Determinants of extracellular fluid after hemodialysis in CKD stage G5D patients measured by the bioelectrical impedance (BIA) method: A propensity score matching study

Background: Hemodialysis patients have a higher incidence of extracellular edema than patients with a normal renal function, even if their dry weight (DW) setting is appropriate. However, the factors determining post-dialysis edema in hemodialysis patients have not been fully elucidated. We investigated the determinants of post-dialysis ECW/TBW index (ratio of extracellular body water to total body water) in hemodialysis patients and compared them with non-chronic kidney disease (non-CKD) patients. Methods: The ECW/TBW index was measured using a bioimpedance body composition analyzer. We measured clinical parameters and the ECW/TBW index in 159 hemodialysis patients and 385 non-CKD patients. We evaluated the relationships with various clinical parameters by a multivariable linear analysis and stepwise regression analysis. Differences in age and BMI between the hemodialysis and non-CKD patients were adjusted by propensity score matching. The modified groups were analyzed by multivariable linear analysis and stepwise regression analyses. Results: The ECW/TBW index was significantly higher in the hemodialysis patients. A multivariable linear analysis with the ECW/TBW index as the objective variable showed significant associations in age, pre-dialysis Hb, Ht, TP, Alb, Cr, human atrial natriuretic peptide (HANP) and percent creatinine generation rate (%CGR) in hemodialysis patients. After propensity score matching for age and BMI, a strong effect of age was observed in the non-CKD patients, while Alb affected the ECW/TBW index in the hemodialysis patients. Conclusion: While age strongly influenced the ECW/TBW index in non-CKD patients, that in hemodialysis patients was more strongly influenced by serum Alb than age. High ECW/TBW index is associated with a poor prognosis in hemodialysis patients, suggesting the importance of paying attention to the pre-dialysis albumin concentration in the setting of the body fluid removal for DW.departmental bulletin pape

Adult onset of C1q nephropathy manifesting only as microhematuria

We report a case of C1q nephropathy that manifested only as microhematuria in a 27-year-old man. The patient had presented with microhematuria for five years. A light microscopic study of a renal biopsy specimen showed predominant mesangial C1q deposition. Staining for C3 was positive in the same mesangial area. Stainings for IgA, IgG and IgM were slightly positive, however, these stainings were not on mesangial lesion, suggesting as non-specific pattern. Electron microscopy indicated high electron-dense deposits in the mesangial area. Histopathological studies were compatible with C1q nephrology. In addition, laboratory data showed no serological evidence of collagen disease. 　Usually proteinuria, occasionally nephrotic syndrome were reported in C1q nephropathy and C1q nephropathy often cause severe damage in the glomerulocapillary area from an early stage. From April 1994 to the end of 2010, we experienced 6 patients with possibility of C1q nephropathy among the all 3614 patients in whom renal biopsy was studied, and the prevalence of C1q nephropathy was 0.17%. All of 6 patients showed continuous microhematuria and proteinuria, and 2 of 6 cases had nephrotic syndrome. Current patient showed only hematuria without proteinuria. Hematuria alone is not a major manifestation of C1q nephropathy. Thus, the clinical findings in our patient may represent a rare phenotype of C1q nephropathy. We report the details of the case with a comparison with previous C1q cases.departmental bulletin pape

Serum endothelial injury markers in hemodialysis patients with arteriovenous fistula stenosis

