Association between the transtheoretical model approach and sustained intradialytic pedaling exercise: A retrospective cohort study.

ABSTRACT: The transtheoretical model (TTM) is a promising approach to the promotion of behavior change, but it remains to be established whether there is an association between the TTM approach and intradialytic exercise among patients on hemodialysis (HD) with low motivation to exercise in a real-world setting.This retrospective cohort study, conducted in a regional hospital in Japan, included adult outpatients receiving HD 3 times per week who had never participated in intradialytic pedaling exercise despite the encouragement of the HD personnel. Patients were divided into 2 groups according to HD weekday. Patients undergoing HD on Tuesday, Thursday, and Saturday were encouraged by the HD unit team to exercise during HD based on the TTM (exposure group) and those receiving HD on Monday, Wednesday, and Friday were encouraged to exercise as usual (control group). The primary outcome was sustained intradialytic exercise using a leg ergometer, defined as a total of 72 sessions of 30-minute pedaling exercise (duration of at least 6 months).Overall, 85 patients were included in the analysis (mean age: 67.1 ±â€Š11.9 years, 22% female). Of 33 patients in the exposure group, 10 (30%) maintained intradialytic exercise, compared with 2 of 52 patients (4%) in the control group. Log-binomial regression models with stabilized inverse probability of treatment weighting showed a significant association between the TTM approach and sustained intradialytic exercise (adjusted risk ratio 9.23 [95% confidence interval 2.13-40.00]). There were no exercise-related cardiovascular events.Among patients with low motivation to exercise during HD, use of the TTM approach in clinical practice was associated with sustained intradialytic exercise compared with usual care.

Living-Donor Kidney Transplantation Performed in a Low-Volume Center by Visiting Surgeons From a High-Volume Center and Managed Clinically Solely by Nephrologists: 1-Year Outcomes.

BACKGROUND: Little is known about the outcome of living-donor kidney transplantation (LDKT) performed in low-volume centers lacking the services of full-time transplant surgeons. This retrospective cohort study assessed the outcome of LDKT performed in a low-volume center by visiting transplant surgeons from a high-volume center and managed perioperatively by transplant nephrologists. METHODS: We compared Japanese adult patients who had no donor-specific antibodies and underwent LDKT between 2006 and 2015 either in a low-volume (n = 31) or high-volume (n = 481) center. In the low-volume center, visiting transplant surgeons from the high-volume center conducted LDKT and transplant nephrologists managed the recipients peri- and postoperatively. The primary outcome was the composite of infection, cardiovascular disease, or cancer during 1-year follow-up. The outcomes of the low- and high-volume centers were compared using 1:2 propensity score matching. RESULTS: After matching, 9 of 29 patients in the low-volume center (31.0%) and 16 of 58 patients in the high-volume center (27.6%) experienced the primary composite outcome (risk ratio = 1.13; 95% confidence interval, 0.57-2.23). There were no significant differences between the 2 groups in graft function at 1 year, all-cause graft loss, biopsy-proven rejection, and urological complications. However, the median duration of post-LDKT hospitalization was significantly longer in the low-volume center than in the high-volume center (23 and 16 days, respectively). CONCLUSIONS: Among Japanese patients without preformed donor-specific antibodies, LDKT conducted at a low-volume center by visiting transplant surgeons from a high-volume center and managed clinically by transplant nephrologists was not associated with significantly higher risk of postoperative complications.

Efficacy and Safety of Adsorptive Granulocyte and Monocyte Apheresis in Elderly and Pregnant Patients With Ulcerative Colitis.

In patients with active ulcerative colitis (UC), adsorptive granulocyte/monocyte apheresis (GMA) is expected to promote remission. We conducted a retrospective cohort study to evaluate the efficacy and safety of GMA in patients with active UC. Twenty-one UC patients including five pregnant or lactating mothers and four elderly patients (aged >60 years) received up to 10 GMA sessions. UC severity was evaluated at baseline and after GMA therapy according to Lichtiger's Clinical Activity Index (CAI). We defined clinical remission as CAI ≤4. Overall, the median CAI score after GMA therapy had decreased from 9 to 4 (P < 0.001). The clinical remission rate was 62%, but in the elderly and pregnant or lactating mothers, the remission rates were 100% and 60%, respectively. No severe adverse effects were seen in this study. Our results may support GMA as an effective and safe treatment for active UC patients, including elderly patients and pregnant cases.

Growth Inhibition of an Opportunistic Yeast Pathogen Trichosporon asahii by Staphylococcus epidermidis.

In the co-culture of Staphylococcus epidermidis and Trichosporon asahii, a fungal pathogen, it was observed that live S. epidermidis inhibited the growth of T. asahii. Soluble active anti-T. asahii substances were speculated to be produced by S. epidermidis in culture medium. Using 1H- and 13C-NMR spectra and electron ionization-high resolution mass spectrometry (HR-negative-FAB-MS), we separated the active molecule and identified it as lactic acid. Commercially available L-lactic acid and D-lactic acid inhibited the growth of T. asahii. These results show that metabolites from bacterial populations are involved in the interactions of pathogenic fungi. The use of antibacterial agents to treat primary diseases could lead to the disruption of normal microbial communities and could cause opportunistic infections such as trichosporonosis.

Proposal of auxiliary diagnosis index for autism spectrum disorder using near-infrared spectroscopy.

Lack of a diagnostic index is a problem that needs to be overcome in the diagnosis of autism spectrum disorder (ASD), because this problem prevents an objective assessment based on biomarkers. This paper describes the development of a diagnostic index for ASD using near-infrared spectroscopy (NIRS). We investigated continuous prefrontal hemodynamic changes depending on reciprocal disposition of working memory and nonworking memory tasks using two-channel NIRS. NIRS signals in the prefrontal cortex were compared between high-functioning ASD subjects ([Formula: see text]) and typically developed (TD) subjects ([Formula: see text]). The brain activities of the TD subjects were related to experimental design. These results were not confirmed in brain activities of ASD subjects, although the task performance rate was almost equivalent. The brain activities of TD subjects and ASD subjects were evaluated using a weighted separability (WS) index obtained from the feature phase of oxy-hemoglobin and its differential value. Calculation of the [Formula: see text]-test (TD subject versus ASD subject) confirmed that WS was significant. This result showed that the proposed index was useful for evaluation of the brain activity of ASD subjects.

Measurement of brain function of car driver using functional near-infrared spectroscopy (fNIRS).

The aim of this study is to propose a method for analyzing measured signal obtained from functional Near-Infrared Spectroscopy (fNIRS), which is applicable for neuroimaging studies for car drivers. We developed a signal processing method by multiresolution analysis (MRA) based on discrete wavelet transform. Statistical group analysis using Z-score is conducted after the extraction of task-related signal using MRA. Brain activities of subjects with different level of mental calculation are measured by fNIRS and fMRI. Results of mental calculation with nine subjects by using fNIRS and fMRI showed that the proposed methods were effective for the evaluation of brain activities due to the task. Finally, the proposed method is applied for evaluating brain function of car driver with and without adaptive cruise control (ACC) system for demonstrating the effectiveness of the proposed method. The results showed that frontal lobe was less active when the subject drove with ACC.