Overview of Regular Dialysis Treatment in Japan as of 31 December 2006

A statistical survey of dialysis patients for the year 2006 was carried out for 4051 medical facilities across Japan, and responses were received from 3985 (98.37%) facilities. There were 264 473 dialysis patients (including 9003 peritoneal dialysis patients) in Japan at the end of 2006, which showed an increase of 6708 (2.6%) from the end of 2005. The number of patients per million population was 2069.9. The crude mortality rate during 2006 was 9.2%. The mean age of the patients who began dialysis (in 2006) was 66.4 years, and the mean age of the entire dialysis population was 64.4 years. The primary renal diseases of the patients who began dialysis were diabetic nephropathy (42.9%), chronic glomerulonephritis (25.6%), and nephrosclerosis (9.4%). Of the 3488 facilities that participated in the survey on the dialysate water quality, 2873 facilities (82.4%) measured the endotoxin concentration in the dialysate; and 1197 facilities (37.1%) out of 3228 measured the bacterial count in the dialysate. The mean hemoglobin concentration in the dialysis population at the end of 2006 was 10.23 ± 1.33 g/dL, which was equal to that at the end of 2005 (10.23 ± 1.37 g/dL). The mean concentration of serum creatinine in 15 853 patients who started dialysis during 2006 was 8.37 ± 3.58 mg/dL. The estimated glomerular filtration rate, which was calculated with formula modified for the Japanese population from the Modification of Diet in Renal Disease (MDRD) Study equation, was 5.46 ± 6.60 mL/min/1.73 m².     

Role of Bile Acids in Duodenal Migrating Motor Complexes in Dogs

Previous studies have suggested thatenterohepatic circulation of bile acids is essential forregular cycling of duodenal migrating motor complexes(MMCs). The present study was an attempt to clarify the role of bile acids in the enterohepaticcirculation system in initiating duodenal MMCs. Sevendogs underwent total external biliary diversion thatresulted in the loss of MMCs originating from theduodenum. Sodium ursodeoxycholate (6 mg/kg/hr) was thengiven either through the portal vein or a peripheralvein, and motility of the gastrointestinal tract wasserially recorded. When sodium ursodeoxycholate was given either through the portal vein or aperipheral vein during external biliary diversion,duodenal MMCs restarted. The cyclic change in plasmamotilin levels during an MMC cycle as induced by sodium ursodeoxycholate was almost the same as in anormal MMC cycle. Total bile acid concentration in theportal vein changed cyclically with MMC cycles when bileflow was intact but did not change cyclically with MMC cycles restarted by intravenous bilesalt infusion. Bile acid stimulation of putativereceptors existing between the portal vein andintrahepatic bile ducts may be involved in initiatingnormal duodenal MMC cycles.     

Intravenous prostaglandin E1 reduces monocyte chemoattractant protein-1 levels in peripheral arterial obstructive disease

Objectives Blood monocytes are the precursors of the lipid-laden foam cells that are the hallmark of early atherosclerotic lesions, and monocyte chemoattractant protein-1 (MCP-1) plays important roles in their recruitment to the vessel wall. In this study, we measured serum levels of MCP-1 in patients with peripheral arterial obstructive disease (PAOD) and investigated whether intravenous prostaglandin E1 (PGE1) treatment, which produces clinical benefits in PAOD, might decrease such levels. Methods Eight patients with PAOD at Fontaine stage II to IV were treated with a daily intravenous infusion of 10 μg of PGE1 for 7 consecutive days. Blood samples before and after 7-day PGE1 treatment were used for assays of MCP-1, interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), von Willebrand factor (vWF), and endothelin-1 (ET-1). Results Serum MCP-1 levels in patients with PAOD were significantly higher than those in healthy control subjects (263.8 ± 52.8 vs 136.5 ± 15.0 pg/mL, P = .002). PGE1 administration for 7 days resulted in a significant decrease in the MCP-1 level, from 263.8 ± 52.8 to 196.1 ± 25.5 pg/mL (P = .02), whereas levels of IL-6, hs-CRP, and ET-1 and the activity of vWF were not affected. Conclusions Serum MCP-1 levels were elevated in patients with PAOD, indicating the involvement of activation of monocytes in the pathogenesis of this disorder. Parenteral administration of PGE1 appeared to decrease circulating MCP-1 levels, which might lead to the suppression of the development of atherosclerotic lesions in patients with PAOD. (Am Heart J 2003;145:330-3.)     

