A digest of the Evidence-Based Clinical Practice Guideline for Nephrotic Syndrome 2020

Clinical and Experimental Nephrology -     

An experience of indwelling of a urethral stent (Urolume Wallstent) for urethral stricture accompanying pelvic fracture in a young man

The patient was a 15-year-old boy, who sustained pelvic fracture and complete disruption of the urethra in a traffic accident. The previous doctor performed two-staged treatment for complete disruption of the urethra, which ended in postoperative urethral stricture. We performed two sessions of endoscopic operations and a pull-through procedure, but the procedures were not effective. Five years later, a urethral stent was indwelt. Urolume Wallstent of AMS, Co, Ltd. was used as the urethral stent. At 4 months, the stent started to be enveloped in the urethral epithelia and no complications have been found in particular. However, detention of a permanent-type stent in a young man such as ours remains a controversial issue and long-term follow-up is needed.     

Burnout among direct-care staff members of facilities for persons with mental retardation in Japan

Using the Pines' Burnout Scale, we conducted the first nationwide survey in Japan to study burnout among 3,774 staff members in 216 social welfare facilities for persons with mental retardation. Mean burnout scores were significantly higher among direct-care staff members than among facility directors, middle managers, and other types of staff personnel. Burnout scores were significantly lower for staff members who reported having supervisors whom they could consult about work or personal problems than those who reported they could not. Findings suggest that supervisor support can reduce burnout among direct-care staff members at social welfare facilities for persons with mental retardation.     

Endothelin-1 enhances vascular cell adhesion molecule-1 expression in tumor necrosis factor alpha-stimulated vascular endothelial cells

Vascular cell adhesion molecule-1 (VCAM-1) is a mononuclear leukocyte-selective adhesion molecule that is expressed in human vascular endothelial cells at sites of local inflammation. It participates in local endothelial-monocyte interactions during the initiation of atherosclerosis. In the present study, endothelin alone did not induce the surface expression and mRNA accumulation of VCAM-1 in human vascular endothelial cells, but inhibition of endogenous nitric oxide (NO) by N(G)-monomethyl-L-arginine enhanced the surface expression and mRNA accumulation of VCAM-1 stimulated by endothelin-1. It is conceivable that in human vascular endothelial cells, stimulation of an endothelin receptor results in the production of nitric oxide (NO), suppressing the expression of VCAM-1. Endothelin-1 enhanced the surface expression and mRNA accumulation of VCAM-1 in cells treated with tumor necrosis factor alpha (TNF-alpha). The enhancement by endothelin-1 may be explained by the inhibitory effect of TNF-alpha on endothelin-induced NO production. Pretreatment with BQ788 (an endothelin ET(B) receptor antagonist) or inhibitors of nuclear factor kappa B (NF-kappaB) activation completely diminished the synergistic enhancement of VCAM-1 expression by endothelin-1 in TNF-alpha-stimulated vascular endothelial cells, both at the protein and mRNA levels. These findings suggest that the synergistic enhancement of VCAM-1 expression by TNF-alpha and endothelin ET(B) receptor stimulation may be augmented by the induction of NF-kappaB binding activity in human vascular endothelial cells.     

The clinical statistics of the operations at the Department of Urology, Tokatsu Hospital: from 1994 to 1999

We investigated the clinical statistics of the operations and inpatients since the establishment of the department in June 1994 up to May 1999. The total number of inpatients was 1,269 (1,047 males and 222 females), and a total of 1,098 operations were performed. Extracorporeal shock wave lithotriopy (ESWL) was also introduced in 1997, and in addition, it seemed that the number of operations and inpatients would be increasing in future.