Surgical Treatment of dialysis-associated spondylosis

【Objective】The purposes of this study were to classify the lesions of dialysis-associated spondylosis and evaluate the results of surgical treatment. 【Subjects and methods】The subjects were 87 patients (43 men and 44 women) who underwent surgery. These patients were studied in terms of lesion classification, surgical method, duration of dialysis, duration of surgery, intraoperative blood loss, and postoperative complications. 【Results】Among patients with cervical spine involvement, 13 had destructive spondyloarthropathy (DSA), 29 had amyloid deposition, and 8 had a dens axis lesion. Among patients with lumbar spine involvement, 20 had DSA, and 17 had amyloid deposition. With regard to 6 patients with a dens axis lesion involving atlantoaxial subluxation, each had posterior fusion (PF) of the occiput to the upper cervical spine. With regard to the patients with lumbar DSA, 10 patients had posterolateral fusion (PLF), 8 patients had posterior lumbar interbody fusion (PLIF) and 2 patients had laminectomy. The duration of dialysis in cases of a dens axis lesion varied between 25 and 35 years, with the mean duration being 28.9 years. 【Conclusions】All patients who underwent surgery for dens axis lesions were long-term dialysis patients who had been on dialysis for 25 years. Lumbar spine DSA was treated with PLIF in patients with lateral slipping and marked instability, with laminectomy in patients with a narrowed intervertebral disk space and no instability

A role for fungal β-glucans and their receptor Dectin-1 in the induction of autoimmune arthritis in genetically susceptible mice

A combination of genetic and environmental factors can cause autoimmune disease in animals. SKG mice, which are genetically prone to develop autoimmune arthritis, fail to develop the disease under a microbially clean condition, despite active thymic production of arthritogenic autoimmune T cells and their persistence in the periphery. However, in the clean environment, a single intraperitoneal injection of zymosan, a crude fungal β-glucan, or purified β-glucans such as curdlan and laminarin can trigger severe chronic arthritis in SKG mice, but only transient arthritis in normal mice. Blockade of Dectin-1, a major β-glucan receptor, can prevent SKG arthritis triggered by β-glucans, which strongly activate dendritic cells in vitro in a Dectin-1–dependent but Toll-like receptor-independent manner. Furthermore, antibiotic treatment against fungi can prevent SKG arthritis in an arthritis-prone microbial environment. Multiple injections of polyinosinic-polycytidylic acid double-stranded RNA also elicit mild arthritis in SKG mice. Thus, specific microbes, including fungi and viruses, may evoke autoimmune arthritis such as rheumatoid arthritis by stimulating innate immunity in individuals who harbor potentially arthritogenic autoimmune T cells as a result of genetic anomalies or variations

Antiatherogenic effect of pioglitazone in type 2 diabetic patients irrespective of the responsiveness to its antidiabetic effect

