First-line Combination Strategy Provides Favorable 5-year Outcomes for Patients with Lupus Nephritis: A Single-center Observational Study

This observational study aimed to clarify the long-term results of the combination of mizoribine (MZB), tacrolimus (TAC) and prednisolone as first-line therapy for lupus nephritis (LN). This was our institution’s standard therapy between 2009 and 2015, when we saw 36 patients with LN. When a patient thus treated achieved SLEDAI remission (= 0) and/or the prednisolone dose could be tapered to 5 mg/day, either MZB or TAC was stopped, and the other was continued for maintenance therapy. If treatment failure or relapse occurred, second-line therapy was introduced. At years 1 and 5, overall complete renal response and SLEDAI remission were 94% and 88%, and 50% and 62%, respectively. Excluding 2 cases lost to follow-up, medications after 5 years were as follows: 20 (59%) were stable on 1 drug (MZB or TAC), 11 (32%) required continuation of both drugs (MZB + TAC), and 3 (9%) required second-line therapy. The 5-year retention rate was 91% (non-secondline), with 0% of relapse in this group. Our first-line combination strategy showed high remission rates in the induction phase, and subsequent maintenance therapy demonstrated good outcomes for up to 5 years. Research that fine-tunes the order of therapeutic agents and institutes appropriate treatment goals may further improve long-term outcomes for patients with LN

Mizoribine, tacrolimus, and corticosteroid combination therapy successfully induces remission in patients with lupus nephritis

Conventional cyclophosphamide-based treatment regimens for lupus nephritis (LN) are still not considered to be optimal. The aim of this study was to evaluate the efficacy and safety of mizoribine, tacrolimus, and corticosteroid combination therapy for LN. We retrospectively evaluated a combination treatment of mizoribine and tacrolimus with corticosteroids as induction therapy in eight newly diagnosed systemic lupus erythematosus (SLE) patients with biopsy-proven LN. All patients were women, and their mean [standard deviation (SD)] age was 48.5 (20) years. All patients (100 %) had positive anti-double-stranded DNA (anti-dsDNA) antibody titers, and four (50.0 %) were nephrotic. Mean (SD) serum creatinine and daily proteinuria levels were 0.72 (0.4) mg/dl (range 0.33-1.55 mg/dl) and 4.56 (2.8) g (range 0.77-8.2 g), respectively. By month 2, significant improvements in the anti-dsDNA antibody titers, levels of proteinuria, serum albumin, and C3, and SLE disease activity index score were observed. By month 6, seven patients (87.5 %) were in complete remission, with normalized levels of both proteinuria and serum creatinine. This pilot study suggests that mizoribine and tacrolimus treatment with corticosteroids is well tolerated and may prove to be an optimal alternative remission-inducing regimen for LN

Enhancement of average thermoelectric figure of merit by increasing the grain-size of Mg_(3.2)Sb_(1.5)Bi_(0.49)Te_(0.01)

Zintl compound n-type Mg_3(Sb,Bi)_2 was recently found to exhibit excellent thermoelectric figure of merit zT (∼1.5 at around 700 K). To improve the thermoelectric performance in the whole temperature range of operation from room temperature to 720 K, we investigated how the grain size of sintered samples influences electronic and thermal transport. By increasing the average grain size from 1.0 μm to 7.8 μm, the Hall mobility below 500 K was significantly improved, possibly due to suppression of grain boundary scattering. We also confirmed that the thermal conductivity did not change by increasing the grain size. Consequently, the sample with larger grains exhibited enhanced average zT. The calculated efficiency of thermoelectric power generation reaches 14.5% (ΔT = 420 K), which is quite high for a polycrystalline pristine material

Airway management in cardiac arrest -- not a question of choice but of quality?

This study presented an innovative method in order to estimate training required for skilful and successful intubations during ED cardiac arrests. Video reviews were taken from a system that routinely records ED staff during cardiac arrests and as these recordings are already part of everyday clinical practice, it is likely that there is minimal Hawthorne effect. Cardiac arrest research often reiterates the fact that the basics should be done well. It is commendable that intubations by the residents in this observational study resulted in a modest mean delay in chest compressions of only 8.6 seconds for the intubation attempt. However, nearly a third of intubation attempts were unsuccessful at the first attempt, and there were 11 oesophageal intubations (albeit they were all recognised) in the 93 patients that were included

Grain boundary dominated charge transport in Mg_3Sb_2-based compounds

Thermally activated mobility near room temperature is a signature of detrimental scattering that limits the efficiency and figure-of-merit zT in thermoelectric semiconductors. This effect has been observed dramatically in Mg_3Sb_2-based compounds, but also to a lesser extent in other thermoelectric compounds. Processing samples differently or adding impurities such that this effect is less noticeable produces materials with a higher zT. Experiments suggest that the behavior is related to grain boundaries, but impurity scattering has also been proposed. However, conventional models using Matthissen's rule are not able to explain the dramatic change in the temperature dependency of conductivity or drift mobility which is observed in Mg3Sb2-based compounds. We find that it is essential to consider the grain boundary region as an effectively separate phase rather than a scattering center, taking into account the weaker screening in semiconductors compared with classical metals. By modeling a grain boundary phase with a band offset, we successfully reproduce the experimentally observed conductivity versus temperature and thermopower versus conductivity relations, which indicate an improved description of transport. The model shows good agreement with measured grain size dependencies of conductivity, opening up avenues for quantitatively engineering materials with similar behavior. Model estimates predict room for >60% improvement in the room temperature zT of Mg_(3.2)Sb_(1.5)Bi_(0.49)Te_(0.01) if the grain boundary resistance could be eliminated

ユウロウセイ ノウキョウ ニタイシテ EWS オ モチイタ キカンシ ジュウテンジュツ ト ロウコウナイ フィブリンコ チュウニュウ ノ ヘイヨウ ガユウコウ デアッタ 1レイ

Background : Empyema with a bronchial fistula is difficult to treat. Recently, bronchial occlusion using endobronchial Watanabe Spigot（EWS）ris reported to be useful for treatment of intractable pneumothorax and thoracic empyema. Case : A ６０ year old man presented fever and left chest pain. He was diagnosed with empyema. Video－ assisted thoracoscopic debridement and decortication for the empyema cavity and drainage for the abscess cavity were performed. Air leak appeared at postoperative day１３. We performed EWS embolization and intrapleural administration of fibrin glue, and the persistent air leak disappeared. Conclusion : We experienced empyema with a bronchial fistula successfully treated with EWS embolization and intrapleural administration of fibrin glue

日本列島におけるミズナラ (Quercus crispula) の堅果重と気象因子との関係

[短報] Short communicatio

ハイ アスペルギローマ ジュツゴ ハイロウ ニ タイシテ PushampSlideホウ ト ロープウェイホウ オ オウヨウ シタ EWS ニヨル キカンシ ジュウテンジュツ ガ ユウヨウ デアッタ 1レイ

Background : Bronchial occlusion using endobronchial Watanabe Spigot（EWS）is reported to be useful for treatment of secondary intractable pneumothorax and thoracic empyema, peripheral bronchial fistula. However, the methods of the bronchial occlusion are sometimes difficult and EWS sometimes fall off from plugged bronchus. Case : A ４４ year old man presented hemosputum. He was diagnosed with Aspergilloma. We performed a resection of the right upper lobe and S６ partial resection. Air leak appeared at postoperative day ３. We performed EWS embolization with an application of push & slide method and the ropeway method, and the persistent air leak disappeared. Conclusion : Our method is useful when the bronchial occlusion is difficult