Demographic trends in the Okinawa Dialysis Study (OKIDS) registry (1971–2000)

Demographic trends in the Okinawa Dialysis Study (OKIDS) registry (1971–2000).BackgroundThe clinical demographics of chronic dialysis patients are changing worldwide. However, long-term data from regional dialysis registries have not yet been analyzed and reported.MethodsThe Okinawa Dialysis Study (OKIDS) registry included all chronic dialysis patients treated in Okinawa, Japan, since 1971. Data for the years 1971 to 1990 were analyzed to predict trends for 1991 to 2000. The predicted values were then compared to the actual values and analyzed statistically, with particular attention being paid to relative risk of death. Multivariate Cox proportional hazards analysis was done to analyze the time factors of relative risk of death.ResultsA total of 5246 patients (2981 men and 2265 women) were registered and the total duration of observation was 28,431 patient-years. The prevalence and incidence of dialysis patients expressed per million population were 2320 and 297, respectively, in 2000, values that were significantly higher (P < 0.02 for both) than the predicted values. The gross mortality rate per 1000 patient-years was 118.4 for 1971 to 1980, 63.3 for 1981 to 1990, and 77.7 for 1991 to 2000. The adjusted hazards ratio (95% confidence interval) for mortality was 0.743 (0.650 to 0.862) for 1981–1990 and 0.721 (0.659 to 0.790) for 1991 to 2000 in comparison to the risk of mortality in 1971 to 1980. The decrease in mortality rate was largely due to the drop in cardiac deaths from 71.0 for 1971 to 1980 to 17.2 for 1991 to 2000.ConclusionsThe incidence and prevalence of chronic dialysis patients increased more than expected over the past decade in Okinawa, Japan. Despite the rapid change in patient demographics, the survival rate did not decrease significantly

小児異所性尿管瘤に対して施行した後腹膜鏡下半腎摘出術の1例

5歳女児.1歳2ヵ月より尿路感染症を繰り返し, 右異所性尿管瘤と診断され保存的に経過観察されていた.IVP, DMSA腎シンチで瘤所属右上半腎は無機能で下半腎に国際分類III度の膀胱尿管逆流症を認めた.1998年8月13日, 右後腹膜鏡下半腎摘出術及び瘤切除, 右下半腎逆流防止術を施行した.術後経過は良好で, 術後3ヵ月目のVCGでも逆流は消失し, 腎機能も良好であった.小児における腹腔鏡下半腎摘出術は現在迄に15例の報告があるが, 後腹膜アプローチは本症例が初めてであるA 5-year-old girl with a history of recurrent urinary tract infection since the age of 14 months was diagnosed as having a right duplicated urinary collecting system with the upper ureter ectopically opening in the urethra. She underwent retroperitoneoscopic heminephrectomy for a right dysplastic kidney and open ureterocelectomy and reimplantation of the refluxing lower ureter via Pfannenstiel incision. She survived the procedure without serious complications and resumed normal daily activities by day 6. To the best of our knowledge, this case is the 16th case of laparoscopic heminephrectomy for pediatric patients and the first case treated by the retroperitoneal approach in the English literature

女児尿道ポリープの1例

Urethral polyps are rarely found in young girls. A total of 12 urethral polyps have been described in young girls in the English literature to date. Here we present a case of urethral polyp that was detected in the distal urethra of a 12-year-girl. Her chief complaint was a sudden blood discharge. On examination, a 15 x 9 mm polypoid mass with a 7 mm pedicle was seen protruding from the urethral meatus. The mass was excised under general anesthesia. Histopathologically, the polyp was covered with urothelium and squamous epithelium, and was composed of congested blood vessels and inflammatory infiltrates. These findings were similar to those of urethral caruncles in postmenopausal female. She has been free from recurrence and has had no complications, as of 12 months after excision.症例は12歳, 女児。生来健康。約1年前より外尿道口から脱出する腫瘤に気付くも症状なく放置していた。2005年10月に外陰部より突然の出血を認めたため, 近医を受診。外尿道口より脱出する小指頭大のポリープを認め, 同年10月31日, 精査加療目的に当院紹介となった。受診時, 他に理学所見上, 特に異常認めず, また尿沈渣, 血液学的検査, エコー, IVPなどにおいても異常所見を認めなかった。同年11月10日全身麻酔下, 尿道膀胱鏡および尿道ポリープ切除術を施行した。尿道鏡にて前部尿道の6時にポリープの起始部を認めた。膀胱内に特に異常所見は認めなかった。起始部からポリープを鋭的に切除し, 欠損部を5-0 PDSにて縫合した。術後経過は良好で術後1日目に尿道カテーテル抜去, 2日目に退院となった。病理組織学的検査にて尿道ポリープは移行上皮および扁平上皮に覆われ, 上皮下組織に小血管の増生と著明な炎症細胞の浸潤を認め, 尿道カルンクラに非常に類似していた。腫瘍性変化や異型細胞の増殖は認めなかった。現在, 術後1年が経過しているが, 再発, 合併症など認めていない。小児における尿道ポリープは稀な疾患であるが, 男児に比べ女児における報告はさらに少ない。われわれが調べうる限り12例の女児尿道ポリープが報告されている。またBen-Meirらは思春期前の女児尿道ポリープの5症例を検討し, 病理組織学的に尿道カルンクラとの類似性を指摘している。今回, われわれは女児尿道ポリープの1例を経験したので若干の文献的考察を加え, ここに報告する。(著者抄録

