Association between Serum Soluble Klotho Levels and Mortality in Chronic Hemodialysis Patients

Klotho is a single-pass transmembrane protein predominantly expressed in the kidney. The extracellular domain of Klotho is subject to ectodomain shedding and is released into the circulation as a soluble form. Soluble Klotho is also generated from alternative splicing of the Klotho gene. In mice, defects in Klotho expression lead to complex phenotypes resembling those observed in dialysis patients. However, the relationship between the level of serum soluble Klotho and overall survival in hemodialysis patients, who exhibit a state of Klotho deficiency, remains to be delineated. Here we prospectively followed a cohort of 63 patients with a mean duration of chronic hemodialysis of 6.7±5.4 years for a median of 65 months. Serum soluble Klotho was detectable in all patients (median 371 pg/mL, interquartile range 309–449). Patients with serum soluble Klotho levels below the lower quartile (<309 pg/mL) had significantly higher cardiovascular and all-cause mortality rates. Furthermore, the higher all-cause mortality persisted even after adjustment for confounders (hazard ratio 4.14, confidence interval 1.29–13.48). We conclude that there may be a threshold for the serum soluble Klotho level associated with a higher risk of mortality

教職実践演習の実証的研究 ～授業観形成の試み～

This paper aims at studying positively the state of the "teaching profession practiceexercise" newly established in the teacher-training course of the university from Heisei 22fiscal year. Especially in elementary school education, it will inquire through a triallesson about "lesson planning ability", "lesson practice power", etc. which are included inthe talent and capability as a teacher

Apocynin reduced doxycycline-induced acute liver injury in ovariectomized mice

To determine the physiological role of estrogen in the development of liver injury, we examined the sensitivities of sham and ovariectomy (ovx) mice against doxycycline (DOXY)-induced acute liver injury. Ovx or sham operation was performed in C57BL/6J wild-type female mice of eight weeks of age. Sham mice and ovx mice were treated with DOXY (240 mg/kg ip) 8 weeks after the operation, 30 min after apocynin (5 mg/kg) or saline administration. Blood and liver samples were obtained at 3 and 6 h after DOXY administration. Liver dysfunction occurred soon after DOXY administration and became more severe in ovx mice than in sham mice. At early phase after DOXY injection, TNF-α and iNOS inductions upregulated almost the same levels in sham and ovx mice. On the other hand, expression levels of IL-6, IL-10, c-fos, cox-2 and HO-1, downstream genes of TNF-α, were significantly increased in ovx mice compared to those in sham mice, correlated with liver dysfunction. In addition, apocynin, a NADPH oxidase (Nox) inhibitor, totally improved DOXY-induced liver injury in both sham and ovx mice, indicating that reactive oxygen species generated through Nox activation by DOXY are responsible for development of acute liver injury. Keywords: Ovariectmized, Doxycycline-induced liver injury, Apocynin, NADPH oxidas

Association between circulating fibroblast growth factor 21 and mortality in end-stage renal disease.

Fibroblast growth factor 21 (FGF21) is an endocrine factor that regulates glucose and lipid metabolism. Circulating FGF21 predicts cardiovascular events and mortality in type 2 diabetes mellitus, including early-stage chronic kidney disease, but its impact on clinical outcomes in end-stage renal disease (ESRD) patients remains unclear. This study enrolled 90 ESRD patients receiving chronic hemodialysis who were categorized into low- and high-FGF21 groups by the median value. We investigated the association between circulating FGF21 levels and the cardiovascular event and mortality during a median follow-up period of 64 months. A Kaplan-Meier analysis showed that the mortality rate was significantly higher in the high-FGF21 group than in the low-FGF21 group (28.3% vs. 9.1%, log-rank, P = 0.034), while the rate of cardiovascular events did not significantly differ between the two groups (30.4% vs. 22.7%, log-rank, P = 0.312). In multivariable Cox models adjusted a high FGF21 level was an independent predictor of all-cause mortality (hazard ratio: 3.98; 95% confidence interval: 1.39-14.27, P = 0.009). Higher circulating FGF21 levels were associated with a high mortality rate, but not cardiovascular events in patient with ESRD, suggesting that circulating FGF21 levels serve as a predictive marker for mortality in these subjects

３年を要した難治性褥瘡ケアの評価

雑誌掲載版患者の意志を尊重しリハビリテーションを継続しながら褥瘡ケアを行う.著者らは褥瘡患者における褥瘡発生・増悪因子を再検討し,個別性に合った評価項目を選定すると共に,画像解析ソフトによる褥瘡面積の明確化を図り評価の1指標とした.定期的な評価を行い褥瘡ケアアルゴリズムを活用し,チーム医療の概念のもと褥瘡ケアを行った結果,褥瘡発生・増悪因子が除去,軽減され,リハビリテーションを継続しながら褥瘡治癒環境を維持でき,自宅退院を可能とした.褥瘡ケアは根拠に基づいた全身状態のトータルケアが必要であり,その為に看護者はアセスメント能力を鍛錬し,チーム一員として役割を果たす必要があると考え

Distribution of circulating FGF21 levels in this study.

<p>FGF21 was detectable in the serum of all 90 patients, with serum concentrations ranging from 164 to 13214 pg/mL (median: 1981, interquartile range: 1034–2995 pg/mL).</p

Correlations coefficients of circulating FGF21 levels for associated clinical factors.

<p>Correlations coefficients of circulating FGF21 levels for associated clinical factors.</p