Muscle mass index in haemodialysis patients: a comparison of indices obtained by routine clinical examinations.

BACKGROUND: Measurement of muscle mass is useful for evaluating protein nutritional status. Various methods for estimating muscle mass in haemodialysis patients have recently been developed. METHODS: The validity of the estimate of creatinine production calculated with the creatinine kinetic model (CKM) was examined in 46 haemodialysis patients by comparing it with the actual creatinine production, this being determined from the sum of creatinine appearing in the dialysate and the estimated metabolic degradation. The correlation of various other muscle mass indices with creatinine production was also investigated in these patients. RESULTS: The estimate of creatinine production using CKM was significantly correlated with creatinine production calculated from the spent dialysate plus an estimate for the extra-renal creatinine degradation (r=0.90, P<0.001). A Bland-Altman analysis revealed that the mean prediction error for the estimate of creatinine production by CKM was +0.10 g/day and the limits of agreement were +0.34 to -0.14 g/day. The cross-sectional area of the thigh muscle measured by computed tomography (CT) was also significantly correlated with creatinine production (r=-0.86, P<0.01). In contrast, the correlations of 3-methylhistidine production measured in the spent dialysate, the mid-upper arm muscle circumference and the skeletal muscle mass estimated by an anthropometric prediction model with creatinine production were lower (r<0.82). CONCLUSION: Creatinine production calculated using CKM and CT measurement of thigh muscle area are valid methods for estimating muscle mass during routine clinical examinations of haemodialysis patients.     

Preliminary evaluation of the Polish tissue adhesive “Chirurcoll/Polfa” in urology

During the past two years, from June 7, 1974 to August 9, 1976, the authors used the Polish tissue adhesive Chirurcoll/Polfa in 60 operated patients. The operations were performed on the solitary kidney, on the kidneys of staghorn calculi, in fixation of a floating kidney and, fixation and elevation of the bladder in women with urinary stress incontinence.In all cases the postoperative course was smooth and the results of operation were satisfactory. None of the patients were re-operated and histological examinations were not performed,     

Contrast Enhancement of the Normal Infundibular Recess Using Heavily T2-weighted 3D FLAIR

Purpose: The purpose of the present study was to evaluate contrast enhancement of the infundibular recess in the normal state using heavily T2-weighted 3D fluid-attenuated inversion recovery (FLAIR) (HT2-FLAIR).Methods: Twenty-six patients were retrospectively recruited. We subjectively assessed overall contrast enhancement of the infundibular recess between postcontrast, 4-hour (4-h) delayed postcontrast, and precontrast HT2-FLAIR images. We also objectively conducted chronological and spatial comparisons by measuring the signal intensity (SI) ratio (SIR). Chronological comparisons were performed by comparing SI of the infundibular recess/SI of the midbrain (SIR_IR-MB). Spatial comparisons were conducted by comparing SI on postcontrast HT2-FLAIR/SI on precontrast HT2-FLAIR (SIR_Post-Pre) of the infundibular recess with that of other cerebrospinal fluid (CSF) spaces, including the superior part of the third ventricle, lateral ventricles, fourth ventricle, and interpeduncular cistern.Results: In the subjective analysis, all cases showed contrast enhancement of the infundibular recess on both postcontrast and 4-h delayed postcontrast HT2-FLAIR, and showed weaker contrast enhancement of the infundibular recess on 4-h delayed postcontrast HT2-FLAIR than on postcontrast HT2-FLAIR. In the objective analysis, SIR_IR-MB was the highest on postcontrast images, followed by 4-h delayed postcontrast images. SIR_Post-Pre was significantly higher in the infundibular recess than in the other CSF spaces.Conclusion: The present results demonstrated that the infundibular recess was enhanced on HT2-FLAIR after an intravenous gadolinium injection. The infundibular recess may be a potential source of the leakage of intravenously administered gadolinium into the CSF.     

PEGylated Carboxyhemoglobin Bovine (SANGUINATE): Results of a Phase I Clinical Trial

PEGylated carboxyhemoglobin bovine (SANGUINATE) is a dual action carbon monoxide releasing (CO)/oxygen (O₂) transfer agent for the treatment of hypoxia. Its components inhibit vasoconstriction, decrease extravasation, limit reactive oxygen species production, enhance blood rheology, and deliver oxygen to the tissues. Animal models of cerebral ischemia, peripheral ischemia, and myocardial ischemia demonstrated SANGUINATE's efficacy in reducing myocardial infarct size, limiting necrosis from cerebral ischemia, and promoting more rapid recovery from hind limb ischemia. In a Phase I trial, three cohorts of eight healthy volunteers received single ascending doses of 80, 120, or 160 mg/kg of SANGUINATE. Two volunteers within each cohort served as a saline control. There were no serious adverse events. Serum haptoglobin decreased, but did not appear to be dose related. The T_1/2 was dose dependent and ranged from 7.9 to 13.8 h. In addition to the Phase I trial, SANGUINATE was used under an expanded access emergency Investigational New Drug. SANGUINATE was found to be safe and well tolerated in a Phase I clinical trial, and therefore it will advance into further clinical trials in patients.     

