ameliorated the cardiac involvement.


Asunto(s)
Eliminación de Componentes Sanguíneos , COVID-19 , Enfermedades del Tejido Conjuntivo , Síndrome Mucocutáneo Linfonodular , Masculino , Humanos , Adulto , COVID-19/complicaciones , COVID-19/terapia , Monocitos , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Granulocitos
14.
Nephrol Dial Transplant ; 27(1): 345-51, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21652550

RESUMEN

BACKGROUND: In chronic kidney disease stage 5D, diagnostic usefulness of bone mineral density (BMD) in predicting fracture has not been established because of variable results in previous studies. The reason for this may be the heterogeneity of underlying pathogenesis of the fracture. METHODS: BMD was measured annually and serum biochemistry monthly for 485 hemodialyzed patients from April 2003 to March 2008, and all fractures were recorded. RESULTS: Forty-six new episodes of any type of fracture and 29 cases of prevalent spine fracture were recorded. Serum bone-specific alkaline phosphatase (b-AP) was a very useful surrogate marker for any type of incident fracture risk [area under curve (AUC) = 0.766, P < 0.0001]. A significantly greater risk of any type of incident fracture was associated with parathyroid hormone (PTH) levels either <150 pg/mL [hazard ratio (HR) = 3.47, P < 0.01] or >300 pg/mL (HR = 5.88, P < 0.0001) compared with 150-300 pg/mL. Receiver-operating characteristic analysis demonstrated a significant predictive power for incident of any type of fracture by BMD at the total hip (AUC = 0.760, P < 0.0001) and other hip regions in females in the lower PTH group (PTH < 204 pg/mL). BMDs at every site but whole body or lumbar spine had significant power to discriminate prevalent spine fracture regardless of gender or PTH. CONCLUSIONS: Hemodialyzed patients with low or high PTH or increased b-AP had a high fracture risk. BMD by Dual Energy X-ray Absorptiometry (DEXA), especially at the total hip region, was useful to predict any type of incident of fracture for females with low PTH or to discriminate prevalent spine fracture for every patient.


Asunto(s)
Biomarcadores/metabolismo , Densidad Ósea , Remodelación Ósea/fisiología , Fracturas Óseas/diagnóstico , Fallo Renal Crónico/complicaciones , Absorciometría de Fotón , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Fracturas Óseas/etiología , Fracturas Óseas/metabolismo , Fracturas Óseas/mortalidad , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de Supervivencia
15.
Clin Exp Nephrol ; 16(2): 187-94, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22389158

RESUMEN

As an independent meeting, the third Asian Forum of Chronic Kidney Disease Initiatives was held on April 18-19, 2009, in Kaohsiung, Taiwan. Nearly 700 participants from 17 countries attended and 78 posters were presented. To begin with, status quo in Asia and in Taiwan was briefed, followed by Theme 1A "Special Epidemiology and Risk Factors", during which the interrelations between chronic kidney disease (CKD) and use of herbs, low birth weight, infections, and immunoglobulin A (IgA) nephropathy were discussed. Theme 1B dealt with both cardiovascular and renal outcomes of CKD patients. In Theme 2, five presenters from different countries shared their experiences on "Cost-effectiveness of Community-based or Nationwide CKD Prevention Programs". In between the conference themes, three international and integrative works--Kidney Disease Improving Global Outcomes, the World Kidney Day, and Kidney Early Evaluation Program--were presented and possible implications for Asia were suggested. Theme 3 was initiated with a thorough discussion on "Equation of the Estimated Glomerular Filtration Rate for Asians" and the preliminary results of a cross-country study were presented. In Theme 4, the care plan, strategies, and outcomes of timely initiation of dialysis in different countries were discussed. The final session started with a concise summary of all speeches and ended with a position statement.


