A multi-institutional, observational study of outcomes after catheter placement for peritoneal dialysis in Japan.

BACKGROUND: This multi-institutional, observational study examined whether the outcomes after peritoneal dialysis (PD) catheter placement in Japan meet the audit criteria of the International Society for Peritoneal Dialysis (ISPD) guideline and identified factors affecting technique survival and perioperative complications. METHODS: Adult patients who underwent first PD catheter placement for end-stage kidney disease between April 2019 and March 2021 were followed until PD withdrawal, kidney transplantation, transfer to other facilities, death, 1 year after PD start or March 2022, whichever came first. Primary outcomes were time to catheter patency failure and technique failure, and perioperative infectious complications within 30 days of catheter placement. Secondary outcomes were perioperative complications. Appropriate statistical analyses were performed to identify factors associated with the outcomes of interest. RESULTS: Of the total 409 patients, 8 who underwent the embedded catheter technique did not have externalised catheters. Of the 401 remaining patients, catheter patency failure occurred in 25 (6.2%). Technical failure at 12 months after PD catheter placement calculated from cumulative incidence function was 15.3%. On Cox proportional hazards model analysis, serum albumin (hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27-0.70) and straight type catheter (HR 2.14; 95% CI 1.24-3.69) were the independent risk factors for technique failure. On logistic regression analysis, diabetes mellitus was the only independent risk factor for perioperative infectious complications (odds ratio 2.70, 95% CI 1.30-5.58). The occurrence rate of perioperative complications generally met the audit criteria of the ISPD guidelines. CONCLUSION: PD catheter placement in Japan was proven to be safe and appropriate.

Associations between patterns of participation in community activities and social support, self-efficacy, self-rated health among community-dwelling older adults.

Certain types of community-based social activities improve the health issues of older adults; however, the present patterns of participation in community activities remain unknown. This study aims 1) to identify community-dwelling older adults' patterns of participation in community-based activities and 2) to evaluate the relationships between social support, self-efficacy, self-rated health, and the patterns of participation in community activities. This cross-sectional study used data collected from 146 older adults aged ≥65 years who participated in community events in Japan in 2018. Cluster analysis was used to identify subjects' patterns of participation in community activities. In the multinomial logistic regression model, the participation pattern (dependent variable), and social support and self-efficacy (independent variables), were included, adjusting for age, sex, and years of residency. Three participation pattern clusters were identified: diverse activities (58%), municipal events (30%), and senior citizen club (12%). The proportion of participants reported themselves healthy were 93%, 88%, and 78% for diverse activities, municipal events, and senior citizen club clusters, respectively. Compared to those in the senior citizen club cluster, older adults in the diverse activities cluster were more likely to have self-efficacy (adjusted odds ratio (aOR): 1.19, p = .041) and social support (aOR: 2.35, p = .018), while participants in the municipal events cluster were associated with only social support (aOR: 3.29, p = .022). Increasing social support and self-efficacy may promote seniors' participation in diverse community activities, which would be beneficial for their healthy aging. Further studies are needed to evaluate the causal relationships.

Clinical Features, Prognosis, Diagnostic Approaches and Treatment of Multiple Primary Malignancies in the Digestive System.

BACKGROUND/AIM: Additional primary malignancy (APM) risk is increasing with improved prognosis of cancer survivors. In order to clarify risk factors and patients susceptible to develop APMs, we investigated the clinical features, prognosis, and approaches for diagnosis and treatment in these patients. PATIENTS AND METHODS: Among 874 patients newly diagnosed with gastrointestinal tract (GIT) or hepato-biliary-pancreatic (HBP) cancers between 2011 and 2014, 124 with a synchronous and/or metachronous APM were identified. Patient characteristics, time interval between the malignancies, clue to detect APMs, treatment approaches, and prognosis were investigated. RESULTS: Patients with APMs were older and predominantly male. Half of the metachronous APMs were detected within 3 years after the first primary malignancy (PM). The main clue to detect synchronous and metachronous APMs was preoperative screening for current PM, and follow-up of prior PM, respectively. There was no significant difference in the overall survival between colon cancer patients with or without APMs. CONCLUSION: Multiple PMs were present in 14.2% of patients. Male and old age were identified to be risk factors for APM. Pre-operative screening and post-operative regular follow-ups are important for detecting synchronous or metachronous APMs.

Differences in characteristics of raters who use the visual estimation method in hospitals based on their training experiences.

