Unexpected Return for Follow-up During the First Year of Multidisciplinary Care May Be Predictive of Rapid Deterioration of Renal Function

Multidisciplinary predialysis education and team care (MDC) may slow the decline in renal function in patients with chronic kidney disease (CKD). However, associations between unexpected return during MDC and progression of renal dysfunction have not been characterized in patients with CKD. Our study aimed to determine the association between exacerbation of renal dysfunction and the frequency of unexpected return during follow-up.A total of 437 patients with CKD receiving multidisciplinary care between January 2009 and June 2013 at the Shin-Kong Wu Ho-Su Memorial Hospital were included in this retrospective observational cohort study, and multiple imputations were performed for missing data. The predictor was the frequency of unexpected return for follow-up during the first year after entering MDC. Main outcome was monthly declines in estimated glomerular filtration rates (eGFR). Moreover, the demographic data, comorbidities, history of medication, and routine laboratory data for patients with CKD were collected.Among all patients, 59.7% were male, the mean age at initiation of MDC was 69.4 ± 13.2 years, and the duration of follow-up was 21.4 ± 3.3 months. The subjects were divided into 2 groups according to frequencies of follow-up (≤4 and > 4 visits) during the 1st year of MDC. The patients with CKD were regularly followed up every 3 months as a part of MDC in our hospital, and patients who returned for more than 4 follow-up visits were included in the unexpected return group. In crude regression analyses, unexpected return was significantly associated with higher monthly declines of eGFR (β = 0.092, 95% confidence interval, 0.014–0.170). This association remained after adjustments for multiple variables, and subgroup analyses of unexpected return showed that male gender, older age, CKD stage 1 to 3, hypertension, history of coronary artery disease, and use of renin–angiotensin system blockade were significantly associated with declines in renal function.In conclusion, unexpected return for follow-up during the 1st year of MDC was significantly associated with the deterioration of renal function.     

Calcification and ossification of chronic encapsulated intracerebral haematoma: case report.

We report a case of calcified chronic encapsulated intracerebral haematoma (ICH) in a 29-year-old female who presented with progressive left sided weakness and intermittent seizures since childhood. The preoperative magnetic resonance (MR) imaging of the head initially suggested that a partially thrombosed aneurysm or vascular malformation was present. However, no vascular stain was found on the digital subtraction angiography (DSA) of both the carotid and vertebral arteries. The excised mass was histologically diagnosed as a chronic ICH. We traced the patient's medical history and found that at the age of one she sustained a head injury after a fall. So far, to our knowledge, no case of epilepsy secondary to a calcified chronic encapsulated ICH occurring 28 years after head injury has been reported. Calcified chronic encapsulated ICH concomitant with new bone formation within is even rarer. The possible pathogenesis of this case is discussed.     

Differential Stripping: Determination of the Amount of Topically Applied Substances Penetrated into the Hair Follicles

The determination of penetration pathways of topically applied substances into the skin is the subject of several investigations. Recently, follicular penetration has become a major focus of interest. To date, a direct, non-invasive quantification of the amount of topically applied substance penetrated into the follicles had not been possible. The development of such a method was the aim of this study. Therefore, the advantages of both stripping techniques, tape stripping and cyanoacrylate skin surface biopsy, were combined and evaluated. Tape stripping was used to remove the part of the stratum corneum that contained the topically applied dye. Subsequently, the follicular contents were ripped off by cyanoacrylate skin surface biopsy. The combined method termed "differential stripping" was evaluated in vitro and in vivo , and the amount of topically applied fluorescent dye penetrated into the hair follicles was quantified after different penetration times. After 30 min, 5% of the recovered concentration of sodium fluorescein was found in the follicular infundibula, where it was still detectable after 48 h. Altogether, the results of this investigation revealed that differential stripping is a new method that can be used to study the penetration of topically applied substances into the follicular infundibula non-invasively and selectively.     

皮肤光老化皱纹形成机制及维A酸类药物的拮抗作用

日光中长波紫外线 (UVA)长期反复照射是户外工作者暴露部位皮肤光老化及相关皮肤肿瘤多发的重要因素 ,皱纹形成是皮肤光老化的最重要特征 ,研究其作用机制对紫外线辐射损伤的防护有重要意义。基质金属蛋白酶 (matrixmetal loproteinases,MMPs)家族在各种生理、病理条件下细胞外基质降解和重塑中起着关键作用。我们研究了皮肤光老化皱纹形成与真皮成纤维细胞MMPs及MMPs组织抑制剂 (tissueinhibitorofmatrixmetallo proteinases,TIMPs)表达的关系 ,并同时观察了维A酸类药物的拮抗作用。一、材料与方法1 真皮成纤维细胞培养 :标本为健康…     

Atropine effects on delayed discrimination performance of rats

The effects of atropine sulfate (ATS) and atropine methyl nitrate (ATM) on the conditional discrimination behavior of rats were investigated in eight-hour experimental sessions. Responding of rats was reinforced on either a lighted or a darkened lever depending on whether lights over both levers had been on during the preceding sample portion of the trial. Zero-delay and four-second-delay trials were randomly interspersed. Quality of performance was analyzed using the A' sensitivity measure of signal detection theory. Both drugs reduced both sensitivity and the percentage of trials on which responding occurred (percent response) below saline treatment levels. The two drugs did not reliably differ from each other in their effects on sensitivity during the zero-delay condition, but reliable differences between the two drugs emerged during the four-second-delay condition at doses above 0.8 mg/kg. Percent response recovered more rapidly for animals treated with ATS than responding occurred (percent response) below saline treatment levels. The two drugs did not reliably differ from each other in their effects on sensitivity during the zero-delay condition, but reliable differences between the two drugs emerged during the four-second-delay condition at doses above 0.8 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evidence for microvascular thrombosis obtained by intravital fluorescence videomicroscopy

A pattern of enlarged capillaries densely packed with red cells and not filled by the intravital dye Na-fluorescein for 10-20 min is described. Probably it corresponds to microvascular thrombosis. Alternative explanations like prolonged stasis appear unlikely. Up to now the pattern has been detected in severe chronic venous incompetence, collagen vascular disease and essential thrombocytosis.     

The influence of metamemory on the quality of life of persons with multiple sclerosis.

This study examined the influence of metamemory (i.e., self-report of memory ability and skills), in combination with other factors, on quality of life for people with multiple sclerosis (MS). Participants (482 persons with MS) completed instruments to measure functional limitations, depressive symptoms, metamemory, and perceived quality of life. Participants reported greater satisfaction with their memory performance but less frequent use of memory aids and strategies compared with 115 older adults on whom the instrument was originally tested. Components of metamemory were significantly related to neurological disability, duration of disease, depressive symptoms, age, and quality of life. Depressive symptoms had a higher impact than other variables in the final regression model on quality-of-life prediction.     

Ultrastructural morphology of early cellular changes in the synovium of primary synovial chondromatosis.

Synovial tissues taken from 13 cases of synovial chondromatosis (SC) were examined by light and electron microscopy. In three of the 13 cases, early cellular changes were observed by electron microscopy. Most of the foci were independently situated within an accumulation of fine, homogenous chondroid matrix in the sublining area of the synovium. Basal laminalike material was observed in these cells. Because this material was not apparent in the mature cartilage cells, the authors postulate that the basilaminar material affects cellular cytodifferentiation in SC during the initial phase of the disease. Ultrastructurally, these cells are morphologically similar to myofibroblasts. However, proliferation of paravascular cells with distinct basal laminae and activated secretory abilities was observed around some of the vessels. These paravascular cells may be the precursor cells of the prechondroblastic cells with basal laminalike material seen in SC.