Combined effects of blood pressure and glucose status on the risk of chronic kidney disease.

This study aimed to assess the combined effects of blood pressure (BP) and glucose status on chronic kidney disease (CKD) incidence in young and middle-aged adults. We examined data from 1,297,341 Japanese individuals aged <60 years (60.1% men; mean age 41.4 ± 9.3 years) with no history of CKD at baseline. The interval-censored Cox proportional hazards model with covariates was used. During a median follow-up period of 2.1 years, new onset CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2 and/or proteinuria) occurred in 80,187 participants. In participants without antihypertensive treatment (AHT), the adjusted hazard ratios (95% confidence interval) per 1-standard deviation, that is, 15 mmHg increase in systolic BP for CKD incidence, were 1.08 (1.07-1.09), 1.12 (1.10-1.13), and 1.15 (1.12-1.18) in normoglycemia, borderline glycemia, and diabetes groups, respectively. These ratios were significantly higher in the borderline glycemia and diabetes groups compared with those in the normoglycemia group (interaction p < 0.0001). The interaction between BP and borderline glycemia was evident when the outcome definition was restricted to proteinuria. In participants under AHT, systolic BP was most strongly associated with CKD risk in the diabetes group, although no significant interaction was observed. High BP and high glucose status may synergistically increase the incidence of CKD. Strict BP management may play an important role in the early prevention of CKD in individuals with worse glucose status within the young and middle-aged population. This large-scale longitudinal cohort study showed high BP and diabetes synergistically increased the risk of CKD in individuals without AHT. Strict BP management may play an important role in the early prevention of CKD in individuals with worse glucose status within the young and middle-aged population.

Multi-anode enhanced the bioelectricity generation in air-cathode microbial fuel cells towards energy self-sustaining wastewater treatment.

Microbial fuel cells (MFCs) hold considerable promise for harnessing the substantial energy resources present in wastewater. However, their practical application in wastewater treatment is limited by inadequate removal of organic matter and inefficient power recovery. Previous studies have investigated aeration as a method to enhance the removal of organic matter, but this method is energy-intensive. To address this issue, this study proposed using MFC-recovered bioelectricity for aeration, thereby mitigating the associated expenses. An air-cathode MFC with multi-anode was constructed and optimized to maximize electricity supply for aeration. Carbon-felt anodes were chosen as the most effective anode configuration, due to the high abundance of electroactive bacteria and genes observed in the biofilm generated on their surface. By incorporating six carbon felt anodes, the MFC achieved a 1.7 and 1.1 fold enhancement in the maximum power and current density, respectively. The optimized MFC unit achieved a stable current density of 0.32 A/m2 and achieved COD removal of 60% in the long-term operation of 140 days in a 50 L reactor. In a reactor scaled up to 1600 L, 72 MFCs successfully powered a mini air pump work for 10 s after an 81-s charging period. The intermittent aeration resulted in partial increases in DO concentrations to 0.03-3.5 mg/L, which is expected to promote the removal of nitrogen compounds by the nitrification-anammox process. These groundbreaking results lay the foundation for self-sustaining wastewater treatment technologies.

The risk of withdrawal from hypertension treatment in coastal areas after the Great East Japan Earthquake: the TMM CommCohort Study.

This study aimed to examine whether risk of withdrawal from HTTx was higher in coastal areas that were severely damaged by tsunami than in inland areas. We conducted a cross-sectional study of 9218 participants aged ≥20 years in Miyagi, Japan. The odds ratios (ORs) and confidence interval (CI) for withdrawal from HTTx in coastal and inland groups were compared using multivariate logistic regression analysis, adjusting for potential confounders. In total, 194 of 5860 and 146 of 3358 participants in the inland and coastal groups, respectively, withdrew from HTTx treatment. OR (95%CI) of withdrawal from HTTx in the coastal group was 1.46 (1.14-1.86) compared to the inland group. According to housing damage, ORs (95% CI) in the no damage, partially destroyed, and more than half destroyed coastal groups compared with the no damage inland group were 1.62 (1.04-2.50), 1.69 (1.17-2.45), and 1.08 (0.71-1.65), respectively. In conclusion, the risk of HTTx withdrawal for participants whose homes in coastal areas were relatively less damaged was significantly higher compared with those in inland areas, while the risk of HTTx withdrawal for participants whose homes were more than half destroyed was not. Post-disaster administrative support for disaster victims is considered vital for continuation of their treatment.

