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Volume 224 (2011)
- Issue 4 Pages 243-
- Issue 3 Pages 163-
- Issue 2 Pages 77-
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Volume 224, Issue 4
August
Displaying 1-10 of 10 articles from this issue
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Review
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Takahito Moriyama, Kosaku Nitta2011 Volume 224 Issue 4 Pages 243-250
Published: 2011
Released on J-STAGE: June 25, 2011
JOURNAL FREE ACCESSIgA nephropathy (IgAN) is the common cause of primary glomerulonephritis worldwide. The clinical course of IgAN is extremely variable and ranges from asymptomatic microscopic hematuria to rapidly progressive renal failure. The pathogenetic mechanisms of IgAN are still unclear, but a hypothesis consisting of two pathways has been proposed. The first pathway is continuous antigenic stimulation of the innate immune system by the tonsillar mucosa via the mucosa-bone marrow axis. In the second pathway, the anomalous stimulated immune response in the bone marrow results in the production of aberrantly glycosylated IgA1 and its subsequent deposition within the mesangial area. Based on the hypothesis, tonsillectomy plus steroid pulse therapy were introduced. A recent meta-analysis showed that tonsillectomy with or without steroid pulse therapy resulted in clinical remission with favorable long-term efficacy in IgAN patients. Tonsillectomy plus steroid pulse therapy now seems to be an effective treatment for IgAN patients with hematuria and minimal proteinuria, and it is more effective in patients with less severe histological findings. The efficacy of the combination therapy depends on the duration of the IgAN. Randomized, controlled trials are needed to examine the efficacy of tonsillectomy plus steroid pulse therapy in different clinical stages of IgAN.View full abstractDownload PDF (396K)
Regular Contributions
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Makoto Shoji, Kouki Katayama, Kunio Sano2011 Volume 224 Issue 4 Pages 251-256
Published: 2011
Released on J-STAGE: June 25, 2011
JOURNAL FREE ACCESSInfluenza epidemics occur periodically during the winter season in temperate areas. Characteristic features of winter include low temperature and low humidity. Humidity is expressed in two different ways: absolute humidity (AH) defined as absolute amount of water in the air, and relative humidity (RH) defined as the relative proportion of water in the air in comparison to the maximum water vapor. There have been many arguments for RH as a determinant factor for influenza epidemics. On the other hand, we have been putting emphasis on AH on the basis of our epidemiological observations. In this context, a recent experimental and theoretical study by other investigators has shown that AH correlates with influenza survival, transmission, and seasonality. Accordingly, we collected meteorological and influenza epidemiological data from 46 prefectures in temperate Japan for 1991-1995 and 1999-2009, and analyzed 2,392 sets of weekly compiled data for each season year by using multiple linear regression analysis, in which the numbers of influenza cases were regarded as a function of AH and RH. We found that the standardized partial regression coefficient for AH was consistently stronger than that for RH with statistical significance. In addition, AH increased and decreased significantly at the time of the epidemic onset and subsidence in seven and twelve out of fourteen influenza seasons, respectively, whereas RH did so in none and two out of fourteen influenza seasons. Thus, we have substantiated our quarter-century-old assertion that AH strongly correlates with the onset and subsidence of influenza epidemics.View full abstractDownload PDF (360K) -
Cihan Sengul, Dursun Duman2011 Volume 224 Issue 4 Pages 257-262
Published: 2011
Released on J-STAGE: July 07, 2011
JOURNAL FREE ACCESSEpicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. Epicardial fat thickness (EFT) and blunted heart rate recovery (HRR) are newly identified cardiovascular risk factors in patients with metabolic syndrome (MS). The objective of this study is to evaluate the association between EFT and HRR in patients with MS. Forty patients with MS and 36 healthy controls were included in the study. Echocardiographic EFT and HRR at 1min after exercise termination (HRR-1) are measured and compared between the two groups. HRR-1 equal to or lower than 18 beats is considered as blunted HRR. EFT was increased (7.2 ± 2 vs. 5.6 ± 1.8 mm; p = 0.001) and HRR-1 was significantly reduced in patients with MS compared to control group (21 ± 8 vs. 26 ± 9; p = 0.006). Among the MS patients, subjects with blunted HRR had increased EFT compared to patients without blunted HRR (8.5 ± 2.0 vs. 5.9 ± 1.1 mm, p < 0.001). In multivariate analysis, EFT was the only independent predictor of blunted HRR in patients with MS (95% confidence interval = 1.42-3.87, OR = 2.34, p = 0.001). Furthermore, EFT of equal to or thicker than 5.5 mm was associated with the blunted HRR with 84% sensitivity and 52% specificity (ROC area under curve: 0.84, 95% confidence interval = 0.70-0.96, p < 0.001). In conclusion, EFT is an independent predictor of blunted HRR, a novel cardiovascular risk factor, in patients with MS.View full abstractDownload PDF (568K) -
