Cohort profile: Alliance for Quality Assessment in Healthcare-Dialysis (AQuAH-D) prospective cohort study of patients on haemodialysis in Japan

PURPOSE: The global burden of kidney failure is increasing, but the treatment of kidney failure varies widely between patients, between dialysis facilities and over time. The Alliance for Quality Assessment in Healthcare-Dialysis (AQuAH-D) aims to conduct efficient and timely cohort studies on associations between those variations and clinical and patient-reported outcomes. PARTICIPANTS: Included are outpatients aged 20 years old or older who are undergoing haemodialysis and have consented to participate. A total of 2895 patients were enrolled from 25 facilities in Japan between August 2018 and July 2020 and are to be followed until 31 December 2026. Chart review and annual questionnaires are used to collect data on patient characteristics and on outcomes including quality of life. Data on medications, haemodialysis prescriptions and blood tests are obtained from existing electronic records. Data are collected retrospectively from 1 January 2017 to patient enrolment, and prospectively from patient enrolment until the end of December 2026. FINDINGS TO DATE: To date, the mean age is 68.3 (SD 12.2) years and 35.2% are female. The most common cause of kidney failure is diabetic nephropathy (37.4%). In January 2020, the facilities' median weekly doses of erythropoietin stimulating agent (ESA) and of intravenous vitamin D ranged from 1846 to 9692 IU (epoetin alfa equivalent) and 0.78 to 2.25 µg (calcitriol equivalent), respectively. The facilities' percentages of patients to whom calcimimetics are prescribed varied from 19% to 79%. During the retrospective period (averaging 1.85 years per participant), the incidence rates of any hospitalisation and of hospitalisation due to cardiovascular disease were 67.2 and 12.0 per 100 person-years, respectively. FUTURE PLANS: AQuAH-D data will be updated every 6 months and will be available for studies addressing a wide range of research questions, using the advantages of granular data and quality-of-life measurement of ageing patients on haemodialysis

High Excitation Molecular Gas in the Galactic Center Loops; 12CO(J =2-1 and J =3-2) Observations

We have carried out 12CO(J =2-1) and 12CO(J =3-2) observations at spatial resolutions of 1.0-3.8 pc toward the entirety of loops 1 and 2 and part of loop 3 in the Galactic center with NANTEN2 and ASTE. These new results revealed detailed distributions of the molecular gas and the line intensity ratio of the two transitions, R3-2/2-1. In the three loops, R3-2/2-1 is in a range from 0.1 to 2.5 with a peak at ~ 0.7 while that in the disk molecular gas is in a range from 0.1 to 1.2 with a peak at 0.4. This supports that the loops are more highly excited than the disk molecular gas. An LVG analysis of three transitions, 12CO J =3-2 and 2-1 and 13CO J =2-1, toward six positions in loops 1 and 2 shows density and temperature are in a range 102.2 - 104.7 cm-3 and 15-100 K or higher, respectively. Three regions extended by 50-100 pc in the loops tend to have higher excitation conditions as characterized by R3-2/2-1 greater than 1.2. The highest ratio of 2.5 is found in the most developed foot points between loops 1 and 2. This is interpreted that the foot points indicate strongly shocked conditions as inferred from their large linewidths of 50-100 km s-1, confirming the suggestion by Torii et al. (2010b). The other two regions outside the foot points suggest that the molecular gas is heated up by some additional heating mechanisms possibly including magnetic reconnection. A detailed analysis of four foot points have shown a U shape, an L shape or a mirrored-L shape in the b-v distribution. It is shown that a simple kinematical model which incorporates global rotation and expansion of the loops is able to explain these characteristic shapes.Comment: 59 pages, accepted to PAS

Medium-term impact of the SARS-CoV-2 mRNA vaccine against disease activity in patients with systemic lupus erythematosus

全身性エリテマトーデスへのコロナワクチンの影響を分析 --中期的な疾患活動性と再燃への影響について--. 京都大学プレスリリース. 2022-10-25.OBJECTIVES: Numerous case reports have referred to new onset or flare of SLE after SARS-CoV-2 messenger RNA (mRNA) vaccines. Several observational studies showed that the short-term flare rate of SLE after SARS-CoV-2 vaccination is low. However, well-controlled clinical surveys are unavailable and the medium-term impact of the SARS-CoV-2 mRNA vaccines against the flare of SLE is uncertain. Therefore, we aimed to analyse the association between vaccination and medium-term subjective and objective disease activities of SLE and flares using matched pair methods. METHODS: Altogether, 150 patients with SLE from the Kyoto Lupus Cohort were included. Patients who received two doses of the SARS-CoV-2 mRNA vaccines were 1:1 matched with unvaccinated patients based on the first vaccination date. The outcome measures were the SLE Disease Activity Index-2000 (SLEDAI-2K), the Japanese version of the SLE Symptom Checklist Questionnaire (SSC-J) and the Safety of Estrogens in Lupus Erythematosus National Assessment-SLEDAI flare index at 30, 60 and 90 days after vaccination. RESULTS: SLEDAI-2K levels were not significantly different in vaccinated and unvaccinated patients with SLE at 30, 60 and 90 days after the second vaccination (adjusted estimate (95% CI): 30 days: -0.46 (-1.48 to 0.56), p=0.39; 60 days: 0.38 (-0.64 to 1.40), p=0.47; 90 days: 0.40 (-0.54 to 1.34), p=0.41). Similar results were observed in the SSC-J score (adjusted estimate (95% CI), 30 days: 0.05 (-1.46 to 1.56), p=0.95; 60 days: -0.63 (-2.08 to 0.82), p=0.40; 90 days: 0.27 (-1.04 to 1.58), p=0.69) and flare index (adjusted OR (95% CI), 30 days: 0.81 (0.36 to 1.85), p=0.62; 60 days: 1.13 (0.50 to 2.54), p=0.77; 90 days: 0.85 (0.32 to 2.26), p=0.74). CONCLUSION: SARS-CoV-2 vaccination did not significantly influence the medium-term subjective and objective disease activities or flares of SLE until 90 days after the second vaccination

