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A case of pulmonary arterial hypertension complicated by anti-neutrophil cytoplasmic antibody-associated vasculitis and systemic sclerosis
Pulmonary arterial hypertension (PAH) is a rare complication of ANCA-associated vasculitis (AAV). We report a 37-year-old man with PAH complicated by both AAV and SSc who presented with dyspnea, cardiac enlargement, positive myeloperoxidase (MPO)-ANCA, anti-centromere antibodies, proteinuria, and urinary casts. Elevated pulmonary arterial pressure (58/22/34âmmHg) and low PAWP (2âmmHg) were confirmed by right heart catheterization. Treatment with glucocorticoids (GC) decreased urinary protein and serum MPO-ANCA; however, PAH did not respond to GC. Therefore, a combination of beraprost, bosentan, and tadalafil was needed. The differences in responses to GC suggest that the pathophysiology of nephropathy is different from that of PAH. We considered that nephropathy was associated with AAV but that PAH was associated with SSc in the present case. We discuss the pathophysiology and treatment response of PAH complicated by AAV, referring to nine past cases
Non-destructive separation of metal ions from wastewater containing excess aminopolycarboxylate chelant in solution with an ion-selective immobilized macrocyclic material
é沢倧åŠçå·¥ç 究åç©è³ªååŠç³»Although the excellent metal-binding capacities of aminopolycarboxylate chelants (APCs) facilitate their extensive use, pre- and post-toxicity of APCs and their high persistence in aquatic environments evoke concerns. Several treatment techniques with a principal focus on the degradation of APCs at the pre-release step have been proposed. Here, we report a technique for the separation of metal ions from waste solution containing excess APCs using a solid phase extraction system with an ion-selective immobilized macrocyclic material, commonly known as a molecular recognition technology (MRT) gel. Synthetic metal solutions with 100-fold chelant content housed in H2O matrices were used as samples. The MRT gel showed a higher recovery rate compared with other SPE materials at 20 °C using a flow rate of 0.2 mL min-1. The effects of solution pH, metal-chelant stability constants and ionic radii were assessed for 32 metals. Compared to the conventional treatment options for such waste solutions, our proposed technique has the advantage of non-destructive separation of both metal ions and chelants. © 2010 Elsevier Ltd. All rights reserved
Separation of dissolved iron from the aqueous system with excess ligand
é沢倧åŠçå·¥ç 究åç©è³ªååŠç³»A new technique for the separation and pre-concentration of dissolved Fe(III) from the ligand-rich aqueous system is proposed. A solid phase extraction (SPE) system with an immobilized macrocyclic material, commonly known as molecular recognition technology (MRT) gel and available commercially, was used. Synthetic Fe(III) solution in aqueous matrices spiked with a 100-fold concentration of EDTA was used. Dissolved iron that was \u27captured\u27 by the MRT gel was eluted using hydrochloric acid and subsequently determined by graphite furnace atomic absorption spectrometry. The effect of different variables, such as pH, reagent concentration, flow rate and interfering ions, on the recovery of analyte was investigated. Quantitative maximum separation (~100%) of the dissolved Fe(III) from synthetic aqueous solutions at a natural pH range was observed at a flow rate of 0.2mLmin-1. The extraction efficiency of the MRT gel is largely unaltered by the coexisting ions commonly found in natural water. When compared with different SPE materials, the separation performance of MRT gel is also much higher. © 2010 Elsevier Ltd
Prescription trend and lactic acidosis in patients prescribed metformin before and after the revision of package insert for allowing metformin administration to patients with moderately decreased kidney function based on real-world data from MID-NET® in Japan
IntroductionThis study was conducted to understand the impact of package insert (PI) revision in Japan on 18 June 2019 to allow metformin use for patients with moderately decreased kidney function (30ââ€âestimated glomerular filtration rate (eGFR)â<â60âmL/min/1.73âm2).MethodsA new user cohort design was employed to examine the prescription trend and the occurrence of lactic acidosis in patients prescribed metformin before and after PI revision using the Medical Information Database Network (MID-NET®).ResultsFrom 12 May 2016 to 31 March 2020, 5,874 patients (before, n =â4,702; after, n =â1,172) were identified as new metformin users, including 1,145 patients (before, n =â914; after, n =â231) with moderately decreased kidney function. Although no marked changes in metformin prescription were observed before and after PI revision, the daily metformin dose at the first prescription decreased after PI revision. For both before and after PI revision, less than 10 cases of lactic acidosis occurred in all patients prescribed metformin, and no lactic acidosis was observed in patients with moderately decreased kidney function.ConclusionThe results of this study are useful for understanding the safety of metformin use in patients with decreased kidney function and suggest no worse impacts of PI revision in Japan, indicating no further safety concerns on metformin use in patients with moderately decreased kidney function under the situation with careful use and safety monitoring of metformin