Asunto(s)
Insuficiencia Renal Crónica/epidemiología , Asia/epidemiología , Análisis Costo-Beneficio , Tasa de Filtración Glomerular , Humanos , Evaluación de Programas y Proyectos de Salud , Diálisis Renal , Insuficiencia Renal Crónica/prevención & control , Factores de Riesgo
16.
Clin Exp Nephrol ; 16(6): 930-7, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22581064

RESUMEN

BACKGROUND: Cause-and-effect associations between sevelamer hydrochloride (HCl) and mortality have yet to be clarified. The effects of sevelamer HCl on mortality, lipid abnormality and arterial stiffness were examined in patients with chronic kidney disease stage 5D. METHODS: The effects of sevelamer HCl were studied by a single-center cohort study that was conducted from January 1, 2005 to December 31, 2008 (n = 483). By the end of the study, 172 patients (Sevelamer group) had succeeded in continuing sevelamer HCl for >6 months (median 37 months), and 300 patients (Control group) had received calcium carbonate (n = 264) or no phosphate binder (n = 36). The mortality and other outcomes were compared between these two groups after matching by a propensity score calculated using age, gender, diabetes prevalence, and dialysis vintage. RESULTS: All-cause [hazard ratio (HR) 0.4, P = 0.02] and cardiovascular (CV)-cause [HR 0.29, P = 0.03] cumulative mortality were significantly lower in the matched Sevelamer group than in the matched Control group. The matched Sevelamer group showed increased high-density lipoprotein cholesterol (P = 0.003) and no change in pulse wave velocity (PWV) and ankle-brachial index (ABI), whereas the matched Control group showed increased serum low-density lipoprotein (LDL) cholesterol (P = 0.003), increased PWV (P = 0.03), and decreased ABI (P = 0.0009). Change in serum LDL cholesterol level correlated inversely with sevelamer HCl dosage (P = 0.02). CONCLUSIONS: Reduced mortality in patients with sevelamer HCl may, at least in part, be explained by an improvement in dyslipidemia and arterial stiffness by sevelamer HCl.


Asunto(s)
Quelantes/farmacología , Metabolismo de los Lípidos/efectos de los fármacos , Poliaminas/farmacología , Diálisis Renal , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/terapia , Rigidez Vascular/efectos de los fármacos , Anciano , Índice Tobillo Braquial , Carbonato de Calcio/farmacología , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Metabolismo de los Lípidos/fisiología , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso , Insuficiencia Renal Crónica/fisiopatología , Sevelamer , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Rigidez Vascular/fisiología
17.
Clin Calcium ; 22(7): 1019-24, 2012 Jul.
Artículo en Japonés | MEDLINE | ID: mdl-22750934

RESUMEN

In the KDIGO CKD-MBD guideline, the disorder "renal osteodystrophy" is defined as bone histological changes, which can be diagnosed only by bone biopsy. New bone diagnosis method, "TMV classification" is introduced instead of classical classification system. In order to diagnose TMV classification, undecalcified bone specimen after tetracycline double labeling is required. In TMV classification, "T" stands for bone turnover and is evaluated by bone formation rate (BFR/BS) or activation frequency (Acf) . "M" stands for bone mineralization and is evaluated by mean osteoid thickness (O.Th) and mineralization lag time (Mlt) . "V" stands for cancellous bone volume and is diagnosed by total bone volume (BV/TV) .


Asunto(s)
Biopsia/métodos , Huesos/patología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Enfermedades Renales/complicaciones , Huesos/metabolismo , Calcificación Fisiológica , Enfermedad Crónica , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/clasificación , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/patología , Humanos , Osteogénesis , Factores de Tiempo
18.
CEN Case Rep ; 11(4): 436-441, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-35275366

RESUMEN

With the worldwide spread of the COVID-19 vaccine program during the COVID-19 pandemic, the numbers of reported cases with new-onset or relapsed kidney disease/vasculitis such as minimal change nephrotic syndrome, immunoglobulinA (IgA) nephropathy, and IgA vasculitis (IgAV) that developed after COVID-19 vaccination are increasing. We present the case of a 67-year-old Japanese woman who developed IgAV with purpura on her extremities and trunk in the evening of the day that she received the second dose of the Pfizer-BioNTech COVID-19 vaccine. She subsequently presented with acute kidney injury and nephrotic syndrome, and a kidney biopsy performed 14 days after the second vaccination showed diffuse mesangial and endocapillary glomerulonephritis with necrotizing crescent formation, accompanied by IgA deposition. One steroid pulse plus four administrations of a monthly intravenous cyclophosphamide injection were applied, followed by oral azathioprine during oral steroid tapering. Her response to this treatment was unsatisfactory and intractable for some time. Eventually, her renal function improved and nephrotic syndrome was resolved, while microscopic hematuria and proteinuria at ~ 1 g/gCr remained at 6 months post-vaccination. Unlike the previous milder renal-involved IgAV cases following COVID-19 vaccination, our patient's case presented severe glomerulonephritis and took a long time to recover despite intensive initial immunosuppressive treatment.


