若年成人女性における仙腸関節部愁訴の発生要因の検討

研究報告Original Articles［目的］本研究は，若年成人女性を対象に，仙腸関節不安定テストによる仙腸関節部愁訴と身体特性および体幹筋力との関連について調査することを目的とした．［方法］対象者は若年成人女性100名（平均年齢21.1±1.0 歳）とした． 4つの仙腸関節不安定テスト（Patrick test，Newton test変法，Gaenslen test，仙腸関節引き離しテスト）を実施し，1つ以上で仙腸関節部に疼痛や違和感を訴えた者を愁訴あり群と分類した．また，身体特性，等速性体幹筋力の測定を行った．［結果］仙腸関節不安定テストによる愁訴あり群は，対象者100名中23名であった．愁訴あり群の身長は，愁訴なし群に比べ，有意に高い値を示した（160.6±5.7 cm vs 158.1±5.2 cm，p＜0.05）．その他の身体特性，体幹筋力においては，愁訴あり群となし群の間で有意差がなかった．［結論］若年成人女性において，身長が高いという身体特性が，仙腸関節部愁訴の要因の一つである可能性が示唆された．また，仙腸関節の安定性を体幹の動的な粗大筋力のみで把握することは難しい．[Purpose]　The purpose of this study was to investigate the physical characteristics and trunk muscular strength of young adult women with sacroiliac joint discomfort by means of instability tests.[Methods]　One hundred women (mean age, 21.1 ± 1.0 years) participated in the study. After undergoing four instability tests, i.e. Patrick test, modified Newton test, Gaenslen test, and sacroiliac distraction test, the study participants were classified into a sacroiliac joint discomfort group and a non-discomfort group. Physical characteristics (height, weight, body mass index, body fat percentage, and waist circumference) were recorded, and isokinetic trunk muscle strength was assessed.[Results] Twenty-three participants experienced discomfort according to instability tests. Participants’ height in the sacroiliac joint discomfort group was significantly greater than that in the non-discomfort group (160.6 ± 5.7 cm vs 158.1 ± 5.2 cm, p < 0.05). However there were no significant inter-group differences with regard to the other parameters measured.[Conclusion]　In young adult women, a taller stature may contribute to sacroiliac joint discomfort. The stability of the sacroiliac joint should not be assessed on the basis of the dynamic gross trunk muscle strength alone

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

インターネット空間上のコミュニケーションにおけるフランス語言語表象に関する研究

2021【要旨

Preferential Accumulation of 14C-N-Glycolylneuraminic Acid over 14C-N-Acetylneuraminic Acid in the Rat Brain after Tail Vein Injection.

The two main molecular species of sialic acid existing in nature are N-acetylneuraminic acid (Neu5Ac) and N-glycolylneuraminic acid (Neu5Gc). Neu5Ac is abundant in mammalian brains and plays crucial roles in many neural functions. In contrast, Neu5Gc is present only at a trace level in vertebrate brains. The brain-specific suppression of Neu5Gc synthesis, which is a common feature in mammals, suggests that Neu5Gc has toxicity against brain functions. However, in vivo kinetics of Neu5Gc in the whole body, especially in the brain, has not been studied in sufficient detail. To determine the in vivo kinetics of Neu5Gc, 14C-Neu5Gc was enzymatically synthesized and injected into rat tail veins. Although most of 14C-Neu5Gc was excreted in urine, a small amount of 14C-Neu5Gc was detected in the brain. Brain autoradiography indicated that 14C-Neu5Gc was accumulated predominantly in the hippocampus. 14C-Neu5Gc transferred into the brain was incorporated into gangliosides including GM1, GD1a, GD1b, GT1b and GQ1b. Reduction of 14C-Neu5Gc after intracerebroventricular infusion was slower than that of 14C-Neu5Ac in the brain and hippocampus. The results suggest that Neu5Gc is transferred from blood into the brain across the blood brain barrier and accumulates in the brain more preferentially than does Neu5Ac