34 research outputs found

    非心臓手術における、術前の蛋白尿と術後急性腎障害の関連: 奈良AKIコホート研究

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    Background: Little is known about the association between pre-operative proteinuria and post-operative acute kidney injury (AKI) in noncardiac surgery. Methods: This is a retrospective cohort study. Adults who underwent noncardiac surgery under general anesthesia from 2007 to 2011 at Nara Medical University Hospital were included. Those with obstetric or urological surgery, missing data for analyses or pre-operative dialysis were excluded. Exposure of interest was pre-operative proteinuria, defined as (+) or more by dipstick test. The outcome variable was post-operative AKI, defined by Kidney Disease: Improving Global Outcomes criteria, within 1 week after surgery. Multivariable logistic regression analyses were performed. Results: Among 5168 subjects, 309 (6.0%) developed AKI. Pre-operative proteinuria was independently associated with post-operative AKI, with an odds ratio (OR) [95% confidence interval (CI)] of 1.80 (1.30-2.51). A sensitivity analysis restricted to elective surgery yielded a similar result. As proteinuria increased, the association with AKI became stronger [OR (95% CI) 1.14 (0.75-1.73), 1.24 (0.79-1.95), 2.75 (1.74-4.35) and 3.95 (1.62-9.62) for urinary protein (+/-), (+), (2+) and (3+), respectively]. Subgroup analyses showed proteinuria was especially associated with post-operative AKI among subjects with renin-angiotensin system inhibitors, other anti-hypertensives, hypoalbuminemia or impaired renal function (P for interaction = 0.05, 0.003, 0.09 or 0.02, respectively). Conclusions: In noncardiac surgery, pre-operative proteinuria was independently associated with post-operative AKI. Subjects with proteinuria should be managed with caution to avoid AKI peri-operatively.博士(医学)・甲第777号・令和3年3月15日© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.This is a pre-copyedited, author-produced version of an article accepted for publication in Nephrology dialysis transplantation following peer review. The version of record Nephrology Dialysis Transplantation, Volume 35, Issue 12, December 2020, Pages 2111–2116, is available online at: https://doi.org/10.1093/ndt/gfz269

    Immune Functions of Former Poison Gas Workers I. Mitogenic response of lymphocytes and serum factors

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    The relation of depressed immune function to carcinogenesis has been estimated in the living body. The authors have measured the immunological parameters in former poison gas workers, a group having a high risk of carcinogenesis, for comparison with age matched normal controls and the following results were obtained. 1) With regard to serum factors, no significant difference could be demonstrated between normal controls and poison gas workers in such immunoglobulins as IgG, IgA, and IgM, in acute phase reactants such as α1-AT, α1-AG, α2-HS and C3 and in such tumor markers as CEA, ferritin, and β2-microglobulin. Furthermore, no difference could be observed in the positive rate of immune complex and in complement activity. 2) No difference could be observed between the two groups with regard to tuberculin skin reaction and number of lymphocytes, but the longer the duration of work at the poison gas factory, the more significant was the increase in those who showed negative tuberculin skin reaction. 3) In comparison with normal controls, mitogenic response to PHA showed a significant decrease in poison gas workers, but no significant difference could be seen in mitogenic response to Con A and PPD and in mixed lymphocyte reaction. 4) No significant difference could be demonstrated between the two groups in the inhibitory effects of serum on mitogenic response to PHA and Con A and on mixed lymphocyte reaction

    Comparison of Various Serum Protein Values in the Japanese and the Japanese-Americans Resident in the United States

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    Measurements were made of various types of proteins, that is α1-antitrypsin, α1-acid glycoprotein, α2-HS glycoprotein, haptoglobin, α2-macroglobulin, transferrin, C3, IgG, IgA and lgM, in the serum of the Japanese-Americans living in Hawaii and the Japanese-Americans living in Los Angeles who are assumed to be genetically almost identical to the Japanese in Hiroshima Prefecture but are known to have a higher intake of animal fats but a lower intake of complex carbohydrates. These were compared with those of the Japanese in Hiroshima Prefecture. α2-macroglobulin values in serum of the male Japanese-Americans living in Hawaii of ages 30-39 years, 40-49 years, and 50-59 years were significantly lower than those of the residents in Hiroshima Prefecture, but no significant difference in these values could be observed between the Japanese-Americans living in Los Angeles and the Japanese in Hiroshima Prefecture. No significant difference could be observed in the values of other serum proteins in all age groups. These findings indicate that the difference in intake volume of animal fats and complex carbohydrates did not affect these serum protein values