BACKGROUND & AIMS: Despite a clinical need, only a few studies have provided information concerning visual estimation training for raters to improve the validity of their evaluations. This study aims to describe the differences in the characteristics of raters who evaluated patients' dietary intake in hospitals using the visual estimation method based on their training experiences. METHODS: We collected data from three hospitals in Tokyo from August to September 2016. The participants were 199 nursing staff members, and they completed a self-administered questionnaire on demographic data; working career; training in the visual estimation method; knowledge, attitude, and practice associated with nutritional care; and self-evaluation of method validity of and skills of visual estimation. We classified participants into two groups, experienced and inexperienced, based on whether they had received training. Square test, Mann-Whitney U test, and univariable and multivariable logistic regression analysis were used to describe the differences between these two groups in terms of their characteristics; knowledge, attitude, and practice associated with nutritional care; and self-evaluation of method validity and tips used in the visual estimation method. RESULTS: Of the 158 staff members (79.4%) (118 nurses and 40 nursing assistants) who agreed to participate in the analysis, thirty-three participants (20.9%) were trained in the visual estimation method. Participants who had received training had better knowledge (2.70 ± 0.81, score range was 1-5) than those who had not received any training (2.34 ± 0.74, p = 0.03). Score of self-evaluation of method validity of the visual estimation method was higher in the experienced group (3.78 ± 0.61, score range was 1-5) than the inexperienced group (3.40 ± 0.66, p < 0.01). Mean total scores of using tips in the visual estimation method in the experienced and inexperienced groups were 19.6 ± 1.76 and 17.9 ± 2.28, respectively (score range was 6-24), differing significantly between the two groups (p < 0.01). Multivariable logistic regression revealed that participants who had been trained had adequate knowledge (OR: 2.78, 95% CI: 1.05-7.35) and frequently used tips in visual estimation (OR: 1.85, 95% CI: 1.26-2.73). CONCLUSION: Trained participants had more required knowledge and they used visual estimation tips more frequently than participants who had not been trained in the visual estimation method. This study provides new evidence for the importance of training clinical staff members to use the visual estimation method appropriately and makes suggestions to improve the validity of the visual estimation method.

Differences in the validity of a visual estimation method for determining patients' meal intake between various meal types and supplied food items.

BACKGROUND & AIMS: The aim of this study was to examine differences in the validity of a visual estimation method for determining patients' meal intake between various meal types and supplied food items in hospitals and to find factors influencing the validity of a visual estimation method. METHODS: There are two procedures by which we obtained the information on dietary intake of the patients in these hospitals. These are both by visual assessment from the meal trays at the time of their clearing, by the attending nursing staff and by weighing conducted by researchers. The following criteria are set for the target trays: A) standard or therapeutic meals, which are monitored by a doctor, for energy and/or protein and/or sodium; B) regular, bite-sized, minced and pureed meal texture, and C) half-portion meals. Visual assessment results were tested for their validity by comparing with the corresponding results of weighing. Differences between these two methods indicated the estimated and absolute values of nutrient intake. RESULTS: A total of 255 (76.1%) trays were included in the analysis out of the 335 possible trays and the results indicated that the energy consumption estimates by visual or weighing procedures are not significantly different (412 ± 173 kcal, p = 0.15). However, the mean protein consumption was significantly different (16.3 ± 6.7 g/tray, p < 0.01) between the two procedures. Compared with standard meals (38 ± 45 kcal, 1.9 ± 2.5 g/tray), raters significantly misestimated the energy and protein intake of half-portion meals (78 ± 65 kcal, 2.8 ± 2.2 g/tray, p = 0.01) but accurately estimated the protein intake of protein controlled meals (0.5 ± 0.6 g/tray, p = 0.03). Trays adding supplied food items were significantly misestimated for energy intake (66 ± 58 kcal/tray) compared to trays with no additions (32 ± 39 kcal/tray, p < 0.01). Moreover, the results of multivariable analysis demonstrated that supplied food items were significantly associated with increased odds of a difference between the two methods (OR: 3.84; 95% confidence interval [CI]: 1.07-13.85). CONCLUSIONS: There were high correlations between the visual estimation method and the weighing method measuring patients' dietary intake for various meal types and textures, except for meals with added supplied food items. Nursing staff need to be attentive to supplied food items.

Association Between Interdialytic Weight Gain, Perception About Dry Weight, and Dietary and Fluid Behaviors Based on Body Mass Index Among Patients on Hemodialysis.