Newly Developed Fully Covered Metal Stent for Unresectable Malignant Biliary Stricture

We herein report two patients with unresectable malignant biliary stricture who underwent stenting with a newly developed fully-covered metal stent. In the first case of lower-middle bile duct cancer, a stent was placed through the stenosis. In the second case of middle bile duct stricture due to lymph node metastases from gallbladder cancer, a stent was placed in the bile duct across the stenosis. No procedure-related complications were observed. Unevenness of the outer surface and a low shortening ratio are expected to lessen the occurrence of complications characteristic of covered metal stents such as stent migration and bile duct kinking

Gastric Cancer in younger patients of less than age 30

Twenty-five gastric cancer of less than 30 years of age were clinically evaluated in comparison with those of manhood. 1) Gastric cancers in younger patients were predominant in female, four times as frequent as in male and the most favorable location in the younger was the cardia of the stomach. 2) In terms of histologic findings, undifferentiated carcinoma of Borrmann IV type was common in younger patients. 3) Peritoneal dissemination and serosal invasion as an extension type of carcinoma were most common in younger patients although hepatic metastasis was very few. 4) Surgical outcome of curative operation was very favorable although that of noncurative one was very pessimistic

Pretransplant serum hepatitis C virus RNA levels predict response to antiviral treatment after living donor liver transplantation.

[Background]Given the limited efficacy and high adverse event rate associated with treatment of recurrent hepatitis C after liver transplantation, an individualized treatment strategy should be considered. The aim of this study was to identify predictors of response to antiviral therapy for hepatitis C after living donor liver transplantation (LDLT) and to study the associated adverse events. [Methods]A retrospective chart review was performed on 125 hepatitis C virus (HCV)-positive LDLT recipients who received interferon plus ribavirin and/or peginterferon plus ribavirin therapy at Kyoto University between January 2001 and June 2011. [Results]Serum HCV RNA reached undetectable levels within 48 weeks in 77 (62%) of 125 patients, and these patients were defined as showing virological response (VR). Of 117 patients, 50 (43%) achieved sustained VR (SVR). Predictive factors associated with both VR and SVR by univariate analysis included low pretransplant serum HCV RNA levels, a non-1 HCV genotype, and low pretreatment serum HCV RNA levels. In addition, LDLT from ABO-mismatched donors was significantly associated with VR, and white cell and neutrophil counts before interferon therapy were associated with SVR. Multivariate analysis showed that 2 variables–pretransplant serum HCV RNA level less than 500 kIU/mL and a non-1 HCV genotype–remained in models of both VR and SVR and that an ABO mismatch was associated with VR. No variables with a significant effect on treatment withdrawal were found. [Conclusions]Virological response to antiviral therapy in patients with hepatitis C recurring after LDLT can be predicted prior to transplant, based on pretransplant serum HCV-RNA levels and HCV genotype. LDLT from ABO-mismatched donors may contribute to more efficacious interferon therapy

Development of sensory neuropathy in streptozotocin-induced diabetic mice.

