Applying computational nanomaterials design to the reactive ion etching of NiO thin films-a preliminary investigation.

We have developed and proposed a model for reactive ion etching (RIE) process design of nickel oxide thin films using a computational materials design based on ab initio calculations. On etching NiO, we found that it was necessary to have hydrogen-based reactive gases in the initial state in order to enhance RIE (e.g. NH(3), CH(4)). We strongly suggest the use of CH(4) or any H-based gas source other than CHF(3) to enhance RIE process.

Suppressed alloreactivity and mixed chimerism in rats with accepted cardiac allografts by intrathymic injection of donor bone marrow cells.

Intrathymic injection of donor bone marrow cells (ITBMCs) at the time of transplantation and treatment with antilymphocyte serum (ALS) permitted the indefinite survival of Brown Norway (BN, RT1n) rat heart grafts in 6 out of 8 Lewis (LEW, RT1l) rat recipients, LEW recipients with long-surviving BN heart grafts (LSGs) also accepted additional BN heart grafts without further immunosuppression, though they rejected Piebald Virol Glaxo (PVG, RT1c) rat heart grafts in the usual fashion. In the in vitro study, the proliferative response of the lymphocytes from LEW recipients with LSGs remained suppressed when they were stimulated by BN spleen cells, but not when stimulated by PVG cells. Bone marrow cells (BMCs) from LEW rats with LSGs showed strong, nonspecific, suppressive effects on the proliferative response in the mixed lymphocyte culture reaction, suggesting that one of the possible explanations for tolerance might be the involvement of a suppressor mechanism.

[Clinical study of pediatric kidney transplantation at Kansai].

BACKGROUND: The clinical study of pediatric kidney transplantation in Kansai area is reported in this paper. METHODS: Seventy six children, 0-15 years old, received renal transplants at 8 transplant centers of Kansai area up to December, 1993. Clinical study was carried out about the etiology of renal failure causes, the graft survival and the complications. RESULTS: End-stage renal failure was due to a variety of diseases. The 3 most common causes were chronic glomerulonephritis, chronic pyelonephritis including of reflux nephropathy and focal segmental glomerulosclerosis (FSGS). The graft rates at 3, 5 and 8 years were 75%, 71% and 53% for children receiving azathioprine (AZ), compared to 77%, 59% and 52% for ones receiving ciclosporin (Cs). Cs has led no improvement of the graft survival. Adult had the better graft survival rate than children in Cs immunosuppressive protocol. In 12 children transplanted kidneys for FSGS, only 3 cases had recurrent FSGS. Neoplasia was found in two case. They were acute leukemia and liposarcoma. CONCLUSION: Kidney transplantation is recommended as the treatment for end-stage FSGS. Even the children should be carefully followed up after transplantation for malignant tumors.

The significant effect of HLA-DRB1 matching on acute rejection in kidney transplants.

The object of the present study was to confirm the HLA-DRB1 matching effect on rejection crisis, its severity, and kidney graft survival based on genotyping. Ninety-four renal allografts were included in this study. DNA typing of HLA-DRB1 was performed by the polymerase chain reaction sequence-specific oligonucleotide method. The incidence of acute rejection within 6 months following transplantation, the frequency of OKT3 administration for steroid-resistant rejection, histopathological findings, and graft survival rate were compared between the DRB1-matched (n = 23) and DRB1-mismatched (n = 71) groups. Four acute rejections occurred in the DRB1-matched group (incidence; 17%) and 40 in the DRB1-mismatched group (56%). In the DRB1-matched group, the incidence of acute rejection was significantly less frequent than that of the DRB1-mismatched group (P < 0.005). In the DRB1-matched group, only one patient received OKT3 administration (4%), in contrast to 16 of 71 patients in the DRB1-mismatched group (23%). The use of OKT3 was significantly less frequent in the DRB1-matched group (P < 0.05). Histopathological findings from biopsy specimens showed no constant distribution of pathological grades of acute rejection according to DRB1 matching in the present study. The graft survival rate in the two groups did not differ significantly, but the graft survival rate in the DRB1-mismatched group had a tendency to decrease as the grafts survived longer. In conclusion, the results of the present study confirm that HLA-DRB1 matching has marked beneficial effects on kidney transplants through reduction of the acute rejection rate and decrease of the severity of rejection, and suggest that improvement of graft survival will be obtained through kidney allocation to a DRB1-matched recipient.

