Research on relation between natural frequency and axial stress of round bar with intermediate-supported ends

In order to make a method be useful to measure an axial stress of a member by a natural frequency, we investigated a relation between a natural frequency and an axial stress of a round bar with intermediate-supported ends, the boundary condition of which was one between a fix-supported end and a simply-supported end. To define an intermediate-supported end condition, we adopted a parameter, a ratio of a moment of a force to a deflection angle at the end. It was shown theoretically that the parameter of an intermediate-supported end could be evaluated by one at a support on a continuous beam consisted of 3 spans. The 3-spanned beam has same vibration characteristics of a beam with intermediate-supported ends. We manufactured a test device of a 3-spanned beam by which we could simulate a vibration under various intermediate-supported end conditions. The theoretical relation and experimental results between a natural frequency and an axial stress agreed for the most part

Inpatient multidisciplinary care can prevent deterioration of renal function in patients with chronic kidney disease: a nationwide cohort study

BackgroundMultidisciplinary care is necessary to prevent worsening renal function and all-cause mortality in patients with chronic kidney disease (CKD) but has mostly been investigated in the outpatient setting. In this study, we evaluated the outcome of multidisciplinary care for CKD according to whether it was provided in an outpatient or inpatient setting.MethodsThis nationwide, multicenter, retrospective, observational study included 2954 Japanese patients with CKD stage 3–5 who received multidisciplinary care in 2015–2019. Patients were divided into two groups: an inpatient group and an outpatient group, according to the delivery of multidisciplinary care. The primary composite endpoint was the initiation of renal replacement therapy (RRT) and all-cause mortality, and the secondary endpoints were the annual decline in the estimated glomerular filtration rate (ΔeGFR) and the changes in proteinuria between the two groups.ResultsMultidisciplinary care was provided on an inpatient basis in 59.7% and on an outpatient basis in 40.3%. The mean number of health care professionals involved in multidisciplinary care was 4.5 in the inpatient group and 2.6 in the outpatient group (P < 0.0001). After adjustment for confounders, the hazard ratio of the primary composite endpoint was significantly lower in the inpatient group than in the outpatient group (0.71, 95% confidence interval 0.60-0.85, P = 0.0001). In both groups, the mean annual ΔeGFR was significantly improved, and proteinuria significantly decreased 24 months after the initiation of multidisciplinary care.ConclusionMultidisciplinary care may significantly slow deterioration of eGFR and reduce proteinuria in patients with CKD and be more effective in terms of reducing initiation of RRT and all-cause mortality when provided on an inpatient basis

Tyr-Pro-Trp-Gly-NH_2(Tyr-W-MIF-1)analogであるTyr-D-Pro-Trp-Gly-NH_2の抗侵害作用におけるμオピオイド受容体の関与について

We have previously reported that Tyr-D-Pro-Trp-Gly-NH_2 (D-Pro^2-Tyr-W-MIF-1) given spinally produces clearly a dose-dependent attenuation of the antinociception induced by Tyr-W-MIF-1 without affecting endomorphins- and[D-Ala^2, NMePhe^4, Gly(ol)^5]-enkephalin (DAMGO)-induced antinociception, and D-Pro^2-Tyr-W-MIF-1 at any doses used (0.025-1.2 nmol) does not show any antinociception or hyperalgesic effect by itself. In the present study, we found that D-Pro^2-Tyr-W-MIF-1 given supraspinally produced the antinociception, which is mediated by stimulation of μ-opioid receptors. D-Pro^2-Tyr-W-MIF-1 (0.5-16 nmol) given intracerebroventricularly (i.c.v.) produced an apparent dose-dependent antinociception. However, at the three highest doses (4, 8 or 16 nmol), there was a ceiling effect (about 30% MPE) where the increase in dose did not lead to a greater effect. The antinociception induced by D-Pro^2-Tyr-W-MIF-1 at a dose of 4 nmol was blocked by i.c.v. co-administration with the μ-opioid receptor antagonist D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH_2 (CTOP), but not by i.c.v. pretreatment with the μ_1-opioid receptor antagonist naloxonazine, the κ-opioid receptor antagonist, nor-binaltorphimine, or the δ-opioid receptor antagonist naltrindole. In contrast, the antinociception induced by DAMGO and Tyr-W-MIF-1 was blocked by i.c.v. co-administration with CTOP or by i.c.v. pretreatment with higher doses of naloxonazine, but not by pretreatment with nor-binaltorphimine or naltrindole. We propose that the antinociception induced by D-Pro^2-Tyr-W-MIF-1 and Tyr-W-MIF-1 is mediated by the stimulation of different subtypes of μ_2-opioid receptors

Encapsulating peritoneal sclerosis with steroid-resistant massive ascites successfully treated by peritoneal lavage