OBJECTIVE: This study aimed to identify dietary and fluid behaviors associated with relative interdialytic weight gain (RIDWG) (divided by the respective dry weight [DW]) by stratifying the patients according to body mass index (BMI). DESIGN AND METHODS: This was a cross-sectional, multicenter investigation. Between July 2016 and March 2017, data were collected from 4 Japanese dialysis centers in 3 cities. The patients (n = 577) were asked to reply to a self-completed questionnaire, including questions on perception about DW and dietary and fluid behaviors. The differences in perception about DW and dietary and fluid behaviors were compared between RIDWG nonadherence (average RIDWG ≥5％ a month) and adherence subgroups. RESULTS: The 360 participants were stratified into thin (<20; 28.6%), normal low (≥20 and <22; 22.5%), normal high (≥22 and <25; 31.7%), and overweight (≥25; 17.2%) groups on the basis of BMI. In the thin and normal low BMI groups, the RIDWG nonadherent patients were more likely to identify their DW as "looking to increase." Although the difference was less prominent between the adherence subgroups in the thin BMI group, the RIDWG nonadherent patients in normal low BMI group seemed to generally take less care to intentionally regulate their behaviors as a representative of sodium-intake/fluid management. Although patients with a larger body size (overweight and normal high BMI groups) were not associated with this perception about DW, they were associated with some demographic characteristics; regarding the normal high BMI group, a higher proportion of RIDWG nonadherent patients worked full-time, and they more frequently reported an irregular eating pattern. CONCLUSION: Dietary and fluid behaviors associated with RIDWG differed according to the BMI group. Assessing more specific types of patient behaviors, focusing on the underlying factors associated with dietary and fluid behaviors, and taking BMI into consideration are required.

Eosinophilic funiculitis initially diagnosed as irreducible inguinal hernia: A case report.

BACKGROUND: Most groin masses are first suspected to be groin hernias. More than 80% of bulging groin lesions are reportedly diagnosed as hernias by ultrasonography. Establishment of the correct diagnosis of hernia among all differential diagnoses is not easy. We herein describe a very rare case of groin eosinophilic funiculitis that presented as an irreducible groin hernia. CASE PRESENTATION: A 59-year-old man presented to our hospital with suspicion of a right groin hernia. He had a 1-week history of a painful right groin tumor. The tumor was about 4 cm without skin redness or warmth, irreducible even in the supine position, and associated with mild tenderness. Enhanced computed tomography showed that the mass seemed to be connected to the intra-abdominal structures. With time, the patient's pain did not increase, the inflammatory response did not worsen, and no ischemic signs were observed by enhanced computed tomography. Therefore, we diagnosed the tumor as an irreducible but not incarcerated hernia and performed elective surgery. Intraoperative examination revealed no hernia sac, and a 4-×3-cm tumor was observed around the spermatic cord. A malignant tumor was not completely ruled out. High orchiectomy was performed after consultation with the urologists. Pathological examination of the tumor showed no malignant features, and the final diagnosis was eosinophilic funiculitis with massive inflammatory changes and eosinophil invasion. CONCLUSION: Eosinophilic funiculitis is very rare; only three cases have been reported to date. We should always consider unusual causes of groin masses during a surgical approach to hernia-like lesions.

Beneficial Effects of Lemon Balm Leaf Extract on In Vitro Glycation of Proteins, Arterial Stiffness, and Skin Elasticity in Healthy Adults.

Glycation, a non-enzymatic glycosylation of proteins, induces tissue damage in association with various diseases and aging phenomena. Pentosidine, an advanced glycation end product, is involved in aging phenomena such as tissue stiffness. In this study, we aimed to find a potent anti-glycation food material and to verify its health benefits by clinical trial. From among 681 hot water plant extracts, lemon balm (Melissa officinalis; LB) leaf extract was selected and revealed to have more potent inhibitory activity for pentosidine formation than a representative anti-glycation agent, aminoguanidine. Rosmarinic acid (RA), a typical polyphenol in Lamiaceae plants, was identified as a major active component in LB extract (LBE). Furthermore, LBE or RA dose-dependently suppressed glycation-associated reactions such as increased fluorescence, yellowing of collagen fiber sheets, and degeneration of the fibrous structure of elastin fiber sheets. An open-label, parallel-group comparative trial was conducted in 28 healthy Japanese subjects aged 31-65 y who consumed LB tea (LB group) or barley tea (Control group) for 6 wk. The LB group showed significant reductions in brachial-ankle pulse wave velocity, reflecting arterial stiffness, and b* (yellow) color values in forearm skin compared with the Control group. A gender-stratified analysis revealed that cheek skin elasticity was significantly improved in the LB group compared with the Control group only in female subjects. It is concluded that the hot water extract of LB leaf has the potential to provide health benefits with regard to glycation-associated tissue damage in blood vessels and skin of healthy adults.

