Ferritin Elevation and Improved Responsiveness to Erythropoiesis-Stimulating Agents in Patients on Ferric Citrate Hydrate

In hemodialysis patients on ferric citrate hydrate, the increase in ferritin level is mainly due to the administration of the compound. We investigated possible other factors associated with ferritin level and how erythropoietin resistance index and erythropoiesis in those patients were affected. We looked at ferritin-elevating factors using data from a Japanese phase III long-term clinical trial of ferric citrate hydrate. Methods: The factors with a strong association with ferritin levels at week 28 were selected by the process of variable selection. In addition, selected factors were analyzed by Mixed Model for Repeated Measurement. Subjects were divided into 3 groups by quantiles (<Q1, Q1–Q3, Q3<) of the most strongly correlated factors. Then the least-squares means of change of ferritin at each time point for each group were calculated. Finally, the differences of the least-squares means were examined. Changes of both erythropoiesis-stimulating agent dose and erythropoietin resistance index for each group were investigated. The differences in mean erythropoietin resistance index between groups at baseline, week 28, and week 52 were analyzed using t tests. Results: Dose of ferric citrate hydrate showed the strongest correlation with change of ferritin and the second strongest was the reduction of erythropoiesis-stimulating agents. The mean erythropoietin resistance index was lowered in group <Q1. Group <Q1 showed significantly lower levels of ferritin at baseline. Discussion: It is suggested that not only iron load but also the erythropoiesis-stimulating agent dose reduction may be involved in ferritin elevation during ferric citrate hydrate treatment, resulting in a decrease of erythropoietin resistance index

Volume Change and Liver Parenchymal Signal Intensity in Gd-EOB-DTPA-Enhanced Magnetic Resonance Imaging after Portal Vein Embolization prior to Hepatectomy

Purpose. To investigate the liver volume change and the potential of early evaluation by contrast-enhanced magnetic resonance imaging (MRI) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) after portal vein embolization (PVE). Materials and Methods. Retrospective evaluations of computed tomography (CT) volumetry of total liver and nonembolized areas were performed before and 3 weeks after PVE in 37 cases. The percentage of future liver remnant (%FLR) and the change ratio of %FLR (%FLR ratio) were calculated. Prospective evaluation of signal intensities (SIs) was performed to estimate the role of Gd-EOB-DTPA-enhanced MRI as a predictor of hypertrophy in 16 cases. The SI contrast between embolized and nonembolized areas was calculated 1 week after PVE. The change in SI contrast before and after PVE (SI ratio) was also calculated in 11 cases. Results. %FLR ratio significantly increased, and SI ratio significantly decreased (both P<0.01). There were significant negative correlations between %FLR and SI contrast and between %FLR and SI ratio (both P<0.01). Conclusion. Hypertrophy in the nonembolized area after PVE was indicated by CT volumetry, and measurement of SI contrast and SI ratio in Gd-EOB-DTPA-enhanced MRI early after PVE may be useful to predict the potential for hepatic hypertrophy

Relationship between Antenatal Mental Health and Facial Emotion Recognition Bias for Children&rsquo;s Faces among Pregnant Women

The importance of identification of facial emotion recognition (FER) bias for a child&rsquo;s face has been reinforced from the perspective of risk screening for future peripartum mental health problems. We attempted to clarify the relationship of FER bias for children&rsquo;s faces with antenatal depression and bonding failure among pregnant women, taking into consideration their broad social cognitive abilities and experience in child raising. This study had a cross-sectional design, and participants were women in their second trimester of pregnancy. Seventy-two participants were assessed by the Edinburgh Postnatal Depression Scale (EPDS), the Mother-to-Infant Bonding Questionnaire (MIBQ), and a series of social cognitive tests. FER bias for a child&rsquo;s face was assessed by Baby Cue Cards (BCC), and a larger number of disengagement responses suggest greater sensitivity to a child&rsquo;s disengagement facial expressions. In a regression analysis conducted using EPDS as the dependent variable, a larger number of disengagement responses to the BCC (&beta; = 0.365, p = 0.001) and the primipara status (&beta; = &minus;0.263, p = 0.016) were found to significantly contribute to antenatal depressive symptoms. Also, more disengagement responses to the BCC also significantly contributed to bonding failure as measured by the MIBQ (&beta; = 0.234, p = 0.048). Maternal sensitivity to the child&rsquo;s disengagement cues was associated with antenatal depressive symptoms and bonding failure more than the other social cognitive variables. The effects of FER bias on postpartum mental health and abusive behavior needs to be clarified by further longitudinal studies

