Risk Score to Predict 1-Year Mortality after Haemodialysis Initiation in Patients with Stage 5 Chronic Kidney Disease under Predialysis Nephrology Care

Background Few risk scores are available for predicting mortality in chronic kidney disease (CKD) patients undergoing predialysis nephrology care. Here, we developed a risk score using predialysis nephrology practice data to predict 1-year mortality following the initiation of haemodialysis (HD) for CKD patients. Methods This was a multicenter cohort study involving CKD patients who started HD between April 2006 and March 2011 at 21 institutions with nephrology care services. Patients who had not received predialysis nephrology care at an estimated glomerular filtration rate (eGFR) of approximately 10 mL/min per 1.73 m2 were excluded. Twenty-nine candidate predictors were selected, and the final model for 1-year mortality was developed via multivariate logistic regression and was internally validated by a bootstrapping technique. Results A total of 688 patients were enrolled, and 62 (9.0%) patients died within one year of HD initiation. The following variables were retained in the final model: eGFR, serum albumin, calcium, Charlson Comorbidity Index excluding diabetes and renal disease (modified CCI), performance status (PS), and usage of erythropoiesis-stimulating agent (ESA). Their β-coefficients were transformed into integer scores: three points were assigned to modified CCI�3 and PS 3–4; two to calcium>8.5 mg/dL, modified CCI 1–2, and no use of ESA; and one to albumin7 mL/min per 1.73 m2, and PS 1–2. Predicted 1-year mortality risk was 2.5% (score 0–4), 5.5% (score 5–6), 15.2% (score 7–8), and 28.9% (score 9–12). The area under the receiver operating characteristic curve was 0.83 (95% confidence interval, 0.79–0.89). Conclusions We developed a simple 6-item risk score predicting 1-year mortality after the initiation of HD that might help nephrologists make a shared decision with patients and families regarding the initiation of HD.This work was supported by grants from the Institute for Health Outcomes & Process Evaluation research

Hope in Adult Patients with Chronic Disease: Qualitative Study.

To identify the sources of hope for patients with chronic disease, a semi - structured interview was conducted with patients middle-aged and older, whose disease types and levels of activities of daily living limitations varied. Six patience - three with chronic kidney disease, one with rheumatoid arthritis, one with spinal cord injury, and another with lumbar spinal canal stenosis - were interviewed by a psychologist and an internist. It was determined that their sources greatly differed depending on individual circumstances, such as types and severity of disease, sources of joy and happiness, family structure, employment status, relationship with friends, etc. However, it also showed a stylization of hope dependent on individual experience; in other words, there was a tendency for patients to redefine their source of hope by setting attainable goals to match their limitations, or acknowledging what they have achieved and finding hope in maintaining their current state. We have determined that the sources of hope are comprised of two categories: ［foundation and process of finding hope］ and ［specific goals and sources］. The former consists of: ［stylization dependent on experience］, ［method and will］, ［use of external information］, ［intrinsic foundation］, and ［extrinsic foundation］. The latter consists of: ［health］, ［source of joy and happiness］, ［family］, and ［social connections］

Cryptorchidism after the Fukushima Daiichi Nuclear Power Plant accident:causation or coincidence?

Cryptorchidism (undescended testes) is among the most common congenital diseases in male children. Although many factors have been linked to the incidence of cryptorchidism, and testicular androgen plays a key role in its pathogenesis, the cause remains unknown in most cases. Recently, a Japanese group published a speculative paper entitled, "Nationwide increase in cryptorchidism after the Fukushima nuclear accident." Although the authors implicated radionuclides emitted from the Fukushima accident as contributing to an increased incidence of cryptorchidism, they failed to establish biological plausibility for their hypothesis, and glossed over an abundance of evidence and expert opinion to the contrary. We assessed the adequacy of their study in terms of design setting, data analysis, and its conclusion from various perspectives. Numerous factors must be considered, including genetic, environmental, maternal/fetal, and social factors associated with the reporting of cryptorchidism. Other investigators have established that the doses of external and internal radiation exposure in both Fukushima prefecture and the whole of Japan after the accident are too low to affect testicular descent during fetal periods;thus, a putative association can be theoretically and empirically rejected. Alternative explanations exist for the reported estimates of increased cryptorchidism surgeries in the years following Japan's 2011 earthquake, tsunami, and nuclear crisis. Data from independent sources cast doubt on the extent to which cryptorchidism increased, if at all. In any case, evidence that radionuclides from the Fukushima Daiichi Nuclear Power Plant could cause cryptorchidism is lacking

The Physics of the B Factories

This work is on the Physics of the B Factories. Part A of this book contains a brief description of the SLAC and KEK B Factories as well as their detectors, BaBar and Belle, and data taking related issues. Part B discusses tools and methods used by the experiments in order to obtain results. The results themselves can be found in Part C

地域住民において過活動膀胱症状の重症度が転倒と関連する : LOHAS研究

京都大学0048新制・課程博士博士(医学)甲第18143号医博第3863号新制||医||1002(附属図書館)31001京都大学大学院医学研究科医学専攻(主査)教授 中山 健夫, 教授 小川 修, 教授 佐藤 俊哉学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

Vehicle configurations associated with anatomical-specific severe injuries resulting from traffic collisions.

Vehicles can be classified by configuration as either bonnet-type or cab-over type according to engine location. Compared to bonnet-type, the front compartment of cab-over type vehicles is considerably shorter; thus, it may be less likely to absorb the energy generated in a collision, and in turn be unable to prevent deformation of the occupant space and protect occupants from injury. This study was a cohort study involving 943 occupants of mini-vehicles who were injured in frontal collision accidents between 2001 and 2015 and transferred to Ohta Nishinouchi Hospital. The vehicle configuration was divided into bonnet-type and cab-over type (i.e., truck-type and wagon-type). The tested outcomes were anatomical-specific severe injury of the pelvis and extremities, the head and neck, the abdomen, and the chest. To estimate adjusted odds ratios (AOR) for associations between vehicle configuration and anatomical-specific severe injury, we fitted generalized estimating equations for each outcome. Compared with bonnet-type vehicles, a greater risk of serious pelvis and extremities injury was found for both truck (AOR: 2.21; 95% Confidence Interval [95% CI]: 1.22-4.00) and wagon-type vehicles (AOR: 3.43; 95%CI 1.60-7.39). For serious head and neck injury, truck-type vehicles were associated with greater risk (AOR: 2.04; 95% CI: 1.10-3.79) than bonnet-type vehicles, whereas wagon-type vehicles were not. Compared with the occupants of bonnet-type vehicles, cab-over type vehicle occupants were more likely to have serious pelvis and extremities injury during frontal collisions. Additionally, truck-type vehicle occupants were more likely to have serious head and neck injury than bonnet-type vehicle occupants. These findings are expected to promote safer behaviors for vehicle occupants and the automobile industry