Initial experience with contrast-enhanced ultrasonography in follow up assessment of small breast cancer treated by cryoablation
BackgroundCryoablation (CA) is a nonsurgical focal therapy for small tumours. To detect residual or relapsed tumour after CA of renal cancer, contrast-enhanced imaging is generally used to identify tumour blood flow, but no definitive criteria are established for such follow-up after CA of breast cancer.AimsThe aim of this study was to compare the usefulness of contrast-enhanced ultrasonography (CEUS) and magnetic resonance (MR) imaging for assessing residual tumours and local relapse following CA of small breast cancers.Methods We enrolled 4 patients treated by CA at our institution between January 2015 and December 2016 for luminal A breast cancer with maximum tumour size of 1.5cm and neither distant metastasis nor metastatic findings in sentinel lymph node biopsy, who underwent CEUS and MR imaging before CA. In addition to our standard postoperative follow-up for breast cancer, these patients underwent CEUS every 3 months and MR imaging every 6 months after CA.Results Six months after CA, no patient showed enhancement at the lesion site on MR imaging, but there were two with continued enhancement on CEUS. They underwent vacuum-assisted breast biopsy under US guidance followed by histopathological examination of tissue that identified no malignancy.ConclusionOur findings of focal enhancement within ablated breast tissue in CEUS after CA is likely attributable to the much higher sensitivity of CEUS to that of other modalities to even slight vascularization. Further investigation in more patients is needed to clarify the utility of CEUS to detect residual or relapsed tumour after CA of small breast cancer
Research Activities in the Department of Nursing
Research activity at the Department of Nursing is overviewed from the point of research topics, the theme of the projects admitted for grant from the Ministry of Education and Science of Japan, and expected research topics, trying to clarify the needs and challenges of the Department from multilateral aspects in future research activities. The Department of Nursing, Aino University is currently divided into the five areas and further into 12 fields. On the other hand, according to the Scientific Research Grant Program (2015 fiscal year), the research topics in nursing science is subdivided into the five areas; a) basic nursing, b) clinical nursing, c) lifelong developmental nursing, d) elderly nursing, and e) community health nursing
Extended investigations of isotope effects on ECRH plasma in LHD
Isotope effects of ECRH plasma in LHD were investigated in detail. A clear difference of transport and turbulence characteristics in H and D plasmas was found in the core region, with normalized radius Ï < 0.8 in high collisionality regime. On the other hand, differences of transport and turbulence were relatively small in low collisionality regime. Power balance analysis and neoclassical calculation showed a reduction of the anomalous contribution to electron and ion transport in D plasma compared with H plasma in the high collisionality regime. In core region, density modulation experiments also showed more reduced particle diffusion in D plasma than in H plasma, in the high collisionality regime. Ion scale turbulence was clearly reduced at Ï < 0.8 in high collisionality regime in D plasma compared with H plasma. The gyrokinetic linear analyses showed that the dominant instability Ï = 0.5 and 0.8 were ion temperature gradient mode (ITG). The linear growth rate of ITG was reduced in D plasma than in H plasma in high collisionality regime. This is due to the lower normalized ITG and density gradient. More hollowed density profile in D plasma is likely to be the key control parameter. Present analyses suggest that anomalous process play a role to make hollower density profiles in D plasma rather than neoclassical process. Electron scale turbulence were also investigated from the measurements and linear gyrokinetic simulations
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