Associations of employment status and educational levels with mortality and hospitalization in the dialysis outcomes and practice patterns study in Japan.

Socioeconomic status (SES) factors such as employment, educational attainment, income, and marital status can affect the health and well-being of the general population and have been associated with the prevalence of chronic kidney disease (CKD). However, no studies to date in Japan have reported on the prognosis of patients with CKD with respect to SES. This study aimed to investigate the influences of employment and education level on mortality and hospitalization among maintenance hemodialysis (HD) patients in Japan.Data on 7974 HD patients enrolled in Dialysis Outcomes and Practice Patterns Study phases 1-4 (1999-2011) in Japan were analysed. Employment status, education level, demographic data, and comorbidities were abstracted at entry into DOPPS from patient records. Mortality and hospitalization events were collected during follow-up. Patients on dialysis < 120 days at study entry were excluded from the analyses. Cox regression modelled the association between employment and both mortality and hospitalization among patients < 60 years old. The association between education and outcomes was also assessed. The association between patient characteristics and employment among patients < 60 years old was assessed using logistic regression.During a median follow-up of 24.9 months (interquartile range, 18.4-32.0), 10% of patients died and 43% of patients had an inpatient hospitalization. Unemployment was associated with mortality (hazard ratio [HR] = 1.57; 95% confidence interval [CI]: 1.05-2.36) and hospitalization (HR = 1.25; 95% CI: 1.08-1.44). Compared to patients who graduated from university, patients with less than a high school (HS) education and patients who graduated HS with some college tended to have elevated mortality (HR = 1.41; 95% CI, 1.04-1.92 and HR = 1.36; 95% CI: 1.02-1.82, respectively) but were not at risk for increased hospitalizations. Factors associated with unemployment included lower level of education, older age, female gender, longer vintage, and several comorbidities.Employment and education status were inversely associated with mortality in patients on maintenance HD in Japan. Employment but not education was also inversely associated with hospitalizations. After adjustment for comorbidities, the associations with clinical outcomes tended to be stronger for employment than education status

Identification of a New <i>N</i>‑Nitrosodimethylamine Precursor in Sewage Containing Industrial Effluents

<i>N</i>-Nitrosodimethylamine (NDMA), a potential human carcinogen, is known to be a disinfection byproduct of chloramination and ozonation. NDMA is formed during ozonation at water purification plants in the Yodo River basin, a major drinking water source in western Japan. An NDMA precursor, 1,1,5,5-tetramethylcarbohydrazide (TMCH) was identified in sewage containing industrial effluents via ultrahigh performance liquid chromatography–tandem mass spectrometry, and ultrahigh performance liquid chromatography–time-of-flight mass spectrometry, as well as nuclear magnetic resonance spectroscopy. The mean of the NDMA molar formation yield of TMCH upon ozonation in four water matrices was 140%. TMCH removal was low during biological treatment processes at a sewage treatment plant. The mean TMCH contribution to total NDMA precursors upon ozonation of the primary, secondary, and final effluents of the sewage treatment plant in January and February of 2014 was 43–72%, 51–72%, and 42–60%, respectively, while the contributions of 4,4′-hexamethylenebis­(1,1-dimethylsemicarbazide) and 1,1,1′,1′-tetramethyl-4,4′-(methylene-di-<i>p</i>-phenylene)­disemicarbazide, two other known NDMA precursors, were limited to 0.6% and 6.9%, respectively. Thus, TMCH was identified as the primary precursor yielding NDMA upon ozonation in the Yodo River basin