Assessment of coronary function in children with a history of Kawasaki disease using (15)O-water positron emission tomography

BACKGROUND: Coronary abnormalities after Kawasaki disease (KD) may be associated with endothelial dysfunction due to intimal hypertrophy. The purpose of this study was to evaluate myocardial flow reserve (MFR) and endothelial function in regressed aneurysmal regions after KD. Methods and Results- Subjects were 12 patients aged 16.0+/-2.6 years who suffered from KD at 1.7+/-1.5 years and 12 normal subjects aged 26.5+/-3.4 years. MFR and endothelial function were estimated, respectively, by changes in myocardial blood flow (MBF) during ATP infusion and by that during cold pressor test using (15)O-water positron emission tomography. Data from 24 regressed aneurysmal regions were compared with those from the corresponding regions (n=36) in the control group. Although the MBF at rest in the regressed aneurysmal regions was similar to that in controls, the MBF at a hyperemic state induced by ATP infusion in the regressed aneurysmal regions was significantly lower than that in the control regions. Therefore, the MFR in regressed aneurysmal regions was significantly lower than that in controls (3.53+/-0.95 versus 4.60+/-1.14; P<0.05). MBF at rest and during the cold pressor test did not change in the control regions, but it was significantly reduced in regressed aneurysmal regions. The ratio of MBF during the cold pressor test to MBF at rest was significantly lower in regressed aneurysmal regions than in control regions (0.67+/-0.15 versus 1.00+/-0.15; P<0.05). CONCLUSIONS: MFR and endothelial function are often impaired in regressed aneurysmal regions after KD, and tomography enables the noninvasive evaluation of coronary function.     

Tongue-coating as risk indicator for aspiration pneumonia in edentate elderly

Silent aspiration of oral microorganisms is a major cause of aspiration pneumonia. To establish oral hygiene criteria for the prevention of aspiration pneumonia in edentulous elderly persons, we investigated the relationship between presence of tongue-coating and number of oral bacteria in saliva and episodes of pneumonia. A total of 71 edentulous Japanese people aged 65 years or older living in nursing homes were enrolled in the study. A tongue plaque index (TPI) was used to evaluate quantity of tongue-coating, with TPI0 signifying no tongue-coating and TPI1 signifying presence of tongue-coating. Edentate elderly with TPI1 demonstrated significantly higher salivary bacterial counts than those with TPI0 (p < 0.05). The number of elderly patients developing aspiration pneumonia was larger (p < 0.005) in patients with TPI-based poor scores (average TPI > 0.5) than in those with TPI-based good scores. The relative risk of developing pneumonia in the good tongue hygiene group compared with in the poor tongue hygiene group was 0.12, 95% confidence interval (CI): 0.02–0.9. The results demonstrate that tongue-coating is associated with number of viable salivary bacterial cells and development of aspiration pneumonia, suggesting that tongue-coating is a risk indicator of aspiration pneumonia in edentate subjects.     

Oxygen transport during incremental exercise load as a predictor of operative risk in lung cancer patients.

To evaluate functional parameters related to the morbidity and mortality after thoracotomy, exercise loading was applied in 31 lung cancer patients under right heart catheterization. The routine pulmonary function and predicted postoperative pulmonary function (ppo) parameters were also evaluated. Patients were grouped according to postoperative complications: no complications (group 1, n = 17), nonfatal complications (group 2, n = 10), and fatal complications (group 3, n = 4). In all the patients %VCppo was above 40 percent and in patients undergoing pneumonectomy, pulmonary artery mean pressure during the unilateral pulmonary artery occlusion test was below 25 mm Hg. FEV1 percent and MVV/BSA were statistically significant between groups 1 and 2 but were not between groups 1 and 3 or groups 2 and 3. The %FEV1 ppo was statistically significant between groups 1 and 2 and groups 1 and 3 but was not between groups 2 and 3. Thus, the routine pulmonary function and predicted postoperative lung function tests, although they are mandatory for screening patients who are at risk, did not definitely discriminate between patients experiencing nonfatal and fatal complications after thoracotomy. VO2/BSALa20, CILa20, O2D/BSALa20, and TPVRILa20 were statistically significant between groups 1 and 3 and groups 2 and 3: in all the group 3 patients, as well as three patients of group 1 and one of group 2, VO2/BSALa20 was below 350 ml/min/m2. On the other hand, O2D/BSALa20 was below 500 ml/min/m2 in all the group 3 patients, while it was above 560 ml/min/m2 in all patients in groups 1 and 2. O2D/BSALa20 was the only parameter that definitely discriminated between experiencing nonfatal and fatal complications. We conclude that in addition to the generally accepted functional guidelines, VO2/BSALa20 should be above 400 ml/min/m2 and O2D/BSALa20 should be above 500 ml/min/m2 in patients who will undergo thoracotomy.     

