Extended-Hours Hemodialysis without Dietary Restrictions Increases Body Mass Index and Normalizes Hypertension: A Case Report.

Dialysis technology has made remarkable progress. However, many patients still suffer from malnutrition and hypertension. They cause many complications and significantly impact patients' quality of life and prognosis. To solve these problems, we developed a new dialysis modality, extended-hours hemodialysis without dietary restrictions. Here we report a case of a man who has received this treatment for 18 years. He had been on conventional hemodialysis (three times a week for 4 hours) since his dialysis initiation. He suffered from hypertension and was on five antihypertensive drugs to control his blood pressure. In addition, dietary restrictions were strict, and the nutritional status was somewhat poor. After being transferred to our clinic, the dialysis time was gradually extended to 8 hours, and dietary restrictions were greatly relaxed. Interestingly, his body mass index (BMI) increased, and his hypertension was controlled. After 3 years, he stopped all antihypertensive drugs. This result suggests that improving nutritional status may control hypertension. However, salt intake was substantially increased. Serum phosphorus and serum potassium levels were at a slightly higher level but were controlled by medications. At the time of transfer, anemia was treated with erythropoiesis-stimulating agents and glycated iron oxide, but these drugs were gradually reduced and discontinued. However, he maintained high average erythrocyte counts and normal hemoglobin levels. Dialysis conditions were wholly slow dialysis, lower than conventional dialysis methods, but the dialysis efficiency was satisfactory. In conclusion, we speculate that extended-hours hemodialysis without dietary restrictions reduces the risk of malnutrition and hypertension.

A novel method to bail out coronary perforation: Micro-catheter distal perfusion technique.

Coronary perforation is a rare, but life-threatening complication during percutaneous coronary intervention. Prolonged balloon inflation is one option for achieving hemostasis, but it often causes ST elevation, chest pain, decreased blood pressure, or fatal arrhythmia due to ischemia. We present the case of a 73-year-old woman who suffered severe coronary perforation after stent implantation and post-dilatation. To allow prolonged balloon inflation without ischemia, we perfused the distal area with the patient's own arterial blood injected via micro-catheter. With this method, we could prolong balloon inflation for 20 min, successfully achieving hemostasis. This novel technique, which we named the "distal perfusion technique," is useful to minimize ischemia during prolonged balloon inflation.

High-resolution magnetic resonance imaging of rotator cuff tears using a microscopy coil: noninvasive detection without intraarticular contrast material.

PURPOSE: The aim of this study was to evaluate the feasibility of high-resolution magnetic resonance imaging (MRI) using a microscopy coil for the diagnosis of rotator cuff tears by comparing the method to conventional MRI and MRI arthrography. MATERIALS AND METHODS: A total of 68 shoulders were prospectively studied using a 1.5-T MRI unit. Conventional MRI scans were obtained with a surface coil and high-resolution MRI scans with a microscopy coil. MRI arthrography was performed in 28 shoulders using a surface coil. MRI evaluation of tears of rotator cuff tendons was compared with arthroscopic findings and surgical results. RESULTS: The surgery revealed 40 full-thickness tears, 13 partial-thickness tears, and 15 intact cuffs. In all, 35 (88%) full-thickness tears were correctly diagnosed on conventional MRI and 40 (100%) on high-resolution MRI. MR arthrography delineated 11 of 12 (92%) full-thickness tears. Altogether, 5 (38%) of the partial-thickness tears were detected on conventional MRI, and 12 (92%) were clearly demonstrated on high-resolution MRI. MRI arthrography depicted three (60%) of five partial-thickness tears. High-resolution MRI showed higher sensitivity than conventional MRI (P < 0.05) and had values equivalent to those of MRI arthrography for diagnosing partial-thickness tears. CONCLUSION: High-resolution MRI with a microscopy coil is a feasible, noninvasive technique for diagnosing rotator cuff tears.

Factors related to successful outcome of conservative treatment for rotator cuff tears.

BACKGROUND: Much controversy exists as to the management of full-thickness tears of the rotator cuff. Not all patients with rotator cuff tears require surgical treatment. We have little information whether there are factors that are related to successful outcome of conservative treatment. AIM. The purpose of this study was to determine the factors related to the successful outcome following conservative treatment. METHODS: This study included 123 shoulders in 118 patients with full-thickness tears of the rotator cuff diagnosed by high-resolution magnetic resonance imaging with a microscopy coil. All patients were treated conservatively for at least 3 months. Clinical symptoms improved in 65 shoulders in 62 patients by conservative treatment (conservative group), but remained unchanged or aggravated in 58 shoulders in 56 patients, who eventually underwent surgical repair (surgical group). RESULTS: The following parameters showed significant differences: 1) integrity of the intramuscular tendon of the supraspinatus (24.1% in the surgical group and 58.4% in the conservative group showed an intact intramuscular tendon); 2) supraspinatus muscle atrophy (occupancy ratio was 69.8% in the surgical group and 78.0% in the conservative group); 3) impingement sign (positive in 79.3% in the surgical group and 30.7% in the conservative group); and 4) external rotation angle (35.0 degrees in the surgical group and 52.2 degrees in the conservative group). The success rate of conservative treatment was 87% in the cases with at least three of these four factors. CONCLUSION: These four factors are useful in selecting patients who will respond well to conservative treatment before initiating the treatment.