Cross-classification by systolic and diastolic blood pressure levels and chronic kidney disease, proteinuria, or kidney function decline.

Predicting and preventing new-onset chronic kidney disease (CKD) through blood pressure (BP) measurements is worthwhile. This study assessed the risk of CKD, which was defined as proteinuria and/or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, according to cross-classification by systolic and diastolic BP (SBP and DBP). This retrospective population-based cohort study analyzed data from 1,492,291 participants without CKD and without antihypertensive treatment in the JMDC database, which contains the annual health check-up data of Japanese aged <75 years. During a mean follow-up of 3.2 years, CKD incidence, proteinuria, and eGFR <60 mL/min/1.73 m2 occurred in 92,587, 67,021, and 28,858 participants, respectively. When the SBP/DBP <120/<80 mmHg group was set as a reference, both high SBP and DBP were significantly associated with an elevated CKD risk. DBP tended to be more strongly associated with CKD risk than SBP; the hazard ratio of CKD was 1.44-1.80 in the group with SBP/DBP of 130-139/≥90 mmHg and 1.23-1.47 in the group with SBP/DBP of ≥140/80-89 mmHg. A similar result was observed for developing proteinuria and eGFR <60 mL/min/1.73 m2. SBP/DBP ≥150/<80 mmHg was strongly associated with an elevated CKD risk due to the increased risk of eGFR decline. High BP, especially isolated high DBP levels, is a significant risk factor for CKD among individuals around middle age without kidney disease. Moreover, attention should be paid to kidney function, particularly eGFR decline, in the case of low DBP with extremely high SBP levels.

"Coexistence of IgA nephropathy and renal artery stenosis in Takayasu arteritis: case report and literature review".

Although Takayasu arteritis (TAK) is a form of large vessel vasculitis, complications of glomerulonephritis have occasionally been observed, with mesangial proliferative glomerulonephritis as the most common. The aim of this work was to present a case-based review regarding the association of glomerulonephritis and IgA nephropathy (IgAN) with TAK. A literature search was carried out using the PubMed and Scopus databases for articles published in English, and the Ichu-shi Web for Japanese. A 34-year-old Japanese man was evaluated for proteinuria, and IgAN was diagnosed by renal biopsy. Simultaneously, aortic wall thickening and right renal artery stenosis confirmed a coexisting TAK. Prednisolone and methotrexate improved both diseases, and percutaneous transluminal renal angioplasty resulted in right renal artery reopening. Our case and literature review revealed that membranous proliferative glomerulonephritis and IgAN are common in eastern Asia, while focal segmental glomerulosclerosis and mesangial proliferative glomerulonephritis are common in other regions. The incidence of IgAN is higher in TAK cases and is mostly reported in Asia. Abdominal aortic involvement and renal artery stenosis are common in cases with preceding TAK. IgAN could be related to the cytokine network involving interleukin-6, suggesting the usefulness of tocilizumab in patients with TAK accompanied by IgAN. The type of glomerulonephritis complicated with TAK differs among regions, and patients with TAK are more likely to experience IgAN than the healthy population.