Background: In hemodialysis patients, failure of arteriovenous fistula (AVF) is a serious problem. AVF stenosis is dominant cause of vascular access failure. We hypothesized that vascular endothelial damage may be involved in arteriovenous fistula (AVF) stenosis. Methods: A cross-sectional observational survey was performed in 122 patients receiving maintenance hemodialysis in January-April 2004. Serum levels of adiponectin, adhesion molecules (intercellular adhesion molecule-1; ICAM-1 and vascular cell adhesion molecule-1; VCAM-1), and endothelial injury markers (CD146 and thrombomodulin) were compared between 46 patients with AVF stenosis and 76 patients without AVF stenosis to determine factors associated with AVF stenosis. Results: The serum adiponectin level was significantly lower in patients with AVF stenosis compared to those without AVF stenosis. Similarly, the serum levels of ICAM-1 and thrombomodulin were significantly lower in patients with AVF stenosis, whereas the serum level of VCAM-1 was significantly higher in patients with AVF stenosis. There were no significant differences in other parameters between the two groups. Logistic regression analysis with the presence or absence of AVF stenosis as the dependent variable showed that administration of an antihypertensive drug, VCAM-1, ICAM-1 and thrombomodulin were significantly associated with the presence of AVF stenosis in hemodialysis patients. Conclusion: The significant associations of administration of an antihypertensive drug, VCAM-1, ICAM-1 and thrombomodulin with AVF stenosis suggest that endothelial injury may play a critical role in this condition.departmental bulletin pape

Impact of Clinical TrainiInstructor’s Teaching Methods who Attended Basic Nursing Skills Practice with Faculty of School of Nursing

【目的】実習指導者（臨床講師）と教員による協働演習が実習指導者（臨床講師）の実習指導に及ぼす影響を明らかにする． 【方法】A 大学病院に勤務し，基礎看護学実習と領域別看護学実習の実習指導者を対象とした．基礎看護技術演習に参加した者を演習群，不参加者を対照群とした．基本属性（年齢，性別，看護職経験年数，看護専門教育の最終学歴，実習指導者講習会受講の有無，実習指導経験年数，協働演習参加回数），実習指導内容について無記名自記式質問紙を用いて調査した．質問紙は回収箱にて回収した．選択式データは基本統計量を求めた．倫理的配慮として，獨協医科大学看護研究倫理委員会にて承認を得た． 【結果】学生の特性の把握，目標の達成度の確認，学生個々に合わせた実習指導，病棟内の看護技術の方法の統一，教員との指導の一貫性については，演習群のほうが対照群に比べて多かった．一方，計画性のある実習指導，学生の課題の明確化については，対照群のほうが多かった． 【結論】実習指導者（臨床講師）の基礎看護技術演習への参加は，学生気質や学習進度を理解する機会となり，実習指導に良い影響を与えていることが示唆された．一方で，協働演習へ不参加であっても，計画性のある実習指導や学生の課題の明確化を意識して実習指導をしている実態が明らかとなった．departmental bulletin pape

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

publishedVersio

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

The Nordic wonder

This thesis explores the integration of Shinrinyoku, the Japanese practice of forest bathing, with textile art to evoke the essence of the Nordic landscape. It addresses the research question of how Shinrinyoku, deeply rooted in Japanese culture, intertwines with the tactile language of textiles to mirror the essence of the Nordic landscape. Employing Arts-Based Research (ABR), the study investigates the translation of the sensory experience of Shinrinyoku into textile art, facilitating a cross-cultural dialogue between Japanese traditions and the aesthetics of Nordic nature. Inspired by the meditative landscapes of Kaii Higashiyama, the research is rooted in a personal artistic journey that reflects a profound connection between humanity and nature. The work comprises two hand-woven textile collections, Conscious and Phenomena, and a series of Jacquard-woven blankets titled Nordic Blankets. These collections provide an artistic interpretation of the Nordic environment, capturing its physical and emotional landscapes through Japanese aesthetic principles. The research unfolds through the creation of the artworks, an exhibition, and audience engagement, leading to a reflective analysis of the artistic process. The exhibition phase of the study serves as a practical application of ABR, offering insights into the cultural impact of the artworks and the public's emotional resonance with them. Additionally, it involves an intimate interaction with the final textile artwork through a photographic session, exploring the textiles' emotive quality and the embodiment of the Shinrinyoku experience. The thesis concludes with a discussion on the symbiotic relationship between art, nature, and cultural perception, acknowledging the study's limitations and proposing directions for future research. The Nordic Wonder aims to contribute to a deeper understanding of the role of art in environmental engagement and cross-cultural expression, highlighting the intersection of Shinrinyoku and textile art in a Nordic context