Asunto(s)
Vacuna BNT162 , COVID-19 , Glomerulonefritis por IGA , Vasculitis por IgA , Síndrome Nefrótico , Anciano , Femenino , Humanos , Vacuna BNT162/efectos adversos , COVID-19/prevención & control , Glomerulonefritis por IGA/inducido químicamente , Vasculitis por IgA/inducido químicamente , Inmunoglobulina A , Síndrome Nefrótico/inducido químicamente , Vacunación/efectos adversos
19.
Clin Exp Nephrol ; 15(1): 121-5, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21069412

RESUMEN

INTRODUCTION: Anemia is a common complication of patients with chronic kidney disease (CKD), which not only lowers their quality of life but also potentially causes cardiovascular diseases such as congestive heart failure and coronary heart disease, and accelerates the progression of renal dysfunction. METHODS: Pre-dialysis patients were assigned to groups A, B, C or D based on hemoglobin levels of ≤ 8.9 (n = 48), 9.0-9.9 (n = 63), 10-10.9 (n = 53), and ≥ 11.0 g/dL (n = 39), respectively. Cardiac function was estimated using echocardiography to clarify the relationship between anemia and cardiac disorders in patients with CKD immediately before starting hemodialysis. RESULTS: Left ventricular ejection fraction (LVEF) was significantly higher in group D than in groups A and B. The fractions with an LVEF of less than 50% were 16.7, 4.8, 1.9, and 0% in groups A, B, C, and D, respectively. Posterior wall thickness was statistically thicker and the deceleration time of the early diastolic wave was longer in groups A and B, respectively, than in groups C and D. The left ventricular mass index in group D was significantly lower than in any other groups. CONCLUSION: Anemia in pre-dialysis patients with CKD is a probable cause of impaired left ventricular systolic function and progressive left ventricular hypertrophy. Our results suggest that Hb levels should be maintained at >11 g/dL by EPO administration from the perspective of protecting cardiac function, although the upper limit of the target Hb level was undetermined.


Asunto(s)
Anemia/complicaciones , Anemia/etiología , Enfermedades Cardiovasculares/etiología , Fallo Renal Crónico/complicaciones , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Anciano , Anemia/fisiopatología , Enfermedades Cardiovasculares/fisiopatología , Estudios Transversales , Ecocardiografía , Humanos , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/fisiopatología , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/terapia
20.
J Oral Maxillofac Surg ; 69(3): 877-84, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21211878

RESUMEN

PURPOSE: The objectives of the present study were to assess the changes in upper airway morphology and function in response to advancement of the maxilla and mandible. PATIENTS AND METHODS: Orthognathic surgery was performed. During the surgery, the maxilla and mandible were each advanced as a maxillomandibular advancement simulation. A total of 18 patients with a chief complaint of malocclusion were studied. The distance in jaw advancement and the anteroposterior and left-right diameters of the velopharyngeal space before and after jaw advancement were measured. After the anteroposterior and left-right dilation rates and area enlargement rates were calculated, we compared advancement of the maxilla with that of the mandible. RESULTS: Each of the jaw advancements resulted in statistically significant increases in the anteroposterior and left-right diameters of the velopharyngeal space, and the area was significantly enlarged. The anteroposterior dilation rate was significantly greater after advancement of the maxilla, and the left-right dilation rate was significantly greater after advancement of the mandible. The velopharyngeal space area enlargement rate was significantly greater with advancement of the maxilla. CONCLUSIONS: These data suggest that the mode of dilation of the velopharyngeal space differs between maxillary advancement and mandibular advancement. Jaw advancement affects the soft palate muscles, and the velopharyngeal space is expanded 3-dimensionally by each of those muscles. The difference in the pattern of expansion of the velopharyngeal space was related to differences in the functions of the soft palate muscles.


Asunto(s)
Maloclusión/cirugía , Avance Mandibular , Osteotomía Le Fort , Paladar Blando/anatomía & histología , Faringe/anatomía & histología , Adolescente , Adulto , Cefalometría , Endoscopía , Femenino , Humanos , Masculino , Músculos Palatinos/fisiología , Adulto Joven
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