MPO-ANCA-positive conversion and microscopic polyangiitis development in idiopathic interstitial pneumonia: a case report.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic autoimmune disease characterized by necrotizing inflammation of the small blood vessels. ANCA-associated vasculitis is subclassified into three variants: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and microscopic polyangiitis (MPA). Myeloperoxidase (MPO) ANCA is a marker antibody for MPA. Interstitial pneumonia (IP) is occasionally complicated with MPA. However, only a few cases of idiopathic IP develop MPO-ANCA-positive conversion and MPA. Therefore, we present a case of a 70-year-old Japanese man with idiopathic IP who developed MPO-ANCA-positive conversion and MPA. We performed renal biopsy, which revealed pauci-immune crescentic glomerulonephritis. The patient was treated with intravenous methylprednisolone pulse therapy and oral prednisone, and the patient's laboratory data gradually improved with steroid therapy. The association between the production of MPO-ANCA and IP remains unclear, and the present case suggests that IP plays a role in inducing MPO-ANCA production. Patients with idiopathic IP should be followed-up carefully for an examination of increased MPO-ANCA levels and MPA development. In addition, early gastric cancer was detected during upper gastrointestinal endoscopy in our case, and it could also be important not to miss malignancy in patients with ANCA-associated vasculitis.

Inhibition of sodium-glucose cotransporter 2 suppresses renal stone formation.

BACKGROUND AND AIMS: Nephrolithiasis is a common renal disease with no effective medication. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, an anti-diabetic agent, have diuretic and anti-inflammatory properties and could prevent nephrolithiasis. Here, we investigated the potential of SGLT2 inhibition against nephrolithiasis using large-scale epidemiological data, animal models, and cell culture experiments. METHODS: This study included the data of diabetic patients (n = 1,538,198) available in the Japanese administrative database and divided them according to SGLT2 inhibitor prescription status. For animal experiments, renal calcium oxalate stones were induced by ethylene glycol in Sprague-Dawley rats, and phlorizin, an SGLT1/2 inhibitor, was used for the treatment. The effects of SGLT2-specific inhibition for renal stone formation were assessed in SGLT2-deficient mice and a human proximal tubular cell line, HK-2. RESULTS: Nephrolithiasis prevalence in diabetic men was significantly lower in the SGLT2 inhibitor prescription group than in the non-SGLT2 inhibitor prescription group. Phlorizin attenuated renal stone formation and downregulated the kidney injury molecule 1 (Kim1) and osteopontin (Opn) expression in rats, with unchanged water intake and urine volume. It suppressed inflammation and macrophage marker expression, suggesting the role of the SGLT2 inhibitor in reducing inflammation. SGLT2-deficient mice were resistant to glyoxylic acid-induced calcium oxalate stone formation with reduced Opn expression and renal damages. High glucose-induced upregulation of OPN and CD44 and cell surface adhesion of calcium oxalate reduced upon SGLT2-silencing in HK-2 cells. CONCLUSION: Overall, our findings identified that SGLT2 inhibition prevents renal stone formation and may be a promising therapeutic approach against nephrolithiasis.

Safety of peritoneal dialysis catheter surgery under dexmedetomidine and local anesthesia for elderly patients in Japan: a single-center prospective cohort study.

BACKGROUND: The number of patients aged ≥ 75 years and who need renal replacement therapy is steadily increasing. The study aimed to determine the safety of open surgery for peritoneal dialysis (PD) catheter placement in such patients. METHODS: This prospective cohort study included patients who underwent PD catheter placement by open surgery under dexmedetomidine (DEX) and local anesthesia at our institution from January 2015 to February 2021. Patients were divided into the following two groups according to age at the time of surgery: ≥ 75 years (group A) and < 75 years (group B). We compared the perioperative and postoperative complications (i.e., time to the first PD-related peritonitis and catheter obstruction requiring surgical intervention within 1 year) between the groups. RESULTS: A total of 118 patients were categorized into groups A (n = 65) and B (n = 53). No significant intergroup differences were observed in the postoperative fever, total duration of surgery, perioperative hemoglobin decrease, changes in the white blood cell count and C-reactive protein, postoperative catheter leakage, postoperative hospital stay, time to the first PD-related peritonitis, and catheter obstruction requiring surgical intervention within 1 year. CONCLUSIONS: The surgery for PD catheter placement by open surgery under DEX and local anesthesia in elderly patients is safe and effective.