Neglect‐induced pseudo‐thrombotic thrombocytopenic purpura due to vitamin B12 deficiency

Although thrombotic thrombocytopenic purpura (TTP) is rare, early diagnosis and treatment are important for decreasing the mortality rate. Acquired vitamin B12 deficiency is frequently overlooked because of its rarity in developed countries, particularly in children and adolescents. The hematological changes in vitamin B12 deficiency present as megaloblastic anemia, increased lactate dehydrogenase, vasoconstriction, increased platelet aggregation, and abnormal activation of the coagulation followed by microangiopathy as well as neutropenia and thrombocytopenia. We report herein the case of a 15‐year‐old girl who had been neglected, which might have caused pseudo‐TTP through malnutrition, particularly vitamin B12 deficiency. When we encounter cases of TTP in children, clinicians must be aware of the possibility of malnutrition, particularly with vitamin B12 deficiency, even in developed countries, and investigate the cause of malnutrition including neglect.     

Lipopolysaccharide-induced cytokine and receptor expression and neutrophil infiltration in the liver of osteopetrosis (op/op) mutant mice

BACKGROUND/AIMS: Mice homozygous for the osteopetrosis (op) mutation are genetically deficient in macrophage colony-stimulating factor (M-CSF/CSF-1) and are characterized by defective differentiation and function of macrophages. The aim of this study is to assess the contribution of M-CSF to lipopolysaccharide (LPS)-induced cytokine expression and neutrophil infiltration in the liver. Methods: We investigated the effects of LPS administration in M-CSF-deficient op/op mutant mice. The expression of cytokines and receptors in the liver was studied by immunohistochemistry and RT-PCR. Neutrophil infiltration in the liver was also examined. RESULTS: After LPS administration, cytokine production and expression of LPS receptors, such as CD14 and scavenger receptor class A (MSR-A), were induced at lower levels in op/op mice than those in littermate mice. Neutrophil infiltration in the liver of op/op mice did not differ significantly from that of littermate mice. Anti-IL-8 receptor homologue and anti-C5a receptor antibody reduced the number of infiltrating neutrophils. CONCLUSIONS: These findings indicate that deficient macrophage activation following LPS injection in op/op mice is associated with decreased expression of CD14 and MSR-A in the liver. Thus, M-CSF plays a critical role in LPS-induced macrophage activation but does not exert a dominant role in neutrophil infiltration in the liver.     

Lipopolysaccharide‐induced cytokine and receptor expression and neutrophil infiltration in the liver of osteopetrosis (op/op) mutant mice

Abstract: Background/Aims: Mice homozygous for the osteopetrosis (op) mutation are genetically deficient in macrophage colony‐stimulating factor (M‐CSF/CSF‐1) and are characterized by defective differentiation and function of macrophages. The aim of this study is to assess the contribution of M‐CSF to lipopolysaccharide (LPS)‐induced cytokine expression and neutrophil infiltration in the liver. Methods: We investigated the effects of LPS administration in M‐CSF‐deficient op/op mutant mice. The expression of cytokines and receptors in the liver was studied by immunohistochemistry and RT‐PCR. Neutrophil infiltration in the liver was also examined. Results: After LPS administration, cytokine production and expression of LPS receptors, such as CD14 and scavenger receptor class A (MSR‐A), were induced at lower levels in op/op mice than those in littermate mice. Neutrophil infiltration in the liver of op/op mice did not differ significantly from that of littermate mice. Anti‐IL‐8 receptor homologue and anti‐C5a receptor antibody reduced the number of infiltrating neutrophils. Conclusions: These findings indicate that deficient macrophage activation following LPS injection in op/op mice is associated with decreased expression of CD14 and MSR‐A in the liver. Thus, M‐CSF plays a critical role in LPS‐induced macrophage activation but does not exert a dominant role in neutrophil infiltration in the liver.     

Clinical evaluation of pneumonia-associated rhabdomyolysis with acute renal failure

This study aims to evaluate the clinical features, diagnosis, and treatment efficacy in patients with pneumonia-associated rhabdomyolysis and acute renal failure. The subjects included six patients who had presented with rhabdomyolysis and acute renal failure due to bacterial or viral pneumonia on admission to our university hospital and the Yokohama Social Insurance Central Hospital between 2004 and 2005. The causative organisms were identified as Legionella pneumophila (N = 1), Staphylococcus epidermidis (N = 2), Staphylococcus aureus (N = 1), and Unknown (N = 2). For anuric or oliguric patients (N = 4), a blood purification therapy was performed, while conservative therapy was administered to those with a normal urine volume (N = 2). The patient suffering from L. pneumophila pneumonia did not survive, while the other patients regained full kidney function. It is important to identify, evaluate, and treat patients with bacterial or viral pneumonia-associated rhabdomyolysis and acute renal failure.     

吡格列酮加伏格列波糖治疗透析的2型糖尿病患者

在一个开放的随机研究中，31位血糖控制不稳定的2型糖尿病血液透析患者接受了恒量的伏格列波糖治疗。患者被随机分为2组：联合治疗组（吡格列酮组）给予吡格列酮（固定剂量为30mg）加伏格列波糖；单一治疗组（控制组）只给予伏格列波糖。疗效用血糖控制（血浆葡萄糖和糖化血红蛋白）和胰岛素抵抗来评价。结果显示，吡格列酮能有效降低4周内的血浆葡萄糖和糖化血红蛋白，