Severity of Glomerulosclerosis Predicts Prognosis of IgA Nephropathy with Proteinuria

We determined the natural history of IgA nephropathy (IgAN) among patients who presented with proteinuria, and factors associated with the development of clinical events, namely blood pressure(BP)竕ｧ130/85 mmHg, serum creatinine 竕ｧ1.4mg/dl. We analyzed data from 16 patients(mean age 35 ﾂｱ 14 years) with IgAN accompanied by proteinuria between 1990 and 1998. We also semiquantified scores of glomerulosclerosis (GS), tubulointerstitial damage (TID), hyaline arteriosclerosis (HA), and IgAN classification. The median duration of follow-up was 48 months. During clinical follow-up, seven (44%) patients became hypertensive, among who five (31%) developed impaired renal function and two (13%) progressed to treatment with hemodialysis. Events did not develop in the other 9 patients (56%). Clinical findings were not significantly different between the events and event-free groups. The GS and TID scores revealed significant differences between patient groups. Only the renal histological parameters of GS and events were statistically correlated with renal survival. We conclude that the severity of GS may be the important prognostic factor inpatients with IgAN accompanied by proteinuria at the time of the initial biopsy

Renal Outcome of Immunoglobulin A Nephropathy With Mild Proteinuria

We determined the natural history of immunoglobulin A nephropathy (IgAN) among patients who presented with mild proteinuria (0.2 to 0.4 g/day), and factors associated with development of adverse clinical events, defined as proteinuria 竕ｧ 1.0g/day, blood pressure > 130/80mmHg, serum creatinine 竕ｧ 1.4mg/dl. We did analyzed data from 27 patients(mean age 30 ﾂｱ 12 years) with IgAN accompanied by mild proteinuria between 1990 and 1998. We also evaluated semiquantitave scores of glomerulosclerosis, tubulointerstitial injury, hyaline arteriosclerosis, and IgAN classification. The median duration of follow-up was 51 months. During followup, at least one adverse clinical event affected 15 patients (56%): among who eight (53%) developed proteinuria. And one of 8 developed impaired renal function and 7 (47%) became hypertensive. Another 12 patients (44%) were not affected by adverse clinical events. The clinical findings were not significantly different between the adverse events and no evens group. The scores of glomerulosclerosis and tubulointerstitial injury reveled significant differences between events. The only renal histological parameters of glomerulosclerosis and adverse clinical events were statistically correlated with renal survival. We concluded that IgAN with mild proteinuria frequently follows a slow by progressive course and that the severity of glomerulosclerosis may be predictable prognostic factor in patients who have IgAN with by mild proteinuria

How is the IUGONET project using TDAS?

GEM Mini-Workshop, San Francisco; 2011-12-0

Development of metadata database and analysis software for upper atmospheric researches by the IUGONET project

第2回極域科学シンポジウム/第35回極域宙空圏シンポジウム 11月15日（火） 国立極地研究所 2階大会議室前フロ

ドッキョウ イカ ダイガク ニ オケル チイキ ホウカツ イリョウ ジッシュウセイ ノ イシキ チョウサ ノ ケントウ ショウライ ノ チイキ イリョウ オ オコナ ウ ジカク ト フアン ニ カンレン スル インシ オ チュウシン ニ

目的:獨協医科大学では2010年度より地域枠入学制度が導入された.そこで2013年に,地域枠入学者の意識調査を施行し,「将来地域医療を行うという自覚」と「自分の将来についての不安」に着目してその調査結果を検討した.方法:対象は,地域枠入学者全員を含む地域包括医療実習生70名である.内訳は,第1学年20名,第2学年20名,第3学年18名,第4学年12名である.68名は学習支援システムを利用して記名式のWebアンケート調査に回答し,2名は自記式で同一調査に回答した.結果:「将来地域医療を行うことを大変自覚している・自覚している」ものは,第1学年85.0%,第2学年90.0%,第3学年77.8%,第4学年100%となった.また「将来地域医療を行うことを大変自覚している」ことは,「将来の自分のめざす医師像をもっている」ことと関与することが示唆された.自分の将来に不安があるものは,第1学年は60%,第2学年は55%,第3学年は50.0%,第4学年は50%であり,全体の半数以上が不安を持っていた.「不安がある」ものは有意に「地域包括医療実習以外にもっと地域医療について勉強の機会を与えてほしい」と考えていた.結論:地域医療教育はカリキュラムを越えてさらに発展する必要があることが示唆された.Objective:Four years have passed since Dokkyo Medical University first introduced an admission system for community medicine?oriented students. Therefore, a survey of community-mindedness among these students was held, and based on this survey, we examined the associated factors of willingness toward future engagement and present anxiety.Methods:Participants were 70 students(20 first-year students, 20 second-year students, 18 third-year students, and 12 fourth-year students)who took the comprehensive community medicine practice course. A total of 68 students answered the questionnaire using the learning medical system website and 2 students answered the questionnaire by hand.Results:Willingness to engage in community-oriented medicine was reported by 85.0% of first-years, 90.0% of second-years, 77.8% of third-years, and 100% of fourthyears, and willingness for future engagement was significantly associated with students\u27 possessing an ideal image of the doctor that they want to be. Present anxiety was reported by 60% of first-years, 55% of second-years, 50%of third-years, and 50% of fourth-years;over 50% of all students had some level of anxiety. Additionally, students who wanted to study more about community medicine beyond this practice course were significantly more likely to have present anxiety.Conclusion:Results suggested that education in community medicine was expected further developments

Usefulness of Transdermal Glyceryl Trinitrate for Radial Arterial Spasm on Arteriovenous Hemodialysis Fistula Operation in Uremic Patients

Vasospasm sometimes disturbs successful blood access for hemodialysis, and prevention of vasospasm is desirable when constructing arteriovenous fistulae. We first investigated vasospasm of the radial artery in this operation and analyzed factors associated with this phenomenon in 20 patients with end-stage renal disease. Alteration of blood flow in the radial artery was evaluated in them, and intima-media thickness (IMT), endothelial function index (EFI) and laboratory data were analyzed. Vasospasm occurred in 9 of 20 cases (45.0%) at 5 min after anastomosis, and displayed a marginally significant correlation (r=0.31, p=0.081) with EFI. We then conducted a randomized study of 84 patients with end-stage renal disease to examine the effects of administering transdermal glyceryl trinitrate (GTN) in this operation. EFI was significantly correlated with IMT (r= -0.45, p<0.001). At 5 min after anastomosis, vasospasm occurred in 12 (28.6%) of 42 patients who were administered GTN, while it occurred in 20 (47.6%) of 42 patients without GTN administration (controls); the difference was marginally significant (p=0.072). In patients with IMT?1.1, alteration of diameter (5 min/1 min after anastomosis) was significantly reduced compared with controls (p=0.032). These data suggest that IMT could offer a predictor of vasospasm occurrence during arteriovenous fistula operations. Use of preoperative transdermal GTN may be effective in preventing vasospasm during such surgery