Criterion validity of the visual estimation method for determining patients' meal intake in a community hospital.

BACKGROUND & AIMS: The accuracy of the visual estimation method is unknown, even though it is commonly used in hospitals to measure the dietary intake of patients. We aimed to compare the difference in the validity of visual estimation according to the raters' job categories and tray divisions, and to demonstrate associations between meal characteristics and validity of visual estimation in a usual clinical setting in a community hospital. METHODS: We collected patients' dietary intake data in usual clinical settings for each tray in 3 ways: visual estimation by nursing assistants, visual estimation by dietitians, and weighing by researchers (reference method). Dietitians estimated the dietary intake using 2 divisions, namely, whole tray and food items. Then we compared the weights and visual estimation data to evaluate the validity of the visual estimation method. RESULTS: Mean nutrient consumption of target trays was significantly different when using the visual estimation of target trays than when using the weighed method (visual estimation by nursing assistants [589 ± 168 kcal, 24.3 ± 7.0 g/tray, p < 0.01], dietitians' whole trays [561 ± 171 kcal, 23.0 ± 6.9 g/tray, p < 0.05], food items [562 ± 171 kcal/tray, p < 0.05], and dietitians' food items [23.4 ± 7.3 g/tray, p = 0.63]). Spearman's correlations for both methods were very high for energy (ρ = 0.91-0.98, p < 0.01) and protein intakes (ρ = 0.88-0.96, p < 0.01), respectively. The limits of agreement in the Bland-Altman plot for both dietary intake categories were -121 kcal to 147 kcal/tray and -6.4 g to 7.0 g/tray (nursing assistants, whole division), -122 kcal-106 kcal/tray and -6.7 g to 5.5 g/tray (dietitians, whole divisions), and -82 kcal to 66 kcal/tray and -4.3 g to 3.9 g/tray (dietitians, food items divisions). High intake rate of grains was significantly associated with decreased odds of a difference between two methods based on the nursing assistant's whole tray evaluation (odds ratio [OR]: 0.85; 95% confidence interval [CI]: 0.76-0.94) and the dietitians' whole tray (OR: 0.80; 95% CI: 0.72-0.89) and food items evaluations (OR: 0.64; 95% CI: 0.56-0.73), respectively. In addition, minced meals were also associated with a difference between two methods, for the nursing assistants' whole tray (OR: 3.53; 95% CI: 1.66-7.51) and dietitians' food items (OR: 2.92; 95% CI: 1.37-6.22). CONCLUSIONS: Visual estimation by nursing assistants and dietitians correlated highly with the weighing method although the limits of agreement were wide. Nursing assistants and dietitians should pay attention to low consumption and modified texture meals when evaluating dietary intake using the visual estimation method.

[Hypertension with chronic kidney disease: anti-hypertensive therapy recommended for the management of hypertension with CKD in JSN-CKD GL 2013 and JSH2014].

For clinical practice guidelines for the management of hypertension with CKD, the Japanese Society of Nephrology (JSN) and the Japanese Society of Hypertension (JSH) evaluated recently published evidence in corporation with each other. After considerable and careful discussion, both JSN and JSH revised their respective guidelines [the Evidence-based Clinical Practice Guideline for CKD 2013 (JSN-CKD GL 2013) and JSH2014]. This section will mainly introduce anti-hypertensive therapy recommended for the management of hypertension with CKD in both guidelines. Recommendation statements for the Management of Hypertension with CKD are as follows: 1) Anti-hypertensive therapy in CKD is strongly recommended to inhibit or prevent the progression of renal dysfunction and to prevent the occurrence or recurrence of CVD by reducing blood pressure (BP) (Grade A). 2) In all diabetic CKD, the target level of clinic BP is recommended as < 130/80 mmHg, irrespective of the presence or absence of albuminuria/proteinuria (Grade B). 3) In all non-diabetic CKD, the target level of clinic BP is strongly recommended as consistently < 140/90 mmHg, irrespective of the presence or absence of albuminuria/proteinuria (Grade A). 4) In non-diabetic CKD with A2 and A3 categories, the target level of clinic BP can be set as < 130/80 mmHg (Grade C1). 5) In diabetic CKD with A1 category, ARBs and ACE inhibitors are suggested as first-line anti-hypertensive drugs(Grade C1). 6) In diabetic CKD with A2 and A3 categories, ARBs and ACE inhibitors are recommended as first-line anti-hypertensive drugs (Grade A). 7) In non-diabetic CKD with A1 category, ARBs, ACE inhibitors, calcium channel blockers (CCBs) and diuretics are recommended as first-line anti-hypertensive drugs (Grade B). 8) In non-diabetic CKD with A2 and A3 categories, ARBs and ACE inhibitors are recommended as first-line anti-hypertensive drugs (Grade B).