The Impact of Preoperative Risk Factors on Peritoneal Dialysis-Related Peritonitis: A Single-Center Prospective Study in Japan.

Background and Objectives: Peritoneal dialysis (PD)-related peritonitis is a critical problem. However, preoperative risk factors for PD-related peritonitis have not been established. Thus, we aimed to determine the preoperative risk factors for PD-related peritonitis. Materials and Methods: This is a single-center prospective observational study. All peritonitis episodes during the study period were recorded, and preoperative and intraoperative clinical parameters were compared between patients with and without peritonitis to examine risk factors for PD-related peritonitis. Furthermore, subcutaneous and abdominal fat volumes were evaluated using computed tomography. Results: Among a total of 118 patients, 24 patients developed peritonitis. The proportion of male patients (83% vs. 61%, p = 0.04), body mass index (25 vs. 22 kg/m2, p = 0.04), and subcutaneous fat area (120 vs. 102 cm2, p = 0.01) were significantly higher and the proportion of patients living with family members (75% vs. 94%, p = 0.02) was significantly lower in the peritonitis group than in the non-peritonitis group. There were no significant differences in age, operation method, surgeon experience, previous abdominal surgery, medical history of diabetic nephropathy, serum albumin level, and renal function between the two groups. Conclusions: Male patients with high subcutaneous fat who are living alone might be at higher risk of PD-related peritonitis. These characteristics might be useful in risk assessment and patient education before PD induction.

Development and validation of a prediction model for failed shockwave lithotripsy of upper urinary tract calculi using computed tomography information: the S3HoCKwave score.

PURPOSE: To develop and validate a new clinical prediction model that accurately predicts the failure of shockwave lithotripsy (SWL) using information obtained from non-contrast-enhanced computed tomography (NCCT). METHODS: This multicentre retrospective cohort study consecutively enrolled patients diagnosed with upper urinary tract calculi by NCCT at five hospitals in Japan from January 1, 2006 to December 31, 2016. Among the candidate predictors, we selected the six most significant predictors a priori. The main outcome was SWL failure after three sessions. Model calibration was evaluated by the calibration slope and the Hosmer-Lemeshow test. Discrimination was evaluated by the receiver-operating characteristic curves and the area under the curve (AUC). A multivariable logistic regression analysis was performed; based on the estimated ß coefficients, predictive scores were generated. RESULTS: Of 2695 patients, 2271 were included. Patients were divided into the development cohort (1666 patients) and validation cohort (605 patients) according to geographical factors. We developed a clinical prediction model with scores ranging from 0 to 49 points. We named the prediction model the S3HoCKwave score based on the initials of the predictors (sex, skin-to-stone distance, size, Hounsfield units, colic, and kidney or ureter). As a result of internal validation, the optimism-corrected AUC was 0.72. In the validation cohort, the Hosmer-Lemeshow test did not show statistical significance (P = 0.33), and the AUC was 0.71 (95% confidence interval 0.65-0.76). CONCLUSIONS: The S3HoCKwave score is easy to understand, has a relatively high predictive value, and allows clinicians to make appropriate treatment selections.

Renal Function after Nephrectomy Influences the Risk of Cardiovascular Events.

We retrospectively analyzed the factors related to postoperative cardiovascular (CV) events in patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN) for clinical T1 renal cell carcinoma (RCC). We identified 570 patients who underwent PN or RN for T1 renal cell carcinoma between January 1998 and December 2009 at our institution and related hospitals. We determined the cumulative incidence rate of CV events and overall survival (OS) using Kaplan-Meier survival curves with a log-rank test, and we evaluated the risk for an increase in CV events and OS using Cox proportional hazard regression. Of the 570 patients, 171 underwent PN and 399 underwent RN. The type of surgery was not significantly related with CV events. The only factor that significantly increased the risk of CV events in both the univariate (HR 2.67, p=0.006) and multivariate analyses (HR 2.14, p=0.044) was a postoperative estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m2. Postoperative eGFR was also a significant risk factor for OS in the univariate analysis (HR 2.38, p=0.0104), but not in the multivariate model. Postoperative renal function was a significant independent predictor of the incidence of subsequent CV events.