Keiichi Ikeda, Takatoshi Saito, Katsuyoshi Tojo2011 Volume 224 Issue 4 Pages 263-271
Published: 2011
Released on J-STAGE: July 14, 2011
JOURNAL FREE ACCESSSteroid biosynthesis is initiated with transportation of cholesterol along with steroidogenic acute regulatory protein (StAR) into the mitchondria and is achieved with several steroidogenic enzymes. It has been reported that Ca2+ channel blockers (CCBs), such as azelnidipine, efonidipine and nifedipine, suppress the biosynthesis of aldosterone and cortisol, but the overall effects of CCBs on steroid biosynthesis remain to be clarified. The present study was designed to evaluate the effects of CCBs on the expression of steroidogenic enzymes and the production of adrenal androgen, dehydroepiandrosterone sulfate (DHEA-S) that has anti-atherosclerotic actions. NCI-H295R human adrenocortical carcinoma cells and HepG2 human hepatoma cells were cultured for 24 hours with or without a CCB (amlodipine, efonidipine, nifedipine, azelnidipine R(−)-efonidipine, verapamil or diltiazem). HepG2 hepatoma cells were used to confirm the effects of CCBs on the expression of StAR. In fact, efonidipine and nifedipine increased the expression of StAR in HepG2 cells. Efonidipine and nifedipine, but not other examined CCBs, also increased the N6, 2'-O-dibutyryladenosine 3',5'-cyclic monophosphate (dbcAMP)-induced StAR mRNA, which reflects the action of adrenocorticotropic hormone, and efonidipine and R(−)-efonidipine enhanced the dbcAMP-induced DHEA-S production in NCI-H295R adrenocortical carcinoma cells. Therefore, efonidipine and nifedipine might increase the expression of StAR and, in turn, efonidipine enhanced the dbcAMP-induced DHEA-S production, independent of Ca2+ channel blockade. These results indicate that such effects are not associated with Ca2+ influx. Moreover, only efonidipine enhanced the angiotensin II-induced expression of StAR mRNA (P < 0.01 vs. angiotensin II alone). In conclusion, efonidipine might exert an additional action beyond anti-hypertensive actions.View full abstractDownload PDF (656K) -
Umut Zubarioglu, Sinan Uslu, Emrah Can, Ali Bülbül, Asiye Nu ...2011 Volume 224 Issue 4 Pages 273-279
Published: 2011
Released on J-STAGE: July 15, 2011
JOURNAL FREE ACCESSThe oxygen support during neonatal resuscitation is not completely defined by evidence-based science. We, therefore, aimed to determine the oxygen saturation (SpO2) levels within the first 15 minutes of life and to evaluate the effect of delivery routes, gender and measurement sites on the mean time to reach preductal and postductal SpO2 levels of 90% among healthy term neonates. The sensors were placed at the right hand for preductally and the left hand for postductally SpO2 measurements. In this prospective observational study, 141 healthy term neonates were included. Seventy-one (50.3%) of the babies were female, and 77 (54.6%) were delivered by caesarean section. Mean gestational age was 38.8 ± 1.1 weeks and mean birth weight was 3,082 ± 425.7 g. Overall, it took 7.5 ± 2.8 and 9.5 ± 3.2 min to reach oxygen saturation levels ≥ 90% preductally and postductally, respectively. The lengths of time to reach ≥ 90% preductal and postductal SpO2 levels were 6.9 ± 2.8 and 8.4 ± 3.2 min for vaginal delivery and 8.0 ± 2.8 and 10.4 ± 2.9 min for caesarean section, respectively. Thus, the time to reach SpO2 levels ≥ 90% was prolonged in the postductal measurements and in the neonates born by caesarean section. Gender was found to have no effect on duration to reach 90% SpO2 levels at both preductal and postductal measurements. The measurement site and the type of delivery must be taken into consideration when oxygen saturation was measured in term healthy newborn in delivery room immediately after birth.View full abstractDownload PDF (995K) -
Jae Hyun Chang, Ji Yong Jung, Hyun Hee Lee, Wookyung Chung, Kwon-Wook ...2011 Volume 224 Issue 4 Pages 281-285
Published: 2011
Released on J-STAGE: July 22, 2011
