Nitinol stenting improves primary patency of the superficial femoral artery after percutaneous transluminal angioplasty in hemodialysis patients: A propensity-matched analysis

BackgroundAlthough percutaneous transluminal angioplasty (PTA) has become a common therapeutic standard for peripheral artery disease (PAD), high restenosis rates in the superficial femoral artery (SFA) remain a major problem. Nitinol stent implantation is reported to reduce restenosis in SFA after PTA in the general population; however, little is known about whether the nitinol stent improves primary patency after PTA in hemodialysis patients who are at higher risk of revascularization failure. The aim of this study was to clarify the effects of nitinol stent implantation for primary patency in SFA after PTA in hemodialysis patients with PAD.MethodsEighty consecutive hemodialysis patients (167 SFA lesions) who underwent PTA with nitinol stents from January 2006 to January 2008 were compared with 64 hemodialysis patients (128 SFA lesions) who received stainless steel stents in the preceding 2 years. In the follow-up study to 2 years, incidence of restenosis, amputation, and all-cause mortality were analyzed. End points between the groups were examined with the Kaplan-Meier and log-rank methods. Prognostic values for end points were calculated by a Cox univariate analysis and Cox multivariable regression models. To statistically minimize the differences in each stent group, a propensity-matched analysis was also performed using the model including male gender, age, diabetes, hypertension, hyperlipidemia, smoking, incidence of ulcer/gangrene, and TransAtlantic Inter-Society Consensus (TASC) type C+D.ResultsThe 2-year primary patency rate was 58% in the nitinol group vs 42% in the stainless steel group (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.39-0.84; P = .0045), despite a higher prevalence of TASC C+D lesion in the nitinol group (68% vs 49%, P = .0014). In 108 lesions matched after propensity score analysis, the primary patency for 2 years was 64% in the nitinol group vs 42% in the stainless steel group (HR, 0.39; 95% CI, 0.24-0.65; P = .0003). Cox multivariate models showed nitinol stent (HR, 0.42; 95% CI, 0.25-0.73; P = .002), age (HR, 1.04; 95% CI, 1.01-1.08; P = .031), and incidence of ulcer/gangrene (HR, 2.35; 95% CI, 1.17-4.75; P = .017) were independent predictors of restenosis.ConclusionThese data suggest that nitinol stent implantation improves primary patency in SFA after PTA compared with the stainless steel stent, even in hemodialysis patients with PAD

Characteristic of GAFCHROMIC XR TYPE T dosimetry film

医療の高度化に伴い,近年では長時間のⅩ線透視を行うInterventional Radiology(IVR)手技が頻繁に行われ,副作用としての難治性放射線皮膚障害例の報告が増加している｡確定的影響である放射線皮膚障害はしきい値を超えると発症し,線量に依存して障害の程度が重篤となるため,患者被曝線量の測定が重要である｡しかし,IVRでは照射部位が多彩で,焦点-皮膚間距離が不安定なため,その測定方法は確立されていない｡本研究では,近年IVR等低エネルギー線量測定用フイルムとして開発されたCAFCHROMIC XR TYPE T について性能評価を行い,患者皮膚入射面の被曝線量測定への応用の可能性について検討した｡その結果,線量特性,線質特性,ネット値の安定性に良好な特性を示し,臨床に使用可能であったので報告する｡In recent years, interventional radiology (IVR) using which uses prolomged fluoroscopy has been performed frequently in clinical radiology. Also, reports of radiation skin injuries whose symptoms occur after IVR has been also increasing. These symptoms will become worse if the radiation induced skin injuries are caused by doses which are above the designated threshold, and the grade of injuries are dependent on dose. Therefore, it is important that patient skin dose is measured correctly. But when perfoming IVR, irradiation is complex pricedure, and there is a measurement error with an unfixed source-to-skin distance. So. in this paper, characteristics of GAFCHROMIC XR TYPE T (which are film for low energy X-rays) are performed. Then, they are decided whether the application to the skin surface incidence dose measurement whoud be posible. From these results usefull data can be obtainned; for exanmpe film characteristics, energy factors and stability of sensivility