Highly n-doped germanium-on-insulator microdisks with circular Bragg gratings.

We demonstrate germanium (Ge) microdisks surrounded by highly reflective circular Bragg gratings on highly n-doped germanium-on-insulator (GOI) substrate. The GOI substrate is fabricated by wafer bonding from Ge grown on Si substrate, and n-type doping concentration of 2.1×1019 cm-3 is achieved by phosphorus diffusion from a spin-on-dopant source. Very sharp Fabry-Perot resonant peaks with high contrast fringes and Q-factors up to 400 are observed near the direct band gap of Ge in photoluminescence spectra. The reflectivity of gratings are enhanced by a factor larger than 3 in a wide wavelength range from 1.57 to 1.82 µm, compared with that of Ge/SiO2 interfaces in normal microdisks without circular Bragg gratings. The surface emission intensity of the devices is found to be increased by the grating period. Our results indicate that GOI microdisk with circular Bragg grating is a promising optical resonator structure suitable for realizing low threshold, compact Ge lasers integrated on Si substrate.

Ultra-wide-field fundus autofluorescence in multiple evanescent white dot syndrome.

PURPOSE: To observe the progression of affected lesions using ultra-wide-field fundus autofluorescence (FAF) in multiple evanescent white dot syndrome. DESIGN: Retrospective, observational case series. METHODS: setting: Institutional. PATIENT POPULATION: 14 eyes of 13 patients (mean age, 35.8 years) with acute disease unilaterally. OBSERVATION PROCEDURES: Patients underwent ultra-wide-field FAF, spectral-domain optical coherence tomography (SD OCT), multifocal electroretinography (mfERG), and Goldmann or automated perimetry; the best-corrected visual acuity (BCVA) and refractive error were measured. MAIN OUTCOME MEASURE: Ability of ultra-wide-field FAF to detect lesions with greater sensitivity compared with color fundus photography. RESULTS: Ultra-wide-field FAF imaging enabled improved visualization of the affected lesions and showed that the core lesion was in the posterior fundus involving the peripapillary retina and posterior pole and surrounded by hyper-autofluorescent spots outside the vascular arcade. The posterior lesions expanded rapidly and peripheral spots spread farther peripherally and reached a maximal extent during the acute stage. During follow-up, the peripheral hyper-autofluorescent spots resolved and then hyper-autofluorescence of the posterior fundus gradually faded. SD OCT showed diffuse disruption of the photoreceptor inner segment/outer segment junction (IS/OS) in the posterior fundus during the acute stage. The correlation between the IS/OS abnormality and hyper-autofluorescent areas was unclear. The disrupted IS/OS was restored with normalization of the FAF. CONCLUSIONS: Ultra-wide-field FAF showed that the lesions arise from the peripapillary retina and the posterior pole and spread peripherally in a centrifugal manner during the acute stage. The hyper-autofluorescent spots faded from the periphery in a centripetal manner.

Modified technique for inducing posterior vitreous detachment through the posterior precortical vitreous pocket during microincision vitreous surgery with a wide-angle viewing system.

PURPOSE: To introduce a simple technique to create a posterior vitreous detachment (PVD) through the posterior precortical vitreous pocket (PPVP) during microincision vitreous surgery using a wide-angle viewing system (WAVS). METHODS: This study included 20 eyes of 20 consecutive patients (mean age, 65.6 years; range, 56-76) with a stage 2 or 3 idiopathic macular hole who underwent 25-gauge microincision vitreous surgery using a WAVS and phacoemulsification surgery. A triamcinolone suspension was injected into the vitreous cavity. The triamcinolone facilitated visualization of the posterior wall of the PPVP. Using a vitreous cutter, we suctioned the outer margin of the PPVP. After a resultant small break of the posterior hyaloid membrane developed and enlarged rapidly, a PVD easily expanded at the periphery. RESULTS: Using this technique, we induced a PVD without close proximity to the optic disk and macula. CONCLUSION: This technique is an easy and safe method for creating a PVD during microincision vitreous surgery using a WAVS.

