Effect of Dietary Protein Restriction and Nutritional Assessment on Early-Stage Diabetic Nephropathy.

We evaluated the effects of a protein-limited diet on renal function, urinary albumin excretion and nutritional status of 16 patients with non-insulin dependent diabetes mellitus (11 males and 5 females, mean age 60.5 years) had a urinary albumin excretion rate of between 15 and 200μg/min and were c1assified into two groups : group Ⅰ patients were placed on a protein-limited diet (0.77g/kg/day), and group Ⅱ followed a conventional diabetic diet (1.33g/kg/day). After six months, the value of creatinine c1earance was significantly reduced in group Ⅰ, but urinary albumin excretion did not change in either group. Anthropometric measurements revealed no significant change in body weight, body mass index, arm circumference or triceps skinfold thickness in either group during the study period, but the arm musc1ec ircumference significantly increased in group Ⅰ. No significant differences were observed in either group with regard to serum level of protein, in c1uding total protein, albumin, prealbumin or transferrin, In conc1usion, a protein-limited diet was useful for prevention of diabetic nephropathy in patients with early-stage diabetic nephropathy

Association of Chlamydia pneumoniae infection with diabetic nephropathy

W badaniu oceniano związek pomiędzy zakażeniem Chlamydia pneumoniae (CP) a rozwojem nefropatii cukrzycowej. W zależności od zaawansowania rozlanych zmian kłębuszkowych, stosując kryteria Gellmana, 60 chorych na cukrzycę typu 2 podzielono na 2 grupy: z rozpoczynającą się i z zaawansowaną nefropatią cukrzycową. Grupę kontrolną stanowiło 34 chorych na cukrzycę typu 2 bez nefropatii (normoalbuminuria) oraz 59 osób niechorujących na cukrzycę. Stężenie przeciwciał IgG przeciwko CP mierzono za pomocą testu ELISA. Przeciwciała przeciw CP wykryto u 45,8% osób z grupy kontrolnej niechorujących na cukrzycę, u 47,1% chorych na cukrzycę bez nefropatii, u 52,6% chorych na cukrzycę z rozpoczynającą się nefropatią oraz u 78% chorych na cukrzycę z zaawansowaną nefropatią. Obecność przeciwciał przeciw CP powodowała 4,22-krotny wzrost ryzyka wystąpienia zaawansowanej nefropatii. Wyniki badania wskazują na związek pomiędzy przewlekłym zakażeniem CP a zaawansowaną nefropatią cukrzycową.We evaluated the association of Chlamydia pneumoniae (CP) infection with progression of diabetic nephropathy. Type 2 diabetic patients (60) were divided into two groups, those with incipient nephropathy and those with advanced nephropathy, based on the severity of diffuse glomerular lesions using Gellman’s criteria. Type 2 (34) diabetic patients without nephropathy (normoalbuminuria) and 59 nondiabetics served as control groups. Serum IgG- -antibody against CP was measured using ELISA. CP antibody was detected in 45.8% of nondiabetic controls, in 47.1% of diabetic patients without nephropathy, in 52.6% of diabetic patients with incipient nephropathy, and 78% of diabetic patients with advanced nephropathy. There was 4.22-fold increase in the risk of advanced nephropathy associated with the presence of CP antibody. Our findings indicate an association between chronic CP infection and advanced diabetic nephropathy

A CASE OF RUPTURED MITRAL VALVE ANEURYSM DUE TO INFECTIVE ENDOCARDITIS

58-year-old woman with aortic regurgitation was admitted to our hospi- tal because of high grade fever. She had infective endocarditis and an aneurysm of the anterior mitral leaflet. Doppler echocardiography indicated a ruptured mitral valve aneurysm. Aortic regurgitant flow along the anterior mitral leaflet was suspected to have contributed to mitral valve endocarditis, aneurysm formation and rupture. She was initially treated with high-dose intravenous penicillin, but congestive heart failure worsened. Mitral valve replacement was then successfully performed

Transcatheter Arterial Chemoembolization to Reduce Size of Hepatocellular Carcinoma before Radiofrequency Ablation