Temperature and Density in the Foot Points of the Molecular Loops in the Galactic Center; Analysis of Multi-J Transitions of 12CO(J=1-0, 3-2, 4-3, 7-6), 13CO(J=1-0) and C18O(J=1-0)

Fukui et al. (2006) discovered two molecular loops in the Galactic center and argued that the foot points of the molecular loops, two bright spots at both loops ends, represent the gas accumulated by the falling motion along the loops, subsequent to magnetic flotation by the Parker instability. We have carried out sensitive CO observations of the foot points toward l=356 deg at a few pc resolution in the six rotational transitions of CO; 12CO(J=1-0, 3-2, 4-3, 7-6), 13CO(J=1-0) and C18O(J=1-0). The high resolution image of 12CO (J=3-2) has revealed the detailed distribution of the high excitation gas including U shapes, the outer boundary of which shows sharp intensity jumps accompanying strong velocity gradients. An analysis of the multi-J CO transitions shows that the temperature is in a range from 30-100 K and density is around 10^3-10^4 cm^-3, confirming that the foot points have high temperature and density although there is no prominent radiative heating source such as high mass stars in or around the loops. We argue that the high temperature is likely due to the shock heating under C-shock condition caused by the magnetic flotation. We made a comparison of the gas distribution with theoretical numerical simulations and note that the U shape is consistent with numerical simulations. We also find that the region of highest temperature of ~100 K or higher inside the U shape corresponds to the spur having an upward flow, additionally heated up either by magnetic reconnection or bouncing in the interaction with the narrow neck at the bottom of the U shape. We note these new findings further reinforce the magnetic floatation interpretation.Comment: 40 pages, 23 figures, accepted by PASJ on Vol.62 No.

Warm and Dense Molecular Gas in the N159 Region: 12CO J=4-3 and 13CO J=3-2 Observations with NANTEN2 and ASTE

New 12CO J=4-3 and 13CO J=3-2 observations of the N159 region in the Large Magellanic Cloud have been made. The 12CO J=4-3 distribution is separated into three clumps. These new measurements toward the three clumps are used in coupled calculations of molecular rotational excitation and line radiation transfer, along with other transitions of the 12CO as well as the isotope transitions of 13CO. The temperatures and densities are determined to be ~70-80K and ~3x10^3 cm-3 in N159W and N159E and ~30K and ~1.6x10^3 cm-3 in N159S. These results are compared with the star formation activity. The N159E clump is associated with embedded cluster(s) as observed at 24 micron and the derived high temperature is explained as due to the heating by these sources. The N159E clump is likely responsible for a dark lane in a large HII region by the dust extinction. The N159W clump is associated with embedded clusters mainly toward the eastern edge of the clump only. These clusters show offsets of 20"-40" from the 12CO J=4-3 peak and are probably responsible for heating indicated by the derived high temperature. The N159W clump exhibits no sign of star formation toward the 12CO J=4-3 peak position and its western region. We suggest that the N159W peak represents a pre-star-cluster core of ~105M_sol which deserves further detailed studies. Note that recent star formation took place between N159W and N159E as indicated by several star clusters and HII regions, while the natal molecular gas toward the stars have already been dissipated by the ionization and stellar winds of the OB stars. The N159S clump shows little sign of star formation as is consistent with the lower temperature and somewhat lower density. The N159S clump is also a candidate for future star formation

Dense Molecular Clumps associated with the LMC Supergiant Shells LMC 4 \& LMC 5

We investigate the effects of Supergiant Shells (SGSs) and their interaction on dense molecular clumps by observing the Large Magellanic Cloud (LMC) star forming regions N48 and N49, which are located between two SGSs, LMC 4 and LMC 5. $^{12}$CO ($J$=3-2, 1-0) and $^{13}$CO ($J$=1-0) observations with the ASTE and Mopra telescopes have been carried out towards these regions. A clumpy distribution of dense molecular clumps is revealed with 7 pc spatial resolution. Large velocity gradient analysis shows that the molecular hydrogen densities ($n({\rm H}_2)$) of the clumps are distributed from low to high density ($10^3$-$10^5$ cm$^{-3}$) and their kinetic temperatures ($T_{\rm kin}$) are typically high (greater than $50$ K). These clumps seem to be in the early stages of star formation, as also indicated from the distribution of H$\alpha$, young stellar object candidates, and IR emission. We found that the N48 region is located in the high column density HI envelope at the interface of the two SGSs and the star formation is relatively evolved, whereas the N49 region is associated with LMC 5 alone and the star formation is quiet. The clumps in the N48 region typically show high $n({\rm H}_2)$ and $T_{\rm kin}$, which are as dense and warm as the clumps in LMC massive cluster-forming areas (30 Dor, N159). These results suggest that the large-scale structure of the SGSs, especially the interaction of two SGSs, works efficiently on the formation of dense molecular clumps and stars.Comment: 26 pages, 7 tables, 16 figure