Restoration of photoreceptor outer segment after vitrectomy for retinal detachment.

PURPOSE: To report photoreceptor restoration and visual outcomes after vitrectomy for retinal detachment. DESIGN: Retrospective, observational case series. METHODS: We prospectively studied the tomographic features of reattached retinas in 20 eyes with a macula-off rhegmatogenous retinal detachment using spectral-domain optical coherence tomography 1, 3, and 6 months after 3-port vitrectomy with SF(6) gas tamponade. All eyes were examined more than 3 months after surgery. RESULTS: The optical coherence tomography foveal findings were classified as a disrupted inner segment and outer segment (IS/OS) line, a residual foveal detachment, and a continuous IS/OS line. A disrupted IS/OS line was seen in 11 eyes (55%) at 1 month and in 8 eyes (40%) at 3 months, a foveal detachment was seen in 8 eyes (40%) at 1 month and in 7 eyes (35%) at 3 months, and a continuous IS/OS line was seen in 1 eye (5%) at 1 month and in 5 eyes (25%) at 3 months. In 18 eyes followed up for 6 months, optical coherence tomography showed a disrupted IS/OS line in 3 eyes (17%), a foveal detachment in 6 eyes (33%), and a continuous IS/OS line in 9 eyes (50%). The mean best-corrected visual acuities at 1 and 6 months were 0.26 and 0.16 with a disrupted IS/OS line, 0.60 and 0.95 with a foveal detachment, and 0.8 and 0.95 with a continuous IS/OS line. The mean best-corrected visual acuity was significantly (P < .0001) lower with a disrupted IS/OS line compared with the other formations at 6 months. CONCLUSIONS: The IS/OS line at the fovea recovered gradually after surgery. The postoperative visual acuity was correlated with a restored IS/OS line.

Metal-insulator-gap-insulator-semiconductor structure for sensing devices.

We report on the use of sensing devices that have a metal-insulator-gap-insulator-semiconductor structure. We have used capacitance-voltage measurements from a metal-insulator-gap-insulator-semiconductor sensing device to characterize different pH solutions and deoxyribonucleic acid (DNA) solutions. Hysteresis in the capacitance-voltage curves results from mobile ionic charges in the solutions and the influence of changes on the sensing surface condition. As the pH decreases in the pH range of 2.7 to 7.0, the flatband voltage shift toward the negative voltage increases. The differences in the flatband voltage shift in capacitance-voltage curves are related to the mobile ionic charge density in solutions with different pH values or DNA molecules.

Restored photoreceptor outer segment and visual recovery after macular hole closure.

PURPOSE: To evaluate restoration of the photoreceptor outer segment and visual outcomes in closed macular holes. DESIGN: Retrospective case series. METHODS: We retrospectively observed the reparative process of macular holes in 28 eyes one, three, and six months postoperatively using spectral-domain optical coherence tomography. We evaluated the reflective line at the junction between the photoreceptor inner and outer segment (IS/OS) and the best-corrected visual acuity (BCVA). RESULTS: The outer photoreceptor layer showed a foveal detachment, a disrupted IS/OS line, or both one month postoperatively. No eye had a continuous IS/OS line. These abnormalities were gradually restored at various levels. At six months, nine eyes had a normal outer photoreceptor layer, four eyes outer foveal defects with a continuous IS/OS line, 12 eyes a disrupted IS/OS line, and three eyes outer foveal defects with a disrupted IS/OS line. The mean BCVAs were significantly (P = .017) lower in groups with a disrupted IS/OS line compared to groups with a continuous IS/OS line with or without outer foveal defects. CONCLUSIONS: Macular hole closure is attained by bridge formation (foveal detachment) and the IS/OS line heals in varying degrees. The visual outcomes were significantly better in eyes with a continuous IS/OS line than in those with a disrupted IS/OS line.