A calcium channel blocker, benidipine, inhibits intimal thickening in the carotid artery of mice by increasing nitric oxide production

OBJECTIVE: Recent studies suggest that several calcium channel blockers exert their protective effects against vascular disorders by increasing nitric oxide (NO) production from the endothelium. The purpose of this study was to clarify the effects of a long-lasting calcium channel blocker, benidipine, on vascular remodeling. METHODS: The left common carotid arteries of mice were completely ligated just proximal to the carotid bifurcation. Treatment with benidipine (3 mg/kg per day) or vehicle was started 1 week before the carotid ligation, and continued throughout the experiments. Four weeks after the carotid ligation, these mice were killed and vascular remodeling was analyzed. Moreover, NO production and endothelial NO synthase (eNOS) expression were assessed. RESULTS: At 4 weeks after ligation, the neointimal area in the vehicle-treated mice was 39,400 +/- 4,900 microm2 (n = 8), whereas that in the drug-treated mice was reduced to 18,300 +/- 3,800 microm2 (n = 10). Consequently, the luminal area was 35% larger in the drug-treated mice. Benidipine increased the basal as well as agonist-induced NO production from the endothelium, detected by Griess method or NOx analyzer. Endothelial NOS expression in vessels of the drug-treated mice was increased compared with that of the vehicle-treated mice. CONCLUSION: Our data provide evidence that benidipine increases NO production via increment of eNOS protein in vessels and prevents intimal thickening in mice. These results show the possibility of benidipine as a protective tool against vascular remodeling independent of its effect on blood pressure.     

Cardiovascular Risks of Dipping Status and Chronic Kidney Disease in Elderly Japanese Hypertensive Patients

Chronic kidney disease (CKD) increases the risk of cardiovascular events and is often associated with the nondipping pattern of blood pressure (BP). We evaluated ambulatory BP, CKD, and the incidence of cardiovascular events in 811 older hypertensive patients. CKD and the dipping pattern increased the risk of cardiovascular events independent of the 24‐hour systolic BP level (CKD: hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.24–4.54; nondippers: HR, 2.16; 95% CI, 1.19–3.91; extreme dippers: HR, 2.38; 95% CI, 1.17–4.83). However, after adjustment for covariates that included CKD, the risk in nondippers was insignificant (HR, 1.83; 95% CI, 0.998–3.34; P=.051), while the risk in extreme dippers remained (HR, 2.59; 95% CI, 1.26–5.32; P=.009) (CKD: HR, 1.81; 95% CI, 0.93–3.54; P=.081). Patients with CKD have an increased risk of cardiovascular events. CKD and other cardiovascular risk factors may account for some of the increased risk in nondippers, but it does not explain the higher risk in extreme dippers.     

A clinical study of liver abscesses at the Critical Care and Emergency Center of Iwate Medical University]

We studied 13 emergency cases of liver abscess. Five cases of septic shock or clouding of consciousness were identified on admission. Six patients had diabetes mellitus. Twelve patients met the diagnostic criteria for systemic inflammatory response syndrome, and nine met the criteria for disseminated intravascular coagulation. Plasma endotoxin levels improved rapidly after drainage. Causative organisms were isolated in all patients, and the most common organism was Klebsiella pneumoniae (seven cases). Percutaneous transhepatic abscess drainage (PTAD) was performed not only in single cases but also in multiple cases with main huge abscesses. Surgical treatment was performed in the following three cases: a ruptured abscess, an ineffective PTAD, and a case of peritonitis after PTAD. Irrigation of abscesses with strong acidic electrolyzed water revealed a significant decrease in treatment duration. In the majority of our cases, severe conditions were identified on admission. Strong acidic electrolyzed water was useful for management of PTAD.