Induction of hepatocyte growth factor production in human dermal fibroblasts and their proliferation by the extract of bitter melon pulp

Hepatocyte growth factor (HGF) is useful as a potential therapeutic agent for hepatic and renal fibrosis and cardiovascular diseases through inducing proliferation of epithelial and endothelial cells. HGF inducers may also be useful as therapeutic agents for these diseases. However, there have been no reports on induction of HGF production by plant extracts or juices. An extract of bitter melon (Momordica charantia L.) pulp markedly induced HGF production. There was a time lag of 72 h before induction of HGF production after the extract addition. Its stimulatory effect was accompanied by upregulation of HGF gene expression. Increases in mitogen-activated protein kinases (MAPKs) were observed from 72 h after the extract addition. Inhibitors of MAPKs suppressed the extract-induced HGF production. The extract also stimulated cell proliferation. Both activities for induction of HGF production and cell proliferation were eluted together in a single peak with 14,000 Da on gel filtration. The results indicate that bitter melon pulp extract induced HGF production and cell proliferation of human dermal fibroblasts and suggest that activation of MAPKs is involved in the HGF induction. Our findings suggest potential usefulness of the extract for tissue regeneration and provide an insight into the molecular mechanism underlying the wound-healing property of bitter melon

〔資 料〕 閉経後女性の体脂肪蓄積，筋肉量および骨密度低下の抑制を 目的とした食事条件を提案するための基礎研究 ―自発運動可能な卵巣摘除メスラットの下肢骨格筋重量，大腿骨骨密度および 走行運動レベルに対する食餌アミノ酸添加の影響―

The present study aims to review whether dietary modifications will prevent body fat accumulation, muscle mass wasting and bone mineral density loss in postmenopausal women who incorporate physical exercise into daily life.9-week-old ovariectomized Wistar strain female rats were divided into four groups: CA-Ex, Gln-Ex, Leu-Ex and CitD-Ex. Depending on which group they were in, the rats were given a 20％ casein protein based experimental diet supplemented with nothing （control diet, CA-Ex）; 5％ of L-glutamine （Gln-Ex）; 5％ of L-leucine （Leu-Ex）; or 2.5％ of L-citrulline＋2.5％ of D-serine （CitD-Ex）, each 11 g per day for 10 weeks. All of these rats were housed in individual cage with a running wheel for 10 weeks. A sham operation was carried out on another group of rats （Sham） and were given the same diet as CA-Ex, the control diet.Results were as follows:1） Uterus weights of the ovariectomized rats, that is group CA-Ex, Gln-Ex, Leu-Ex and CitD-Ex, appeared to show lower values than that of the group Sham. 2） No significant differences were observed in a）changes in body weight, b）blood analyses, c）liver, kidney, uterus and muscle weights, and d）femoral-bone mineral density in groups Gln-Ex, Leu-Ex, and CitD-Ex as compared to the group CA-Ex.3） Relatively higher running activity was observed in group CitD-Ex than that of group CA-Ex. This observation suggests that increasing dietary L-citrulline plus D-serine in postmenopausal rats may lead to an increase in physical activity. Further research is needed to understand the physiological and nutritional significance of the unexpected results that dietary amino acid may accelerate the physical activity

地域活動を“いきいき”として支えている人の要因

本研究の目的は、地域活動を“いきいき”として支えている人の要因を明らかにし、どうしたらそのような人を増やせるのかを検討することである。地域に住み、地域において“いきいき”とボランティアや役員として活動している13名を対象に、半構成的インタビューを行った。KJ法を用いて分類・図解した結果、“いきいき”と活動を続けられる要因は「いきいきと活動するサイクル」と「支援するサイクル」の2つに分けられ、「いきいきと活動するサイクル」を回すためには「支援するサイクル」を円滑に回す事が必要であった。二つのサイクルが円滑に回り、地域活動を発展し続ける事で“いきいき”と活動する人が増えると考えられた

Construction of an explanatory model for quality of life in outpatients with ulcerative colitis

