腎盂尿管移行部狭窄症に逆行性エンドピエロトミーを行った小児の1例

右腎盂尿管移行部狭窄症の6歳女児に対し, アキュサイス尿管切開バルーン装置(軟性尿管カテーテル, 7Fr)を用いた逆行性エンドピエトロトミーを行いその実用性を検討した.全身麻酔下でアキュサイスカテーテルを膀胱鏡操作下に腎盂内にまで挿入し, 狭窄部を電気的に切開し更に同部位をバルーンで24Frまで拡張した.切開終了後にエンドピエトロトミー用尿管カテーテル(6/10Fr)を留置し, これを8週間後に抜去した.手術時間は45分間で, 患者は術後3日目に退院した.特に手術に関する合併症はなく, 術後8ヵ月目の経静脈性腎盂撮影と利尿レノグラムによる評価で, 水腎症の程度は改善していたTo determine the feasibility of retrograde endopyelotomy in the management of pediatric ureteropelvic junction (UPJ) obstruction, we treated one girl aged 6 years with the Acucise cutting balloon devise for symptomatic UPJ obstruction. The Acucise catheter (7 Fr, flexible) was placed by a cystoscope over a guide wire with fluoroscopic guidance under general anesthesia. After cutting the stenotic area electronically and dilation until 24 Fr for 10 seconds, a 6/10 Fr endopyelotomy ureteral catheter was left in situ for 8 weeks after the operation. Total operating time was 45 minutes and the child was discharged 3 days after the operation. There were no acute complications and short-term, follow-up 8 months after the operative results were satisfactory as determined by intravenous pyelography and diuretic renogram. UPJ obstruction in children may be treated by retrograde endopyelotomy with the Acucise catheter as well as adults. The principal potential advantage of this procedure is reduced morbidity as compared with antegrade endopyelotomy

カルシウム含有結石マトリックス内蛋白におけるオステオポンチンの同定

蓚酸カルシウム, リン酸カルシウム, 尿酸, リン酸マグネシウムアンモニウムの4種類の結石内マトリックスを, Stains-All染色によりトロンビン分割の有無でオステオポンチン(OPN)の存在を確認した.マトリックス成分は0.1M EDTA溶液で抽出した.その上N末端より20残基のアミノ酸分析を施行した.蓚酸カルシウム, リン酸カルシウムのみOPNが存在し尿酸, リン酸マグネシウムアンモニウム結石内には認めなかった.骨のマトリックスとして骨形成に関わり, 強固にヒドロキシアパタイトと結合するOPNが, カルシウム含有結石形成過程においても重要であるOsteopontin (OPN) has been identified as a matrix protein of calcium oxalate urinary stones by sequencing c-DNA for urinary stone protein. OPN, a phosphoprotein, is susceptible to thrombin digestion and specifically stainable with Stains-All. We examined the matrix in 4 kinds of urinary stones, calcium oxalate dihydrate, calcium phosphate, magnesium ammonium phosphate and uric acid; for the presence of OPN by staining thrombin-digestion and undigested matrix with Stains-All. Matrix was extracted with a 0.1 M ethylenediamine tetraacetic acid (EDTA) solution. Furthermore, the amino acid sequence was determined for the NH2-terminal 20 amino acid residues. OPN was identified in calcium oxalate dihydrate and calcium phosphate stones, but was absent in magnesium ammonium phosphate and uric acid stones. Our findings suggest that OPN, which binds tightly to hydroxyapatite and is related to bone formation as bone matrix, also participates in the formation of calcium-containing urinary stones

胎盤早期剥離後に発生した急性両側性腎皮質壊死

急性腎不全をきたす疾患のうち，両側性腎皮質壊死は，妊娠後期における胎盤早期剥離，敗血症，外傷，および術後などに発生するまれ，かっきわめて予後不良な疾患である. 1886年に最初の報告をみて以来，現在まで約400例の報告をみるが，生存しえたのは24例で，しかもそのほとんどが血液透析をうけたここ数年間の患者である。またその腎機能回復率は20%以下ときわめて不良である。急性両側腎皮質壊死の発生機序に関しては不明な点が多いが、 その腎組織学的検索で、はフィプリン折出による腎小葉間動脈の栓塞がおもにみられ，腎皮質の広範な壊死を認める反面，腎髄質はほとんど正常に保たれている。同時に臨床的には出血傾向と全身臓器の小動脈の栓塞を認め， DIC (disseminated intravascular coagulation) との関連性が重要視されている。今回，われわれは39歳の高齢初産婦にみられた胎盤早期剥離後，急性腎不全をきたし， 6カ月間の血液透析ののち，同種腎移植を施行され成功したが，その際えられた腎組織は両側性腎皮質壊死と診断された症例を経験したので、その臨床経過を報告するとともに，急性両側性腎皮質壊死の発生機序，診断，予後などにつき考察を加えた

