Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients

Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients.BackgroundCardiovascular event is the major cause of mortality in patients on maintenance hemodialysis. We prospectively tested the predictive values of atherosclerotic parameters for all-cause and cardiovascular outcomes in 219 hemodialysis patients (age, 58 ± 13 years; time on hemodialysis, 13 ± 7 years; male/female, 144/75).MethodsWe measured blood homocysteine (Hcy), ultrasound carotid artery intima media thickness (IMT) and % aortic wall calcification at L2/3 region [% of calcification index in the abdominal aortic wall (%ACI)] by computed tomography (CT) scan, and followed all patients for 5 years.ResultsDuring the follow-up periods, 54 patients (25%) died, 40 (74%) of them of cardiovascular causes. IMT was significantly higher in patients who expired (0.75 ± 0.02mm) than in those who survived (0.62 ± 0.01mm). IMT was significantly correlated with age (r = 0.47, P < 0.01) and %ACI (r = 0.27, P < 0.01). The survival rate during the observation was significantly lower in the final IMT third (58%) than in the first (90%) and the middle IMT third (80%) (P < 0.01). Multivariate Cox proportional hazards analysis revealed that diabetes and IMT became independent determinants of all-cause and cardiovascular death. Adjusted hazards ratios of all-cause and cardiovascular mortality for an increase of 0.1mm in IMT were 1.31 (95% CI, 1.07 to 1.59) and 1.41 (95% CI, 1.12 to 1.76). In contrast, %ACI at abdominal aorta and blood Hcy did not affect their 5-year mortality.ConclusionThese findings suggested that measurement of carotid artery IMT is useful for predicting long-term mortality in patients receiving maintenance hemodialysis

Association of HCV Core Antigen Seropositivity with Long-Term Mortality in Patients on Regular Hemodialysis

Anti-hepatitis C virus (HCV) antibody seropositivity is independently associated with poor prognosis in hemodialysis (HD) patients. However, anti-HCV antibody cannot distinguish between patients with active infection and those who have recovered from infection. We therefore aimed in this study to examine the association of HCV core antigen (HCVcAg) seropositivity with mortality in HD patients. We first measured serum HCVcAg using an immunoradiometric assay and anti-HCV antibody in 405 patients on regular HD, and followed them for 104 months. There were 82 patients (20.2%) who had been positive for anti-HCV antibodies; 57 (69.5%) of these were positive for HCVcAg. During the follow-up, 29 patients were excluded, so we tested the association of HCVcAg seropositivity with all-cause, cardiovascular (CV) and non-CV mortalities in 376 patients. A total of 209 patients (55.6%) had expired during the observational period, 92 out of them due to CV causes. After adjusting for comorbid parameters, HCVcAg was independently associated with overall mortality (HR 1.61, 95% CI 1.05–2.47, p < 0.05). HCV infection was significantly related to liver disease-related mortality. Past HCV infection also contributed to CV mortality (HR 2.63, 95% CI 1.27–5.45, p < 0.01). In contrast, anti-HCV antibody and HCVcAg seropositivities did not associate with infectious disease-related and cancer-related (expect for hepatocellular carcinoma) mortality. It follows from these findings that HCVcAg serology is associated with all-cause and CV mortality in HD patients

Condominium residents and local lives in the era of urban core revival : a comparative survey in Kyoto and Osaka

本研究では京都市と大阪市という二つの都市の都心区のマンション住民に質問紙調査を行い、その比較分析を行った。関西を代表するこれらの都市の都心区で起こったことは、1990年頃まで減少していた人口が大規模なマンションの建設により増加を始めたことである。両都市の「都心回帰」のジエントリファイヤーであるマンション住民が増加することによって、①専門的・技術的職業従事者が増加し、事務職やサービス職従業者は漸増、生産工程従事者や運輸関係従事者は減少しており、地域社会の階層構造が大きく変化している。また、彼らは、②交通の利便性や通勤・通学の便を求めて都心に移住してきたことが共通点であった。他方で、マンション住民の近隣交際や地域活動への参与は大阪市では低くなっており、京都市ではある程度はなされていた。また、町内会などの地域住民組織の加入は大阪市では京都に比べてかなり低かった。そして、彼らのコミュニティ意識は、京都市では「共同体」意識が、大阪市では「コミュニティ」意識が相対的に高かった。This study aims at a comparative analysis between the urban condominium residents of Kyoto city and Osaka city by conducting a questionnaire survey in a central ward of each city. Due to the large-scale developments of condominiums, the central wards of the two cities have experienced population growth since around 1990, after several decades of population decline. The influx of new residents has altered the social composition of the central wards; the number of professional workers has increased, while the number of blue-collar workers has decreased. Our analysis reveals that in both cities, the most important reason why those gentrifiers, have migrated to the areas is traffic accessibility to places of works/schools, residents of Osaka have less social connections in their neighborhood than those of Kyoto. And residents of Kyoto tend to respect and obey local rules/traditions compared with those of Osaka who aspire to improve their community through cooperation with neighbors.論文(Article