Abstract Introduction: To date, no studies have reported explanatory models of health-related quality of life (HRQoL) in patients with ulcerative colitis. Therefore, this study aimed to examine HRQoL and its related factors in outpatients with ulcerative colitis to construct an explanatory model. Methods: We conducted a cross-sectional survey at a clinic in Japan. The HRQoL was evaluated using the 32-item Inflammatory Bowel Disease Questionnaire. We extracted explanatory variables of HRQoL from demographic, physical, psychological, and social factors reported in previous studies and created a predictive explanatory model. The relationship between explanatory variables and the questionnaire total score was examined using Spearman’s rank correlation coefficient, the Mann–Whitney test, or the Kruskal–Wallis test. We conducted multiple regression and path analyses to examine the effect of explanatory variables on the total score. Results: We included 203 patients. Variables that were associated with the total score were the partial Mayo Score (r = −0.451), treatment side effects (p = 0.004), the Hospital Anxiety Scale-Anxiety score (r = −0.678), the Hospital Anxiety Scale-Depression score (r = −0.528), and the availability of an advisor during difficult times (p = 0.001). The model included the partial Mayo Score, treatment side effects, the Hospital Anxiety Scale-Anxiety score, and the availability of an advisor during difficult times as explanatory variables of the total score that showed the best goodness-of-fit (adjusted R2 = 0.597). The anxiety score exerted the greatest negative effect on the questionnaire total score (β = −0.586), followed by the partial Mayo Score (β = –0.373), treatment side effects (β = 0.121), and availability of an advisor during difficult times (β = −0.101). Conclusion: Psychological symptoms exerted the strongest direct effect on HRQoL in outpatients with ulcerative colitis and mediated the relationship between social support and HRQoL. Nurses should listen carefully to the concerns and anxieties of patients to ensure that a social support system is provided by leveraging multidisciplinary collaborations

A sucking louse（Insecta, Anoplura）from captive Senegal bushbaby, Galago senegalensis, kept in an aquarium in Japan

A larva of a sucking louse was obtained from the dorsal side of captive Senegal bushbaby, Galago senegalensis, kept in an aquarium in Kanagawa Pref., Japan. It is the first local record of the anoplura from the bushbaby was born and kept in Japan.神奈川県の水族館で飼育されていたショウガラゴ Galago senegalensis 1個体の背側部被毛から、シラミ類の幼虫と目される個体が採集された。シラミ類が日本国内で生まれたショウガラゴで検出されたのは初記録であった

Successful resection of growing teratoma syndrome in the abdominal wall with reconstruction using tensor fascia lata muscle flap: A case report and literature review

While cancer cure is the primary goal, fertility preservation is also a cornerstone of the underlying principle of treatment for ovarian germ cell tumors. Growing teratoma syndrome (GTS) presents with growth of mature teratomas during or after chemotherapy. We report a case of successful treatment of GTS in the anterior abdominal wall involving reconstruction. A 23-year-old woman with a suspected right ovarian mature teratoma with torsion underwent emergency laparoscopically assisted extracorporeal ovarian cystectomy. Histopathological findings revealed a grade 1 immature teratoma. After two months, postoperative α-fetoprotein (AFP) levels increased, and disseminated lesions developed not only in the pelvic cavity but also in the abdominal wound where the tumor had been extracted using an extracorporeal technique at the time of primary surgery. The patient underwent laparoscopic right salpingo-oophorectomy, excision of multiple peritoneal nodules, and biopsy of abdominal wall mass. The left rectus abdominis muscle tumor could not be removed. All of these nodules were diagnosed as metastatic immature teratomas. Although the patient received three cycles of chemotherapy, the residual tumor in the abdominal wall grew remarkably despite post-chemotherapy normalization of AFP levels. Both rectus abdominis muscles involving the residual tumors were removed and reconstructed using a left tensor fascia lata muscle flap. Histopathologically, the residual tumors were identified as mature teratomas with no immature elements, resulting in GTS. The patient got pregnant without the need of fertility treatment and gave birth uneventfully by cesarean section. Thus, reconstruction with a tensor fascia lata muscle flap facilitated complete removal of GTS while preserving fertility