Beneficial Effects of Citrus Juice Fermented with Lactobacillus plantarum YIT 0132 on Japanese Cedar Pollinosis.

Recently, the prevalence of allergies in Japan has been increasing. Certain types of fruit juice and lactic acid bacteria are known to alleviate allergic symptoms. Therefore, we examined whether citrus juice fermented by a specific lactic acid bacteria can improve the symptoms of Japanese cedar pollinosis (JCPsis). Lactobacillus plantarum YIT 0132 (LP0132) was selected based on its high proliferative activity in citrus juice and anti-inflammatory interleukin-10-inducing activity. Dietary administration of heat-killed LP0132 cells or citrus juice fermented with LP0132 was found to significantly suppress nasal rubbing in a JCPsis mouse model, indicating relief of allergy symptoms. To evaluate the effects of LP0132-fermented citrus juice on pollinosis symptoms and quality of life (QOL) in humans with JCPsis, a single-blind, placebo-controlled, parallel-group clinical trial was conducted. The participants were 42 adults with JCPsis. They ingested 100 mL of sterilized LP0132-fermented citrus juice (active group) or unfermented citrus juice (placebo group) once daily for 8 weeks. Immediately after the pollen peak when allergy symptoms and QOL loss were most severe, itchy eyes, itchy skin, and QOL loss by JCPsis were alleviated in the active group compared with the placebo group. At 10 weeks after starting the intervention, increased the levels of blood eosinophils were significantly suppressed in the active group compared with the placebo group. We conclude that continuous ingestion of citrus juice fermented with LP0132 may help alleviate the allergy symptoms and impaired QOL caused by JCPsis.

One-minute mental status examination for category fluency is more useful than mini-mental state examination to evaluate the reliability of insulin self-injection in elderly diabetic patients.

AIMS/INTRODUCTION: We investigated the factors associated with the reliability of insulin self-injection in elderly diabetic patients receiving insulin therapy. MATERIALS AND METHODS: We enrolled diabetic patients aged ≥65 years and receiving insulin therapy, and assessed their cognitive function by the mini-mental state examination and 1-min mental status examination for category fluency. We also observed their technique of insulin self-injection, and evaluated whether or not patients were able to inject insulin by themselves according to nine defined details in terms of insulin self-injection. The predictive factors for the reliability of insulin self-injection were determined by univariate and multivariate logistic regression analysis. There were 278 participants (135 males, 143 females) enrolled in the present study. RESULTS: According to multivariate logistic regression analysis, only the 1-min mental status examination score was found to be a significant independent predictor of the reliability of insulin self-injection (odds ratio 0.75; 95% confidence interval 0.62-0.90; P = 0.002). CONCLUSIONS: The 1-min mental status examination for category fluency can be considered more useful than mini-mental state examination to evaluate the reliability of insulin self-injection in elderly diabetic patients receiving insulin therapy.

Lactobacillus casei Shirota enhances the preventive efficacy of soymilk in chemically induced breast cancer.

