Long-term effect of cinacalcet hydrochloride on abdominal aortic calcification in patients on hemodialysis with secondary hyperparathyroidism

Background: Secondary hyperparathyroidism (SHPT) is one of the common complications in dialysis patients, and is associated with increased risk of vascular calcification. The effects of cinacalcet hydrochloride treatment on bone and mineral metabolism have been previously reported, but the benefit of cinacalcet on vascular calcification remains uncertain. The aim of this study was to evaluate the impact of cinacalcet on abdominal aortic calcification in dialysis patients. Subjects and methods: Patients were on maintenance hemodialysis with insufficiently controlled SHPT (intact parathyroid hormone [PTH] >180 pg/mL) by conventional therapies. All subjects were initially administered 25 mg cinacalcet daily, with concomitant use of calcitriol analogs. Abdominal aortic calcification was annually evaluated by calculating aortic calcification area index (ACAI) using multidetector computed tomography (MDCT), from 12 months before to 36 months after the initiation of cinacalcet therapy. Results: Twenty-three patients were analyzed in this study. The mean age was 59.0±8.7 years, 34.8% were women, and the mean dialysis duration was 163.0±76.0 months. After administration of cinacalcet, serum levels of intact PTH, phosphorus, and calcium significantly decreased, and mean Ca × P values significantly decreased from 67.4±7.9 mg2/dL2 to 52±7.7 mg2/dL2. Although the ACAI value did not decrease during the observation period, the increase in ACAI between 24 months and 36 months after cinacalcet administration was significantly suppressed. Conclusion: Long-term administration of cinacalcet was associated with reduced progression of abdominal aortic calcification, and achieving appropriate calcium and phosphorus levels may reduce the rates of cardiovascular events and mortality in patients on hemodialysis

Circulating KCNH2 Current-Activating Factor in Patients with Heart Failure and Ventricular Tachyarrhythmia

It is estimated that approximately half of the deaths in patients with HF are sudden and that the most likely causes of sudden death are lethal ventricular tachyarrhythmias such as ventricular tachycardia (VT) or fibrillation (VF). However, the precise mechanism of ventricular tachyarrhythmias remains unknown. The KCNH2 channel conducting the delayed rectifier K(+) current (I(Kr)) is recognized as the most susceptible channel in acquired long QT syndrome. Recent findings have revealed that not only suppression but also enhancement of I(Kr) increase vulnerability to major arrhythmic events, as seen in short QT syndrome. Therefore, we investigated the existence of a circulating KCNH2 current-modifying factor in patients with HF.We examined the effects of serum of HF patients on recombinant I(Kr) recorded from HEK 293 cells stably expressing KCNH2 by using the whole-cell patch-clamp technique. Study subjects were 14 patients with non-ischemic HF and 6 normal controls. Seven patients had a history of documented ventricular tachyarrhythmias (VT: 7 and VF: 1). Overnight treatment with 2% serum obtained from HF patients with ventricular arrhythmia resulted in a significant enhancement in the peaks of I(Kr) tail currents compared to the serum from normal controls and HF patients without ventricular arrhythmia.Here we provide the first evidence for the presence of a circulating KCNH2 channel activator in patients with HF and ventricular tachyarrhythmias. This factor may be responsible for arhythmogenesis in patients with HF

[資料] 専門看護師によるコンサルテーションにおける課題の明確化と共有に関する文献検討

要旨：目的：専門看護師によるコンサルテーションにおける課題の明確化と共有のプロセスに焦点を当て、既存の資料や文献に示された知見を整理し、実践的示唆や今後の課題について検討すること。方法：「専門看護師」「コンサルテーション」「課題」「共有」をキーワードに文献検索し、コンサルテーションの定義や類似する役割、課題の明確化や共有のための働きかけに関する事項を抽出した。倫理的配慮：著作権を遵守した。結果：コンサルテーションの定義は、コンサルタントがコンサルティ課題解決を側面的に援助する過程に総括された。コンサルタントが早期に課題を明確化・共有することはモデルやアプローチの判断を促進し、そのためにインタビューをはじめとする研究的な能力、コンサルティの自己省察や気づきを得るための働きかけが活用されていた。考察：コンサルテーションにおける課題の明確化・共有を推進するためには、コンサルテーションや類似する役割に関する理解の推進、コンサルタントの専門性や研究的な能力を活用することが重要である。結論：コンサルテーションにおける課題の明確化・共有はコンサルタントの研究的な能力やコンサルティの自己省察や気づきを得るための働きかけにより推進されていた。Abstract:Objective: To focus on the process of clarifying and sharing issues in consultation with a Certified Nurse Specialist (CNS), to organize the findings presented in existing materials and literature, and to consider practical suggestions and future issues.Method: A literature review was conducted using the keywords "Certified Nurse Specialist (CNS)," "consultation," "issues," and "share." Items related to the definition of consultation, similar roles, and efforts to clarify and share issues were extracted.Ethical considerations: Copyright compliance.Results: The definition of consultation was summarized as the process by which the consultant assisted the consultee in solving the problem. Early clarification and sharing of issues by consultants facilitate the judgment of models and approaches, and for that purpose, research abilities such as interviews, self-reflection by consultants and efforts to gain awareness are utilized.Discussion: In order to promote clarification and sharing of issues in consultation, it is important to promote an understanding of consultation and similar roles, and to utilize the expertise and research ability of consultants.Conclusion: Clarification and sharing of issues in consultation was enhanced by the consultant\u27s research ability, selfreflection of the consultation, and efforts to gain awareness

The serum vaspin levels are reduced in Japanese chronic hemodialysis patients

Background: Visceral adipose tissue-derived serine proteinase inhibitor (vaspin) is an adipokine identified in genetically obese rats that correlates with insulin resistance and obesity in humans. Recently, we found that 7% of the Japanese population with the minor allele sequence (A) of rs77060950 exhibit higher levels of serum vaspin. We therefore evaluated the serum vaspin levels in Japanese chronic hemodialysis patients. Methods: Healthy Japanese control volunteers (control; n = 95, 49.9 +/- 6.91 years) and Japanese patients undergoing hemodialysis therapy (HD; n = 138, 51.4 +/- 10.5 years) were enrolled in this study, and serum samples were subjected to the human vaspin RIA system. Results: The measurement of the serum vaspin levels demonstrated that a fraction of control subjects (n = 5) and HD patients (n = 11) exhibited much higher levels (> 10 ng/ml; Vaspin(High) group), while the rest of the population exhibited lower levels (< 3 ng/ml; Vaspin(Low) group). By comparing the patients in the Vaspin(Low) group, the serum vaspin levels were found to be significantly higher in the control subjects (0.87 +/- 0.24 ng/ml) than in the HD patients (0.32 +/- 0.15 ng/ml) (p < 0.0001). In the stepwise regression analyses, the serum creatinine and triglyceride levels were found to be independently and significantly associated with the vaspin concentrations in all subjects. Conclusions: The creatinine levels are negatively correlated with the serum vaspin levels and were significantly reduced in the Japanese HD patients in the Vaspin(Low) group