[Clinical study on cerebrovascular diseases after renal transplantation].

Between October 1975 and December 1994, 131 renal transplants were performed on our hospital. Eight of these patients had 9 cerebrovascular diseases, which were 2 cerebral hemorrhages, 5 cerebral infarctions, 2 subarachnoid hemorrhages. Five of the 8 patients whose graft functions were bad died. We studied the relationship of the incidence of these complications to some factors as follows; 1) blood pressure, 2) hypercholestemia, 3) duration of hemodialysis, and 4) graft function. The cerebrovascular diseases after renal transplantation were related to the hypertension after renal transplantation and no correlation with the other factors could be found. Therefore, we think that the control of the hypertension after renal transplantation is the most important for the cerebrovascular diseases and the patient's prognosis.

[Tissue type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) in transplanted kidneys].

We have studied the involvement of fibrinolysis in acute rejection after kidney transplantation by analyzing changes in urinary levels of substances such as FDP, D-dimer, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI). Fibrinolytic activity was found to be low (that is, PAI is dominant) during acute rejection, and it was elevated (that is, PA became dominant) as acute rejection subsided. It appears that the dominance of PA leads to an increase in the products of fibrinolysis and an elevation in the D-dimer/FDP ratio, resulting in disappearance of the acute rejection. Based on these findings, we thought it necessary to administer t-PA to kidney recipients so that PA becomes dominant earlier and the acute rejection can be reduced. It is necessary for us to directly study the phenomena within the kidneys. Therefore, we recently conducted a histochemical study of the distribution of t-PA, Urokinase type PA (u-PA) and PAI in transplanted kidneys. Transplanted kidney, which functioned well or showed signs of acute or chronic rejection, were biopsied. These renal samples as well as control samples (biopsied from normal nongrafted kidney) were examined as to distribution of t-PA, u-PA and PAI by the indirect enzyme complement method. In conclusion, t-PA, u-PA and PAI were detected in the glomeruli, arterioles, tubule and interstices of the control kidneys, well functioning grafts, acutely rejected grafts chronically rejected grafts. All samples showed intense chromatic responses in the arterioles and part of the tubules. On the whole, the chromatic response tended to be more intense in the acute rejection group than in the other group.

[Clinical study of the timed voiding schedule for urinary incontinence in demented elders].

Fourty-one demented elderly patients who had been diapered because of urinary incontinence in Hanwa-Senboku Hospital were treated with the one-week timed voiding schedule. Finally 14 patients (34%) became dry, and free from diapers for more than 1 week after the treatment. With regard to their cystometrogram findings, 10 (67%) of 15 patients having normoactive detrusor function, 3 (14%) of 21 patients having overactive detrusor function and 1 (20%) of 5 patients having underactive detrusor function became free from diapers after the treatment. Therefore a patient with normoactive detrusor function is thought to be a good candidate for the timed voiding schedule. Regardless of their detrusor function, those who showed good responsiveness to the treatment had better activities in daily life (better than D in the Katz index) and small amount of residual urine (less than 80 ml), indicating that not only the detrusor function but also both activities in daily life and the amount of residual urine are the important factors to reestablish voiding behavior in demented elderly patients. The timed voiding schedule is thought to be a useful method to treat incontinence in demented elderly patients, and should be tried first of all, although intermittent catheterization and/or other alternatives would be necessary for those with a large amount of residual urine with poor activities in daily life.

[Anticholinergic therapy of urinary incontinence and urinary frequency associated with the elderly--with special reference to dementia].