Transcatheter arterial chemoembolization (TACE) is often performed before radiofrequency ablation (RFA) for the treatment of early-stage hepatocellular carcinoma (HCC). TACE prior to RFA can expand the ablated area and reduce the tumor size, facilitating complete ablation. However, the factors correlated with size reduction remain uncertain. The aim of this study was to identify the factors associated with size reduction by TACE and develop a formula to predict the reduction rate. A total of 100 HCC patients treated with TACE followed by RFA at least 20 days later were enrolled. The tumor size was measured at the time of TACE and RFA, and correlations between the reduction rate and 13 clinical factors were examined. A formula to predict the reduction rate was built using the factors obtained by the analysis. Reduction in the tumor size was observed in 69 nodules, and the median reduction rate was 16.2%. A multivariate regression analysis revealed that a large tumor size (p< 0.01) and a long interval between the therapies (p= 0.01) were factors for a high tumor reduction rate, with tumor size more strongly related to the degree of reduction. A size reduction of more than 10% can be expected by waiting 20 days after TACE when the size of the tumor at TACE is over 25 mm in diameter. The tumor siz

QUALITY OF LIFE IN PATIENTS WITH DIABETES MELLITUS

We evaluated the quality of life (QOL) in 268 patients with diabetes mellitus (NIDDM, 250 cases; IDDM, 10 cases; and other type of diabetes, 8 cases) to determine which aspects were adversely affected by the disease. Information concerning life satisfaction, social activities, ability to work, sexual problems and physical symptoms was obtained from a 30-item questionnaire. Clinical characteristics including duration of diabetes, glycemic control, current treatment, obesity, hypertension, hyperlipidemia, macro- and microvascular complications were obtained from medical records. Diminished QOL was most pronounced in patients who had had a long duration of disease, required insulin therapy, and whose health was disturbed by cerebrovascular disease, end-stage renal disease, mono- and autonomic neuropathy. A significant difference in the subdimensional QOL score was noted in life satisfaction, social activities, ability to work, sexual problems and physical symptoms under these circumstances

Magnifying Endoscopy with Blue Laser Imaging Improves the Microstructure Visualization in Early Gastric Cancer: Comparison of Magnifying Endoscopy with Narrow-Band Imaging

Backgrounds. Magnifying endoscopy with blue laser imaging (ME-BLI) for diagnosis of early gastric cancer (EGC) is as effective as magnifying endoscopy with narrow-band imaging (ME-NBI). However, there are different EGCs in microstructure visualization between ME-BLI and ME-NBI. This study aimed to clarify the pathological features of the EGCs, in which microstructure visualization was different between ME-NBI and ME-BLI. Methods. EGCs were classified into groups A (irregular microsurface pattern (MSP) in ME-BLI and absent MSP in ME-NBI), B (irregular MSP in two modalities), or C (absent MSP in two modalities), according to the vessel plus surface classification. We compared the pathological features of EGCs between the three groups. Results. 17, four, and five lesions could be evaluated in detail in groups A, B and C, respectively. Well-differentiated adenocarcinomas with shallow crypts were more frequent in group A than in group B (58.8 and 0%, resp.). The mean crypt depth of group A was significantly shallower than that of group B (56 ± 20, 265 ± 64 μm, resp., P=0.0002). Conclusions. ME-BLI could better visualize the microstructures of the EGCs with shallow crypts compared with ME-NBI. Therefore, ME-BLI could enable a more accurate diagnosis of EGC with shallow crypts

Establishment of a Novel Fluorescence-Based Method to Evaluate Chaperone-Mediated Autophagy in a Single Neuron

Background: Chaperone-mediated autophagy (CMA) is a selective autophagy-lysosome protein degradation pathway. The role of CMA in normal neuronal functions and in neural disease pathogenesis remains unclear, in part because there is no available method to monitor CMA activity at the single-cell level. Methodology/Principal Findings: We sought to establish a single-cell monitoring method by visualizing translocation of CMA substrates from the cytosol to lysosomes using the HaloTag (HT) system. GAPDH, a CMA substrate, was fused to HT (GAPDH-HT); this protein accumulated in the lysosomes of HeLa cells and cultured cerebellar Purkinje cells (PCs) after labeling with fluorescent dye-conjugated HT ligand. Lysosomal accumulation was enhanced by treatments that activate CMA and prevented by siRNA-mediated knockdown of LAMP2A, a lysosomal receptor for CMA, and by treatments that inactivate CMA. These results suggest that lysosomal accumulation of GAPDH-HT reflects CMA activity. Using this method, we revealed that mutant cPKC, which causes spinocerebellar ataxia type 14, decreased CMA activity in cultured PCs. Conclusion/Significance: In the present study, we established a novel fluorescent-based method to evaluate CMA activity in a single neuron. This novel method should be useful and valuable for evaluating the role of CMA in various neurona

The Constrained Maximal Expression Level Owing to Haploidy Shapes Gene Content on the Mammalian X Chromosome.