In-match physical demands on elite Japanese rugby union players using a global positioning system

ObjectivesOur aim of this study was to quantify the physical demands of elite rugby union players by each position as a step towards designing position-specific training programme using a Global Positioning System/accelerometer system.MethodsThis study was performed as a retrospective observational study. Data were obtained from 45 official matches. The sample size used for the analysis was 298. The per-match total distances, accelerations and impacts were calculated and statistically compared for the forwards and backs and for individual positions.ResultsTotal distances for the forwards and backs were 5731.1±507.8 and 6392.1±646.8 m, respectively. The high-velocity running distances (>18.0 km/hour) covered by the forwards and backs were 317.4±136.9 and 715.0±242.9 m, respectively. The number of accelerations (>1.5 m/s2) for the forwards and backs were 76.3±18.9 and 100.8±19.6 times, respectively, and the number of high impacts (>10 g) were 48.0±46.9 and 35.6±28.3 times for the forwards and backs, respectively. All characteristics were significantly different between the forwards and backs (p<0.05). The per-position characteristics were also calculated. Within the backs, scrum half (SH) and wingers (WTBs) covered high-velocity running significantly higher distance than fly-half (SH d=2.571, WTBs d=1.556) and centres (SH d=1.299, WTBs d=0.685) (p<0.05).ConclusionBy clarifying the physical demands according to the positions, it will be possible to create optimised position-specific training programmes

Determination of the functional domain of a mouse autonomous replicating sequence.

We previously isolated from mouse cells an autonomous replicating sequence (ARS) ARS65 (Ariga, Itani and Iguchi-Ariga, Mol. Cell. Biol. 7, 1-6, 1987). Here we report the nucleotide sequence of ARS65. The sequence from BgIII to EcoRI sites cloned as ARS was 2658 bp long. There exist three interesting domains: a TA repeat, a myc like box (essential sequence for c-myc ARS), and a T rich region. Cloned DNAs containing various segments of pARS65 were transfected to rat 3Y1 cells together with the hygromycinB resistance expression vector, and hygromycinB resistant clones were isolated. Established cell lines transfected with plasmids carrying either a myc-like box or a T rich region harbored the replicated plasmids, indicating that these two elements are necessary for the ARS function of pARS65

An eClinical trial system for cancer that integrates with clinical pathways and electronic medical records.

[Background] Various information technologies currently are used to improve the efficiency of clinical trials. However, electronic medical records (EMRs) are not yet linked to the electronic data capture (EDC) system. Therefore, the data must be extracted from medical records and transcribed to the EDC system. Clinical pathways are planned process patterns that are used in routine clinical practice and are easily applicable to the medical care and evaluation defined in a trial protocol. However, few clinical pathways are intended to increase the efficiency of clinical trials. [Purpose] Our purpose is to describe the design and development of a new clinical trial process model that enables the primary use of EMRs in clinical trials by integrating clinical pathways and EMRs. [Methods] We designed a new clinical trial model that uses EMR data directly in clinical trials and developed a system to follow this model. We applied the system to an investigator-initiated clinical trial and examined whether all data were extracted correctly. At the protocol development stage, our model measures endpoints based on clinical pathways with the same diagnosis. Next, medical record descriptions and the format of the statistical data are defined. According to these observations, screens for entry of data, which are used both in clinical practice and for study, are prepared into EMRs with an EMR template, and screens are prepared for data checks on our EMR retrieval system (ERS). In an actual trial, patients are registered and randomly assigned to a protocol treatment. The protocol treatment is executed according to clinical pathways, and the data are recorded to EMRs using EMR templates. The data are checked by a local data manager using reports created by the ERS. After edit checks and corrections, the data are extracted by the ERS, archived in portable document format (PDF) with an electronic signature, and transferred in comma-separated values (CSV) format to a coordinating centre. At the coordinating centre, the data are checked, integrated, and made available for a statistical analysis. [Results] We verified that the data could be extracted correctly and found no unexpected problems. [Limitation] To execute clinical trials in our system, the EMR template and efficient ERSs are required. Additionally, to execute multi-institutional clinical trials, it is necessary to create templates appropriate for EMRs at all participating sites and for the coordinating centre to validate local templates and procedures. [Conclusion] We proposed and pilot tested a new eClinical trial model. Because our model is integrated with routine documentation of clinical practice and clinical trials, redundant data entries were avoided and the burden on the investigator was minimised. The reengineering of the clinical trial process would facilitate the establishment of evidence in the future