Pharmacotherapy with anticholinergic agents was studied in a total of 80 patients aged 65 years or older with chief complaints of urinary frequency (4 patients) and/or ugency incontinence (76 patients). The subjects were 45 men and 35 women at the age ranging between 65 and 92 (mean 73.7). The patients received anticholinergic agents (terodiline hydrochloride 24 mg/day, oxybutynin hydrochloride 6 mg/day, propantheline bromide 60 mg/day separately or in combination) for more than two weeks. Subjective symptoms and objective findings were assessed before and after the administration. In addition, according to the result of Hasegawa's dementia rating scale the patients were divided into dementia group and non-dementia group for further evaluation of the study drugs. As a result, cystometrogram revealed significant increase of maximum bladder capacity in either dementia group or non-dementia group. There was no significant difference in rate of objective improvement between both groups. On the other hand, rate of subjective improvement was significantly higher in non-dementia group (40%) than in dementia group (15%). As mentioned above, improvement of cystometrogram findings was not associated with improvement of subjective symptoms in the demented patients. This suggests that the major cause of incontinence in demented patients is not the bladder dysfunction but the specific conditions of demented patients such as agnosia and apraxia.

[Investigation on unsuccessful endoscopic operation for cases with vesicoureteral reflux].

Endoscopic operation of vesicoureteral reflux (VUR) has several advantages such as less invasiveness and technical ease with the procedure and shorter hospitalization for the operation in comparison with coeliotomy, but the cure rate achieved by endoscopic operation compares unfavorably with that by coeliotomy. The unsuccessful cases of VUR by endoscopic operation were investigated to promote the success rate by endoscopic operation. Of 66 ureters in 55 patients 50 were successfully treated with the first operation, and 4 of 8 ureters with the second one. All 15 infants were cured, but the cure rate in females between 17 and 45 year old was significantly low (57%). An equally high cure rate was obtained by the endoscopic operation even in patients who had a high grade VUR, patulous ureteral orifices, an underlying neurogenic bladder, or episodes of urinary tract infection. All ureters were cured just after operation. The recurrence of VUR occurred in 19 ureters (29%) and 16 ureters were discovered at one month examination after operation, which indicates that olive oil dissolving teflon paste was partly absorbed to bladder tissue. Teflon paste shifted to internal urethral orifice in 4 unsuccessful ureters. Based on these findings, the endoscopic operation should be considered to be the preferred treatment among others in the management of VUR and the injection of sufficient volume of teflon paste into submucosal and muscular space of the bladder trigone could promote the cure rate.

[Evaluation of kidney graft function with dynamic MRI--preliminary report].

The value of dynamic magnetic resonance imaging (MRI) in the examination of the function of transplanted kidneys was examined. Dynamic MRI was performed on 14 renal transplant patients. After the injection of Gd-DTPA (dimeglumine gadopentetate), we used small tip angle gradient echo (STAGE) technique with a flip angle of 20 degrees. The cortex was higher in signal intensity of well functioning grafts than the medulla before the injection in Gd-DTPA. Signal intensity of the cortex decreased after 30 seconds. After 1 minute the signal intensity of the cortex recovered and low intensity band meaning passage of Gd-DTPA at corticomedullary differentiation was displayed. Signal intensity of the medulla decreased after 3 minutes. Signal intensity of the parenchyma of transplanted kidney after 5 minutes was much the same as that before injection. Image of poor functioning grafts displayed unclear figures. Time-intensity values of both cortex and medulla in well functioning grafts decreased rapidly after about 2 minutes, and rose thereafter. Time-intensity curves of both cortex and medulla were almost flat on and after 5 minutes. Time-intensity curves of both cortex and medulla in poor functioning grafts were almost flat through out the examination. We concluded that effective parameters of the graft function for the time-intensity curve were delta I1 and delta I2. Dynamic MRI was suggested to be useful in the evaluation of kidney graft function.