Soy foods are known to be effective for breast cancer prevention. The habitual consumption of soy isoflavones in combination with the probiotic Lactobacillus casei Shirota (LcS) was shown to decrease the risk of breast cancer occurrence in our previous population-based case-controlled study among Japanese women. The present study aimed to elucidate the cooperative prevention mechanism of soymilk and LcS using an animal carcinogenic model. Female Sprague-Dawley rats received a high-fat, AIN-76A diet containing soymilk, LcS, both soymilk and LcS, or none and were orally exposed to 2-amino-1-methyl-6-penylimidazo[4,5-b]pyridine at a dose of 85 mg/kg bodyweight eight times for 2 weeks. The development of palpable mammary tumors was monitored for 17 weeks. Tumor tissues were immunohistochemically examined for estrogen receptor (ER)-α, Ki-67 and CD34. Compared with the control group, the incidence and multiplicity of mammary tumors were reduced by soymilk alone and soymilk in combination with LcS, while tumor volume was decreased by LcS alone and LcS in combination with soymilk. An immunohistochemical analysis revealed that soymilk in combination with LcS more effectively reduced the numbers of ER-α-positive and Ki-67-positive cells in tumors than soymilk alone and that both soymilk and LcS inhibited tumor angiogenesis. These results demonstrated that soymilk prevents the development of mammary tumors and that LcS suppresses tumor growth, potentially enhancing the preventive efficacy of soymilk. The habitual consumption of LcS in combination with soymilk might be a beneficial dietary style for breast cancer prevention.

[A questionnaire survey on current status of anti-diabetic therapy for diabetic patients with dementia].

AIM: It is important to establish treatment goals and optimal anti-diabetic therapy for diabetic patients with dementia. However, there are currently no established treatment guidelines. Recently, the West Tokyo Diabetes Association has established the Diabetes and Dementia Study Group to investigate the status of anti-diabetic therapy for diabetic patients with dementia. Here, we assessed the current status of such patients by a questionnaire survey. METHODS: In November 2011, we conducted a mailed survey to the clinics and hospitals affiliated with Kita-Tama, Hachioji and Tachikawa Medical Associations in Tokyo, Japan. The survey evaluated the most suitable anti-diabetic therapy for elderly diabetic patients or diabetic patients with dementia, combined anti-diabetic therapy, insulin therapy for elderly diabetic patients and diabetic patients with dementia, combination therapy of insulin and oral anti-diabetic agents for diabetic patients with dementia, factors that make it difficult for diabetic patients with dementia to continue insulin therapy, and selection of treatment or care for diabetic patients with dementia. RESULTS: The responses indicated that the anti-diabetic agents appropriate for diabetic patients with dementia are dipeptidyl peptidase-4 inhibitors. Those inappropriate for the same patients are metformin and insulin. Family support was a major factor for insulin therapy continuation for diabetic patients with dementia. Moreover, anti-diabetic agents for these patients are selected according to their ease of use and compatibility with available familial and social resources. CONCLUSION: Our survey results can be utilized for the creation of new guidelines and educational resources for the anti-diabetic therapy of diabetic patients with dementia.

Decomposition of insoluble and hard-to-degrade animal proteins by enzyme E77 and its potential applications.

Insoluble and hard-to-degrade animal proteins are group of troublesome proteins, such as collagen, elastin, keratin, and prion proteins that are largely generated by the meat industry and ultimately converted to industrial wastes. We analyzed the ability of the abnormal prion protein-degrading enzyme E77 to degrade insoluble and hard-to-degrade animal proteins including keratin, collagen, and elastin. The results indicate that E77 has a much higher keratinolytic activity than proteinase K and subtilisin. Maximal E77 keratinolytic activity was observed at pH 12.0 and 65 °C. E77 was also adsorbed by keratin in a pH-independent manner. E77 showed lower collagenolytic and elastinolytic specificities than proteinase K and subtilisin. Moreover, E77 treatment did not damage collagens in ovine small intestines but did almost completely remove the muscles. We consider that E77 has the potential ability for application in the processing of animal feedstuffs and sausages.

Spontaneous renal hemorrhage in hemodialysis patients.

Dialysis patients have a tendency to bleed, and clinicians sometimes encounter cases with a significant amount of spontaneous hemorrhage. We herein report two cases of spontaneous renal hemorrhage in hemodialysis patients. CASE 1: A 70-year-old male who had received hemodialysis for 8 years presented with right abdominal pain. He had a history of renal failure due to diabetes mellitus. CT showed a right perirenal hemorrhage. Angiography revealed a right renal artery hemorrhage, and catheter embolization was performed. CASE 2: A 76-year-old male who had undergone 7 years of continuous ambulatory peritoneal dialysis and 1 year of hemodialysis presented with right abdominal pain. He had a history of renal failure due to IgA nephropathy. CT showed a right perirenal hemorrhage. He received a blood transfusion and was put on absolute bed rest. At 2 days after admission, his anemia was found to have improved.