    日本における保険診療全透析患者追跡と死亡数の現状

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    Background: The survival rate of chronic dialysis patients in Japan remains the highest worldwide, so there is value in presenting Japan's situation internationally. We examined whether aggregate figures on dialysis patients in the National Database of Health Insurance Claims and Special Health Checkups of Japan (NDB), which contains data on insured procedures of approximately 100 million Japanese residents, complement corresponding figures in the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). Methods: Subjects were patients with medical fee points for dialysis recorded in the NDB during 2014-2018. We analyzed annual numbers of dialysis cases, newly initiated dialysis cases- and deaths. Results: Compared with the JRDR, the NDB had about 6-7% fewer dialysis cases but a similar number of newly initiated dialysis cases. In the NDB, the number of deaths was about 6-10% lower, and the number of hemodialysis cases was lower, while that of peritoneal dialysis cases was higher. The cumulative survival rate at dialysis initiation was approximately 6 percentage points lower in the NDB than in the JRDR, indicating that some patients die at dialysis initiation. Cumulative survival rate by age group was roughly the same between the NDB and JRDR in both sexes. Conclusion: The use of the NDB enabled us to aggregate data of dialysis patients. With the definition of dialysis patients used in this study, analyses of concomitant medications, comorbidities, surgeries, and therapies will become possible, which will be useful in many future studies.博士(医学)・甲第818号・令和4年3月15日© 2021. The Author(s). Open Access This article is licensed under a Creative Commons Attri bution 4.0 International License, which permits use, sharing, adapta tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/

    IgA 腎症における腎生検後 5 年間の治療反応性と腎予後の関連性

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    Background: Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis. Since most patients have a relatively benign renal prognosis, long-term follow-up is required. During such a long course of disease, relapse of IgAN is occasionally observed after upper respiratory tract infection or without any trigger. However, little is known about the impact of relapse on long-term renal outcomes. Methods: In this retrospective cohort study of biopsy-proven primary IgAN, we analyzed the association of 5-year therapeutic responsiveness (relapse) with the subsequent development of end-stage kidney disease (ESKD) using a 5-year landmark analysis (Cox model) and explored predictors of relapse from histological and clinical data at baseline. Results: Among 563 patients from the exploratory cohort, most relapses (13.7%) occurred within 5 years after treatment. Using 5-year landmark analysis, among 470 patients, 79 developed ESKD during a median follow-up period of 155 months. Even after adjustment for clinicopathological relevant confounders, hazard ratios (95% confidence intervals) in the relapse and non-responder groups compared with the remission group were 2.86 (1.41-5.79) and 2.74 (1.48-5.11), respectively. Among 250 patients who achieved remission within 5 years, proteinuria, eGFR, mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, and crescent, but not interstitial fibrosis/tubular atrophy, were independent predictors of 5-year relapse in multivariable logistic regression analysis, CONCLUSIONS: Both relapsers and non-responders had similarly strong association with ESKD in patients with IgAN. We also confirmed the predictors of relapse 5 years after renal biopsy, which may guide the treatment strategies for patients with IgAN who occasionally relapse after remission.博士(医学)・乙第1530号・令和5年3月15

    加令によるヒトリンパ球の mitogen による lgG 産生の増強 : 特に T 細胞の効果について

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    When in vitro IgG production by mitogen-stimulated peripheral lymphocytes from healthy aged (70-93 year old) and young (20-29 year old) subjects was compared, it was found that the level of IgG production was elevated in the aged subjects. Co-culture studies were performed to determine whether the increase was clue to changes in T or non-T cells. IgG production was significantly higher when reference non-T cells from normal young adults were mixed with T cells from aged subjects than with T cells from young adults. In contrast, no significant difference in IgG production was observed when reference T cells from normal young adults were mixed with non-T cells from either young or aged subjects. The suppressor activity of Tγ cells and helper activity of non-Tγ T cells of young and aged subjects were then determined. The results revealed that the suppressor activity of Tγ cells of aged individuals was significantly lower than that of young adults, but the helper activity of non-Tγ T cells of young and aged subjects was comparable. These results indicate that the increase in production of IgG by the peripheral lymphocytes of aged individuals is due in part to changes in the T cells which are related to a decrease in suppressor activity of Tγ cells
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