WSTĘP. Tiazolidinediony (TZD) to grupa leków zwiększających wrażliwość na insulinę, które stosuje się w leczeniu cukrzycy typu 2. Działają one także przeciwmiażdżycowo. Celem badania było wyjaśnienie zależności między przeciwmiażdżycowym a przeciwcukrzycowym działaniem pioglitazonu, leku z grupy TZD, u chorych na cukrzycę typu 2. MATERIAŁ I METODY. W badaniu wzięło udział 136 chorych na cukrzycę typu 2 narodowości japońskiej. Uczestników podzielono na 2 grupy: chorych leczonych pioglitazonem w dawce 30 mg na dobę przez 3 miesiące (n = 70) oraz pacjentów niepoddanych leczeniu (grupę kontrolną, n = 66). Podczas badania kontrolowano zmiany metabolizmu glikolipidów, stężenia w osoczu białka C-reaktywnego (CRP, C-reactive protein), leptyny i adiponektyny oraz prędkość fali tętna (PWV, pulse-wave velocity), aby przeanalizować zależność między przeciwmiażdżycowym a przeciwcukrzycowym działaniem pioglitazonu. WYNIKI. U osób leczonych pioglitazonem stwierdzono istotne obniżenie hiperglikemii, hiperinsulinemii i stężenia HbA1c oraz wzrost stężenia adiponektyny w osoczu w porównaniu z grupą kontrolną (p < 0,01). Ponadto, odnotowano istotne obniżenie stężenia CRP i PWV (p < 0,01). Przeciwmiażdżycowe działanie pioglitazonu zaobserwowano zarówno u pacjentów, u których nie uzyskano poprawy wyrównania cukrzycy, a redukcja stężenia HbA1c wynosiła poniżej 1% (n = 30) (nonresponders, osoby niepodatne na leczenie), jak i u chorych z dobrą odpowiedzią na terapię (responders, osoby podatne na leczenie), u których redukcja stężenia HbA1c przekraczała 1% (n = 40). Stosując model ANCOVA wykazano, że leczenie pioglitazonem wiązało się z niskimi wartościami CRP i PWV, niezależnie od zmian parametrów związanych z metabolizmem glukozy. WNIOSKI. W omawianym badaniu po raz pierwszy przedstawiono przeciwmiażdżycowe działanie pioglitazonu zarówno u chorych podatnych, jak i niepodatnych na przeciwcukrzycowe działanie leku. Wyniki badania sugerują, że pioglitazon może wywierać efekt przeciwmiażdżycowy niezależnie od wpływu na glikemię.INTRODUCTION. Thiazolidinediones (TZD), a class of insulin-sensitizing agents used clinically to treat type 2 diabetes, are also antiatherogenic. This study was designed to elucidate the relationship between the antiatherogenic and antidiabetic effects of pioglitazone, a TZD, in type diabetic patients. MATERIAL AND METHODS. A total of 136 Japanese type 2 diabetic patients were included and divided into two groups: the pioglitazone-treated group (30 mg daily 3 months) (n = 70) and the untreated control group (n = 66). The changes in glycolipid metabolism as well as plasma high-sensitivity C-reactive protein (CRP), leptin, adiponectin, and pulse wave velocity (PWV) were monitored to analyze the relationship between the antiatherogenic and antidiabetic effects of pioglitazone. RESULTS. The pioglitazone treatment significantly reduced hyperglycemia, hyperinsulinemia, and HbA1c levels and increased plasma adiponectin concentrations relative to the control group (P < 0.01). It also significantly decreased CRP and PWV (P < 0.01). The antiatherogenic effect was observed in both the nonresponders showing < 1% of reduction in HbA1c (n = 30) and responders showing > 1% of reduction (n = 40). ANCOVA revealed that treatment with pioglitazone was associated with a low CRP and PWV, independent of the changes in parameters related to glucose metabolism. CONCLUSIONS. This study represents the first demonstration of the antiatherogenic effect of pioglitazone in both nonresponders and responders with respect to its antidiabetic effect and suggests that pioglitazone can exert its antiatherogenic effect independently of its antidiabetic effect

Characterization of Individuals with Sacroiliac Joint Bridging in a Skeletal Population: Analysis of Degenerative Changes in Spinal Vertebrae

Theaimof this study was to characterize the individualswith sacroiliac joint bridging (SIB) by analyzing the degenerative changes intheirwhole vertebral column and comparing themwith the controls.Atotal of 291modern Japanesemale skeletons,with an averageage at death of 60.8 years, were examined macroscopically. They were divided into two groups: individuals with SIB and thosewithout bridging (Non-SIB).The degenerative changes in their whole vertebral column were evaluated, and marginal osteophytescores (MOS) of the vertebral bodies and degenerative joint scores in zygapophyseal jointswere calculated. SIBwas recognized in 30individuals froma total of 291 males (10.3%).The average of age at death in SIB group was significantly higher than that in Non-SIBgroup. The values ofMOS in the thoracic spines, particularly in the anterior part of the vertebral bodies, were consecutively higherin SIB group than in Non-SIB group. Incidence of fused vertebral bodies intervertebral levels was obviously higher in SIB groupthan in Non-SIB group. SIB and marginal osteophyte formation in vertebral bodies could coexist in a skeletal population of men.Some systemic factors might act on these degenerative changes simultaneously both in sacroiliac joint and in vertebral column

Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients

Background: The features of early-phase acute respiratory distress syndrome (ARDS) are leakage of fluid into the extravascular space and impairment of its reabsorption, resulting in extravascular lung water (EVLW) accumulation. The current study aimed to identify how the initial EVLW values and their change were associated with mortality. Methods: This was a post hoc analysis of the PiCCO Pulmonary Edema Study, a multicenter prospective cohort study that included 23 institutions. Single-indicator transpulmonary thermodilution-derived EVLW index (EVLWi) and conventional prognostic factors were prospectively collected over 48 h after enrollment. Associations between 28-day mortality and each variable including initial (on day 0), mean, maximum, and Δ (subtracting day 2 from day 0) EVLWi were evaluated. Results: We evaluated 192 ARDS patients (median age, 69 years (quartile, 24 years); Sequential Organ Failure Assessment (SOFA) score on admission, 10 (5); all-cause 28-day mortality, 31%). Although no significant differences were found in initial, mean, or maximum EVLWi, Δ-EVLWi was significantly higher (i.e., more reduction in EVLWi) in survivors than in non-survivors (3.0 vs. ?0.3 mL/kg, p = 0.006). Age, maximum, and Δ-SOFA scores and Δ-EVLW were the independent predictors for survival according to the Cox proportional hazard model. Patients with Δ-EVLWi > 2.8 had a significantly higher incidence of survival than those with Δ-EVLWi ? 2.8 (log-rank test, χ2 = 7.08, p = 0.008). Conclusions: Decrease in EVLWi during the first 48 h of ARDS may be associated with 28-day survival. Serial EVLWi measurements may be useful for understanding the pathophysiologic conditions in ARDS patients. A large multination confirmative trial is required

Development and validation of questionnaires for eating‐related distress among advanced cancer patients and families

Background: Eating‐related distress (ERD) is one type of psychosocial distress among advanced cancer patients and family caregivers. Its alleviation is a key issue in palliative care; however, there is no validated tool for measuring ERD. Methods: The purpose of this study was to validate tools for evaluating ERD among patients and family caregivers. The study consisted of a development and validation/retest phase. In the development phase, we made preliminary questionnaires for patients and family caregivers. After face validity and content validity, we performed an exploratory factor analysis and discussed the final adoption of items. In the validation/retest phase, we examined factor validity with an exploratory factor analysis. We calculated Pearson's correlation coefficients between the questionnaire for patients, the Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale (FAACT ACS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Cachexia 24 (EORTC QLQ‐CAX24) and Pearson's correlation coefficients between the questionnaire for family caregivers and the Caregiver Quality of Life Index‐Cancer (CQOLC) for concurrent validity. We calculated Cronbach's alpha coefficients (Cronbach's alpha) and intraclass correlation coefficients (ICCs) for internal consistency and test–retest reliability. We performed the Mann–Whitney U test between the questionnaires and cancer cachexia based on criteria from the international consensus for known‐group validity. Results: In the development phase, 162 pairs of patients and family caregivers were asked to participate, and 144 patients and 106 family caregivers responded. In the validation/retest phase, 333 pairs of patients and family caregivers were asked to participate, and 234 patients and 152 family caregivers responded. Overall, 183 patients and 112 family caregivers did the retest. Seven conceptual groups were extracted for the ERD among patients and family caregivers, respectively. Patient factors 1–7 correlated with FAACT ACS (r = −0.63, −0.43, −0.55, −0.40, −0.38, −0.54, −0.38, respectively) and EORTC QLQ‐CAX24 (r = 0.58, 0.40, 0.60, 0.49, 0.38, 0.59, 0.42, respectively). Family factors 1–7 correlated with CQOLC (r = −0.34, −0.30, −0.37, −0.37, −0.46, −0.42, −0.40, respectively). The values of Cronbach's alpha and ICC of each factor and all factors of patients ranged from 0.84 to 0.96 and 0.67 to 0.83, respectively. Those of each factor and all factors of family caregivers ranged from 0.84 to 0.96 and 0.63 to 0.84, respectively. The cachexia group of patients had significantly higher scores than the non‐cachexia group for each factor and all factors. Conclusions: Newly developed tools for measuring ERD experienced by advanced cancer patients and family caregivers have been validated