Soybean-derived phosphatidylserine improves memory function of the elderly Japanese subjects with memory complaints.

Soybean-derived phosphatidylserine (Soy-PS) is a phosphatidylserine made from soybean lecithin by enzymatic reaction with L-serine. A double-blind, randomized controlled study was conducted to investigate the effects of Soy-PS on the cognitive functions of the elderly Japanese subjects with memory complaints. Seventy-eight elderly people with mild cognitive impairment (50-69 years old) were randomly allocated to take Soy-PS (100 mg, 300 mg/day) or placebo for 6 months. As a result, there was no difference in blood markers and vital signs during Soy-PS treatment and any side effect caused by Soy-PS treatment was not observed. Neuropsychological test scores were similarly increased in all groups including placebo group. However, in the subjects with relatively low score at baseline, the memory scores in PS treated groups were significantly increased against the baseline, while those of placebo group remained unchanged. And the memory improvements in Soy-PS-treated groups were mostly attributed to the increase in delayed verbal recall, a memory ability attenuated in the earliest stage of dementia. In conclusion, Soy-PS used in this study is considered as safety food ingredient and 6 months of Soy-PS supplementation could improve the memory functions of the elderly with memory complaints.

Anti-bovine viral diarrhoea virus and hepatitis C virus activity of the cyclooxygenase inhibitor SC-560.

BACKGROUND: A number of compounds were examined for their inhibitory effect on bovine viral diarrhoea virus (BVDV) replication in cell cultures and found that some cyclooxygenase (COX) inhibitors had antiviral activity against the virus. METHODS: Determination of compounds for their anti-BVDV activity was on the basis of the inhibition of virus-induced cytopathogenicity in Mardin-Darby bovine kidney (MDBK) cells. Anti-hepatitis C virus (HCV) activity was assessed by the inhibition of viral RNA synthesis in the subgenomic HCV RNA replicon cells. RESULTS: Among the test compounds, 5-(4-chlorophenyl)-1-(4-methoxyphenyl)-3-(trifluoromethyl)-1H-pyrazole (SC-560) was the most active against BVDV, and its 50% effective and cytotoxic concentrations were 10.9 +/-2.8 and 93.9 +/-24.5 microM in virus and mock-infected MDBK cells, respectively. The compound also suppressed BVDV RNA synthesis in a dose-dependent fashion. Studies on the mechanism of action revealed that SC-560 did not interfere with viral entry to the host cells. Furthermore, it was assumed that the antiviral activity of SC-560 was not associated with its inhibitory effect on COX. The combination of SC-560 and interferon-alpha was additive to synergistic in inhibiting BVDV replication. More importantly, the compound proved to be a selective inhibitor of HCV replication. CONCLUSIONS: SC-560 and its derivative might have potential as novel antiviral agents against HCV.

Differential representation of spectral and temporal information by primary auditory cortex neurons in awake cats: relevance to auditory scene analysis.

We investigated how the primary auditory cortex (AI) neurons encode the two major requisites for auditory scene analysis, i.e., spectral and temporal information. Single-unit activities in awake cats AI were studied by presenting 0.5-s-long tone bursts and click trains. First of all, the neurons (n=92) were classified into 3 types based on the time-course of excitatory responses to tone bursts: 1) phasic cells (P-cells; 26%), giving only transient responses; 2) tonic cells (T-cells; 34%), giving sustained responses with little or no adaptation; and 3) phasic-tonic cells (PT-cells; 40%), giving sustained responses with some tendency of adaptation. Other tone-response variables differed among cell types. For example, P-cells showed the shortest latency and smallest spiking jitter while T-cells had the sharpest frequency tuning. PT-cells generally fell in the intermediate between the two extremes. Click trains also revealed between-neuron-type differences for the emergent probability of excitatory responses (P-cells>PT-cells>T-cells) and their temporal features. For example, a substantial fraction of P-cells conducted stimulus-locking responses, but none of the T-cells did. f(r)-dependency characteristics of the stimulus locking resembled that reported for "comodulation masking release," a behavioral model of auditory scene analysis. Each type neurons were omnipresent throughout the AI and none of them showed intrinsic oscillation. These findings suggest that: 1) T-cells preferentially encode spectral information with a rate-place code and 2) P-cells preferentially encode acoustic transients with a temporal code whereby rate-place coded information is potentially bound for scene analysis.