X chromosomes are unusual in many regards, not least of which is their nonrandom gene content. The causes of this bias are commonly discussed in the context of sexual antagonism and the avoidance of activity in the male germline. Here, we examine the notion that, at least in some taxa, functionally biased gene content may more profoundly be shaped by limits imposed on gene expression owing to haploid expression of the X chromosome. Notably, if the X, as in primates, is transcribed at rates comparable to the ancestral rate (per promoter) prior to the X chromosome formation, then the X is not a tolerable environment for genes with very high maximal net levels of expression, owing to transcriptional traffic jams. We test this hypothesis using The Encyclopedia of DNA Elements (ENCODE) and data from the Functional Annotation of the Mammalian Genome (FANTOM5) project. As predicted, the maximal expression of human X-linked genes is much lower than that of genes on autosomes: on average, maximal expression is three times lower on the X chromosome than on autosomes. Similarly, autosome-to-X retroposition events are associated with lower maximal expression of retrogenes on the X than seen for X-to-autosome retrogenes on autosomes. Also as expected, X-linked genes have a lesser degree of increase in gene expression than autosomal ones (compared to the human/Chimpanzee common ancestor) if highly expressed, but not if lowly expressed. The traffic jam model also explains the known lower breadth of expression for genes on the X (and the Z of birds), as genes with broad expression are, on average, those with high maximal expression. As then further predicted, highly expressed tissue-specific genes are also rare on the X and broadly expressed genes on the X tend to be lowly expressed, both indicating that the trend is shaped by the maximal expression level not the breadth of expression per se. Importantly, a limit to the maximal expression level explains biased tissue of expression profiles of X-linked genes. Tissues whose tissue-specific genes are very highly expressed (e.g., secretory tissues, tissues abundant in structural proteins) are also tissues in which gene expression is relatively rare on the X chromosome. These trends cannot be fully accounted for in terms of alternative models of biased expression. In conclusion, the notion that it is hard for genes on the Therian X to be highly expressed, owing to transcriptional traffic jams, provides a simple yet robustly supported rationale of many peculiar features of X's gene content, gene expression, and evolution

RESPONSE TO THE FUROSEMIDE TEST MAY PREDICT THE EFFECTS OF DELAPRIL ON RENAL FUNCTION IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY

Background : It is not clear whether the administration of an angiotensin- converting enzyme (ACE) inhibitor consisitently slows the progression of disease in patients with renal disease. We investigated the usefulness of the furosemide test in predicting the efficacy of delapril, an ACE inhibitor, in patients with chronic renal insuffi- clency. Methods : Delapril (7.5 mg to 15 mg) was administered daily to 24 patients with chronic renal insufficiency as indicated by a serum concentration of creatinine (Scr) between 1.2 mg/dl and 3.0 mg/dl. Patients were classified into improved, unchanged, and worsened groups based on the effect of delapril on the Scr. We measured the following parameters before the administration of delapril for a mean of 9 months blood pressure, Scr, urinary protein excretion, urinary sodium excretion, and changes in the renin and aldosterone response (the PRA ratio and PAC ratio) to a furosemide test. Results : Renal function was improved in 6 patients, unchanged in 8 patients, and worsend in 10 patients after delapril treatment. Urinary protein excretion was decreased, but not significantly, in all three groups. No significant differences in baseline parameters were observed among the groups before treatment. The PRA ratio was significantly higher in the group showing improvement vs. the groups showing either no improvement or a worsening of renal function. Conclusions : Delapril tended to reduce the urinary excretion of protein in patients with chronic renal insufficienty. However, delapril did not consistently reduce the rate of decline in glomerular filtration rate. The protective effect of this drug on renal function appeared to be related to the renin response to furosemide test