Encapsulating peritoneal sclerosis (EPS) is the most serious complication of long-term peritoneal dialysis (PD). EPS is diagnosed by clinical symptoms (abdominal pain, nausea, vomiting, diarrhea, and anorexia.) and image study (intestinal expansion, peritoneal thickening and calcification, and ascites.). Steroid therapy and surgery are recommended as the treatment of EPS. Here, we report a case of EPS with steroid-resistant massive ascites successfully treated with peritoneal lavage. A 59-year-old female with end-stage kidney disease secondary to hypertension was started on PD in 2003. Due to recurrent exit-site infection and two episodes of peritonitis, she was transferred to hemodialysis (HD), and her PD catheter was removed in 2011. In February 2012, six months after discontinuation of PD, she was found to have massive ascites on abdominal computerized tomography (CT). The patient was diagnosed to have EPS and was started on prednisolone. Despite eight months of prednisolone therapy, the ascites did not decrease. Therefore, the PD catheter was inserted again, and she was started on daily peritoneal lavage from September 2012. After four months of daily peritoneal lavage, her ascites disappeared in January 2013. The PD catheter was removed in July 2013. Steroid treatment was completed in May 2014, and there has been no recurrence of ascites since then. The evaluation of ascites by abdominal CT is important in a patient on long-term PD. Since EPS may appear any time after the discontinuation of PD, it is important to start screening abdominal CT shortly after the discontinuation of PD. Steroid-resistant massive ascites can be successfully treated with peritoneal lavage

Association between Daily Urinary Sodium Excretion, Ratio of Extracellular Water-to-Total Body Water Ratio, and Kidney Outcome in Patients with Chronic Kidney Disease

Whether dietary salt intake affects chronic kidney disease (CKD) progression remains unclear. We conducted a retrospective cohort study to analyze the effects of both daily salt intake (DSI) and volume status on renal outcomes in 197 CKD patients. DSI was estimated by 24-h urinary sodium excretion and volume status was assessed by the ratio of extracellular water (ECW) to total body water (TBW) measured by bioelectrical impedance analysis (BIA). We divided patients into two groups according to DSI (6 g/day) or median ECW/TBW (0.475) and compared renal outcomes of each group. Furthermore, we classified and analyzed four groups according to both DSI and ECW/TBW. The higher DSI group showed a 1.69-fold (95% confidence interval (CI) 1.12–2.57, p = 0.01) excess risk of outcome occurrence compared to the lower group. Among the four groups, compared with Group 1 (low DSI and low ECW/TBW), Group 3 (high DSI and low ECW/TBW) showed a 1.84-fold (95% CI 1.03–3.30, p = 0.04) excess risk of outcome occurrence; however, Group 2 (low DSI and high ECW/TBW) showed no significant difference. High salt intake appears to be associated with poor renal outcome independent of blood pressure (BP), proteinuria, and volume status

Endomorphin analogues containing D-Pro(2) discriminate different μ-opioid receptor mediated antinociception in mice

The antagonistic actions of D-Pro(2)-endomorphins on inhibition of the paw withdrawal response by endomorphins were studied in mice. D-Pro(2)-endomorphin-1 and D-Pro(2)-endomorphin-2, injected intrathecally (i.t.), had no significant effect on the nociceptive thermal threshold alone. When D-Pro(2)-endomorphin-1 (0.05–0.1 pmol) was injected simultaneously with i.t. endomorphin-1 (5.0 nmol) or endomorphin-2 (5.0 nmol), antinociception induced by endomoprhin-1 was reduced significantly, whereas endomorphin-2-induced antinociception was not affected by D-Pro(2)-endomorphin-1. Antinociception induced by i.t. endomorphin-2 (5.0 nmol) was reduced significantly by its analogue, D-Pro(2)-endomorphin-2 (100 pmol), but not by D-Pro(2)-endomorphin-1. D-Pro(2)-endomorphin-1. D-Pro(2)-endomorphin-1 also antagonized the antinociceptive effect of i.t. DAMGO, a μ-opioid receptor agonist, whereas D-Pro(2)-endomorphin-2 failed to reduce the effect of DAMGO. These results suggest that endomorphin analogues containing D-Pro(2) are able to discriminate the antinociceptive actions of μ(1)- and μ(2)-opioid receptor agonists at the spinal cord level

Age Modifies the Association of Dietary Protein Intake with All-Cause Mortality in Patients with Chronic Kidney Disease

Whether the effect of a low-protein diet on progression to end-stage renal disease (ESRD) and mortality risk differs between young and elderly adults with chronic kidney disease (CKD) is unclear. We conducted a retrospective CKD cohort study to investigate the association between protein intake and mortality or renal outcomes and whether age affects this association. The cohort comprised 352 patients with stage G3-5 CKD who had been followed up for a median 4.2 years, had undergone educational hospitalization, and for whom baseline protein intake was estimated from 24-h urine samples. We classified the patients into a very low protein intake (VLPI) group (<0.6 g/kg ideal body weight/day), a low protein intake (LPI) group (0.6⁻0.8 g), and a moderate protein intake (MPI) group (>0.8 g). Compared with the LPI group, the MPI group had a significantly lower risk of all-cause mortality (hazard ratio: 0.29; 95% confidence interval: 0.07 to 0.94) but a similar risk of ESRD, although relatively high protein intake was related to a faster decline in the estimated glomerular filtration rate. When examined per age group, these results were observed only among the elderly patients, suggesting that the association between baseline dietary protein intake and all-cause mortality in patients with CKD is age-dependent