Diabetic polyneuropathy is a major complication of diabetes and the most common cause of peripheral neuropathy. Sensory-dominant neuropathy is the most common type. We previously used streptozotocin (STZ)-induced diabetic ddY mice with sensory neuropathy to evaluate the therapeutic effects of vascular endothelial growth factor and placental growth factor isoforms. In this study, to characterize the development of diabetic sensory neuropathy, electrophysiological, behavioral, and histopathological studies were performed in these diabetic mice. A significant difference in sensory conduction velocity in the tail nerve was observed between healthy and diabetic mice at 1 week after STZ injection. Diabetic mice developed hypoalgesia at 5 weeks after STZ injection. Axon area and myelin thickness of the myelinated fibers were increased in 17-week-old healthy mice compared with those in 8-week-old healthy mice. However, these increases were retarded in 17-week-old diabetic mice. In unmyelinated fibers, axon area was significantly reduced in 17-week-old diabetic mice compared with 8- and 17-week-old healthy mice. These findings suggest that both impaired maturation of myelinated fibers and atrophy of unmyelinated fibers simultaneously occur in the early stage of diabetes in these mice. Our mouse model may be useful for studying the pathogenesis of and therapies for diabetic sensory neuropathy.Diabetic polyneuropathy is a major complication of diabetes and the most common cause of peripheral neuropathy. Sensory-dominant neuropathy is the most common type. We previously used streptozotocin (STZ)-induced diabetic ddY mice with sensory neuropathy to evaluate the therapeutic effects of vascular endothelial growth factor and placental growth factor isoforms. In this study, to characterize the development of diabetic sensory neuropathy, electrophysiological, behavioral, and histopathological studies were performed in these diabetic mice. A significant difference in sensory conduction velocity in the tail nerve was observed between healthy and diabetic mice at 1 week after STZ injection. Diabetic mice developed hypoalgesia at 5 weeks after STZ injection. Axon area and myelin thickness of the myelinated fibers were increased in 17-week-old healthy mice compared with those in 8-week-old healthy mice. However, these increases were retarded in 17-week-old diabetic mice. In unmyelinated fibers, axon area was significantly reduced in 17-week-old diabetic mice compared with 8- and 17-week-old healthy mice. These findings suggest that both impaired maturation of myelinated fibers and atrophy of unmyelinated fibers simultaneously occur in the early stage of diabetes in these mice. Our mouse model may be useful for studying the pathogenesis of and therapies for diabetic sensory neuropathy

Epithelial EP4 plays an essential role in maintaining homeostasis in colon

Colonic epithelial cells comprise the mucosal barrier, and their dysfunction promotes microbial invasion from the gut lumen and induces the development of intestinal inflammation. The EP4 receptor is known to mediate the protective effect of prostaglandin (PG) E2 in the gastrointestinal tract; however, the exact role of epithelial EP4 in intestinal pathophysiology remains unknown. In the present study, we aimed to investigate the role of epithelial EP4 in maintaining colonic homeostasis by characterizing the intestinal epithelial cell-specific EP4 knockout (EP4 cKO) mice. Mice harboring the epithelial EP4 deletion showed significantly lower colonic crypt depth and lower numbers of secretory cell lineages, as well as impaired epithelial cells in the colon. Interestingly, EP4-deficient colon epithelia showed a higher number of apoptotic cells. Consistent with the defect in mucosal barrier function of colonic epithelia and secretory cell lineages, EP4 cKO colon stroma showed enhanced immune cell infiltration, which was accompanied by increased production of inflammatory cytokines. Furthermore, EP4-deficient colons were susceptible to dextran sulfate sodium (DSS)-induced colitis. Our study is the first to demonstrate that epithelial EP4 loss resulted in potential "inflammatory" status under physiological conditions. These findings provided insights into the crucial role of epithelial PGE2/EP4 axis in maintaining intestinal homeostasis

Protein-protein interactions of the hyperthermophilic archaeon Pyrococcus horikoshii OT3

BACKGROUND: Although 2,061 proteins of Pyrococcus horikoshii OT3, a hyperthermophilic archaeon, have been predicted from the recently completed genome sequence, the majority of proteins show no similarity to those from other organisms and are thus hypothetical proteins of unknown function. Because most proteins operate as parts of complexes to regulate biological processes, we systematically analyzed protein-protein interactions in Pyrococcus using the mammalian two-hybrid system to determine the function of the hypothetical proteins. RESULTS: We examined 960 soluble proteins from Pyrococcus and selected 107 interactions based on luciferase reporter activity, which was then evaluated using a computational approach to assess the reliability of the interactions. We also analyzed the expression of the assay samples by western blot, and a few interactions by in vitro pull-down assays. We identified 11 hetero-interactions that we considered to be located at the same operon, as observed in Helicobacter pylori. We annotated and classified proteins in the selected interactions according to their orthologous proteins. Many enzyme proteins showed self-interactions, similar to those seen in other organisms. CONCLUSION: We found 13 unannotated proteins that interacted with annotated proteins; this information is useful for predicting the functions of the hypothetical Pyrococcus proteins from the annotations of their interacting partners. Among the heterogeneous interactions, proteins were more likely to interact with proteins within the same ortholog class than with proteins of different classes. The analysis described here can provide global insights into the biological features of the protein-protein interactions in P. horikoshii

Surgery for complications by diverticular disease of the colon

Surgical experience with fifteen complications of diverticular disease of the colon has been reported. These had a considerably long period from onset to operation except for perforation episode. Conservative treatment prior to surgery is of great benefit to avoid postoperative complications. The surgical outcome, thereafter is satisfactory and recurrence has not been experienced