Characterization of the cDNA encoding bullfrog, Rana catesbeiana, osteocalcin and two forms of the protein isolated from bone.

A full-length cDNA clone encoding osteocalcin from the bullfrog, Rana catesbeiana (bone Gla-protein, BGP) has been isolated, and the complete coding sequence for the 100-amino-acid pre-pro-osteocalcin protein was determined. The amino acid sequence of Rana catesbeiana osteocalcin, especially the mature 49-amino acid sequence, is closer to the mammalian than to the fish, Sparus osteocalcin. Rana mature osteocalcin has a similarity of 67% with human or 59% with rat osteocalcin, and only 42% with fish mature osteocalcin. The 51-amino-acid pre-pro-peptide contains the expected hydrophobic leader sequence and the dibasic Arg-Arg sequence preceding the NH2-terminal Ser of the mature 49-amino-acid Rana osteocalcin. The pro-peptide sequence also contains the expected motif of polar and hydrophobic residues, which targets vitamin K-dependent gamma-carboxylation of three specific Glu residues at positions 17, 21, and 24 in the mature protein. At the native protein expression levels, extraction from Rana cortical bone in the presence of protease inhibitor cocktail resulted in the isolation of two distinct forms of osteocalcin, P-1 and P-2, with a 3:2 distribution. Using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and amino acid sequence analysis of the N-terminal domain, we confirmed that P-1 is the intact 49-residue osteocalcin with N-terminal SNLRNAVFG., and that P-2 lacks four amino acids from the N-terminus, (NAVFG.). These results demonstrate the existence of a form of osteocalcin lacking four N-terminal amino acids in Rana bone, and that mature Rana osteocalcins remained highly conserved in their molecular evolution, especially with respect to the conservation of the C-terminal domain (residues 14-49).

Val216 decides the substrate specificity of alpha-glucosidase in Saccharomyces cerevisiae.

Differences in the substrate specificity of alpha-glucosidases should be due to the differences in the substrate binding and the catalytic domains of the enzymes. To elucidate such differences of enzymes hydrolyzing alpha-1,4- and alpha-1,6-glucosidic linkages, two alpha-glucosidases, maltase and isomaltase, from Saccharomyces cerevisiae were cloned and analyzed. The cloned yeast isomaltase and maltase consisted of 589 and 584 amino acid residues, respectively. There was 72.1% sequence identity with 165 amino acid alterations between the two alpha-glucosidases. These two alpha-glucosidase genes were subcloned into the pKP1500 expression vector and expressed in Escherichia coli. The purified alpha-glucosidases showed the same substrate specificities as those of their parent native glucosidases. Chimeric enzymes constructed from isomaltase by exchanging with maltase fragments were characterized by their substrate specificities. When the consensus region II, which is one of the four regions conserved in family 13 (alpha-amylase family), is replaced with the maltase type, the chimeric enzymes alter to hydrolyze maltose. Three amino acid residues in consensus region II were different in the two alpha-glucosidases. Thus, we modified Val216, Gly217, and Ser218 of isomaltase to the maltase-type amino acids by site-directed mutagenesis. The Val216 mutant was altered to hydrolyze both maltose and isomaltose but neither the Gly217 nor the Ser218 mutant changed their substrate specificity, indicating that Val216 is an important residue discriminating the alpha-1,4- and 1,6-glucosidic linkages of substrates.

Effect of lumbar disc herniation on clinical symptoms in lateral recess syndrome.

This study investigated the differences in the clinical features of lateral recess syndrome attributable to the bony entrapment of the spinal nerve root under the superior articular facet, and lateral recess syndrome and associated lumbar disc herniation. Ninety patients with pure bony entrapment (47 men, 43 women) ranging in age from 19 to 83 years (mean age, 63 years) and 59 patients with lumbar disc herniation in the lateral recess (43 men, 16 women) 19 to 85 years of age (mean age, 49 years) were included in this study. All patients had L5 root radiculopathies and were treated surgically. Although the early symptoms of patients with lateral recess syndrome often were in the lower extremities, many of the patients with associated lumbar disc herniation had a transition initially experiencing low back pain and subsequently having lower extremity symptoms. Flexion and extension of the lumbar spine exacerbated symptoms, particularly in patients with lumbar disc herniation. The results of the current study show that the clinical presentation of lateral recess syndrome differs depending on the cause of the compression in the lateral recess.