Effects of the introduction of interprofessional conferences on the intensive care unit: Comparison of the length of stay in the intensive care unit before and after the introduction of interprofessional conferences

AbstractRecently, interprofessional team medicine has been practiced to achieve medical safety and improve patient outcomes. This study evaluated the effects of interprofessional conferences on intensive care units (ICUs) by comparing outcomes before and after their introduction. This study was conducted at a single center and included 1,765 patients who were admitted to the ICU between April 2017 and March 2019. There were 898 patients in the group before the introduction of conferences (before group) and 867 patients in the group after the introduction of conferences (after group). The interprofessional conferences involved physicians, nurses, physical therapists, nutritionists, and pharmacists. Data were extracted from the medical records. The primary outcome measure was the ICU length of stay (LOS). The secondary outcome measures were hospital LOS and rehabilitation and nutrition started within 48 hours of ICU admission. These outcomes were compared before and after the introduction of interprofessional conferences. The adjusted variables were gender, age, body mass index, ICU readmission, outcome, Barthel index at admission, and disease (classified by the International Statistical Classification of Diseases and Related Health Problems 10th edition). The ICU LOS (regression coefficient: -0.08; 95% confidence interval [CI]: -0.13 to -0.04) and hospital LOS (regression coefficient: -2.96; 95% CI: -5.20 to -0.72) were significantly shorter in after group than in the before group. Moreover, the proportion of patients who commenced nutrition (odds ratio [OR]: 1.45; 95% CI: 1.14 to 1.84) and rehabilitation (OR: 0.77; 95% CI: 0.51 to 1.17) within 48 hours of ICU admission was significantly higher in the after group than in the before group. Interprofessional conferences effectively reduced the ICU LOS and hospital LOS and improved the likelihood of commencing nutrition and rehabilitation within 48 hours of ICU admission.</jats:p

Therapeutic Potential of Two Derivative Prescriptions of Rokumijiogan, Hachimijiogan and Bakumijiogan against Renal Damage in Nephrectomized Rats

Background: Hachimijiogan (HJG) and Bakumijiogan (BJG), two derivative prescriptions of Rokumijiogan (RJG), were selected to investigate their renoprotective potential in the 5/6 nephrectomized (5/6Nx) rat model. Methods: Rats were treated with HJG and BJG orally at 150 mg/kg body weight/day once daily for 10 weeks after resection of 5/6 of the renal volume, and their renoprotective effects were compared with 5/6Nx vehicle-treated and sham-operated control rats. Results: Improvements in renal lesions, glomerulosclerosis, tubulointerstitial injury, and arteriosclerotic lesions estimated by histologic scoring indices in the HJG-treated group were compared with those in the BJG-treated group. HJG- and BJG-treated groups ameliorated the renal function parameters. Elevated levels of renal oxidative stress-related biomarkers were reduced, while decreased antioxidant defence systems (superoxide dismutase and the glutathione/oxidized glutathione ratio) were increased in the HJG-treated group rather than the BJG-treated group. In contrast, BJG administration significantly reduced expression of the inflammatory response through oxidative stress. The HJG-treated group showed a decrease in inflammatory mediators through the JNK pathway. To gain a deeper understanding of their therapeutic action, the effects of the main components detected in HJG and BJG were evaluated using the LLC-PK1 renal tubular epithelial cell line, which is the renal tissue most vulnerable to oxidative stress. Corni Fructus and Moutan Cortex-originated compositions afforded important protection against oxidative stress induced by peroxynitrite. Conclusions: From our described and discussed analyses, it can be concluded that RJG-containing prescriptions, HJG and BJG are an excellent medicine for chronic kidney disease. In the future, appropriately designed clinical studies in people with chronic kidney disease are necessary to evaluate the renoprotective activities of HJG and BJG.</jats:p