JOURNAL FREE ACCESSThe use of higher erythropoietin (EPO) doses is associated with an increased risk of an adverse outcome and increased mortality in patients with renal failure. Resistin is related to heart disease, and may contribute to an increased atherosclerotic risk. We hypothesized that a link between resistin and EPO responsiveness may exist. We therefore investigated the relationship between resistin and the EPO resistance index (ERI) in nondiabetic hemodialysis (HD) patients. Fifty-seven patients enrolled in the study underwent HD for ≥ 3 months and intravenous EPO therapy to maintain a target hemoglobin (Hb) level of 11.0 g/dl. The ERI was defined as the weekly EPO dose per unit Hb per body weight. The mean patient age was 52.6 ± 11.9 years and the mean time on dialysis was 4.9 ± 4.4 years. Serum Hb and ERI were 10.4 ± 0.7 g/dl, and 13.3 ± 7.0 (IU/kg/week/g/dl), respectively. Serum resistin levels were 23.6 ± 9.3 μg/L. EPO resistance is associated with low body mass index (BMI) (coefficient β =−0.393, p = 0.002) and with high serum resistin levels (coefficient β = 0.332, p = 0.018). According to a multiple regression analysis, the serum resistin level was a significant independent factor related to EPO resistance (p = 0.017). The results suggest that serum resistin levels reflect EPO responsiveness in nondiabetic HD patients. Resistin may therefore be considered as a new marker of EPO responsiveness in HD patients.View full abstractDownload PDF (388K) -
Keiko Tanabe, Koji Tamakoshi, Jun Murotsuki2011 Volume 224 Issue 4 Pages 287-292
Published: 2011
Released on J-STAGE: July 27, 2011
JOURNAL FREE ACCESSThe women's own intrauterine environment may influence their own pregnancy and their babies. The aim of our study was to investigate how a woman's birth weight affects the course of her pregnancy later in life as well as the body size of her babies; this study was based on the developmental origins of health and disease (DOHaD) concept. We collected Maternal and Child Health handbooks from 414 women and their biological mothers. They were classified into 3 categories based on the Fetal growth curve of Japan: light-for-date (LFD), which means birth weight is less than the −1.5SD; appropriate-for-date (AFD), which means it lies between the −1.5SD and +1.5SD; and heavy-for-date (HFD), which means it is in the +1.5SD, or higher. In the first trimester, systolic blood pressures (SBPs) were 117.6 (14.4 mmHg), 111.6 (12.4 mmHg), and 105.0 (11.6 mmHg), and diastolic blood pressures (DBP) were 71.0 (8.5 mmHg), 65.7 (9.4 mmHg), and 62.1 (8.7 mmHg) in women born LFD, AFD, and HFD, respectively (SBP: p for trend = 0.018, DBP: p for trend = 0.027). In the second and third trimesters, both SBP and DBP were higher for women born LFD than for those of the other 2 groups. Birth weights of the babies of women born LFD, AFD, and HFD were 2,791.1 (483.0 g), 3,043.4 (361.0 g), and 3,248.0 (431.5 g), respectively (p for trend < 0.01). Our findings support the DOHaD concept and suggest that intrauterine environment in fetal life may be passed down from generation to generation.View full abstractDownload PDF (342K) -
Jae-Woo Jung, Hye-Ryun Kang, Jae-Woo Kwon, Tae-Eun Kim, So-Hee Lee, Ky ...2011 Volume 224 Issue 4 Pages 293-300
Published: 2011
Released on J-STAGE: July 29, 2011
JOURNAL FREE ACCESSRevaprazan is the first acid pump antagonist with a function similar to that of proton pump inhibitors (PPIs). It has a dual action, active suppression of gastric acid secretion and gastric mucosa protection. While PPIs are known to enhance the prolongation of prothrombin time by warfarin, no research has been done on the drug interaction between revaprazan and warfarin. This study was conducted in order to verify the potential drug interaction between revaprazan and warfarin. Omeprazole, a representative PPI, was used as the control for revaprazan. We searched for patients who were given either revaprazan or omeprazole along with warfarin using the medical record database of Seoul National University Hospital between July 2007 and June 2010. Among the 15 patients who took revaprazan and warfarin together, 73.3% (11/15) showed more than 30% reduction of anticoagulation effect by warfarin after revaprazan was added. The revaprazan group showed a significant shortening of prothrombin time during revaprazan administration compared to pre- and post-revaprazan medication (P < 0.05) while the omeprazole group did not show such difference. Revaprazan seems to have cumulative dose-dependent anti-warfarin or anti-coagulation effect, as judged from the fact that the longer medication with revaprazan showed correlation with the shortening of prothrombin time (R = −0.632, P < 0.05). This study shows a possible interaction between revaprazan and warfarin and suggests that revaprazan can cause shortening of prothrombin time. Therefore, when revaprazan is prescribed to patients on warfarin therapy, prothrombin time should be frequently monitored.View full abstractDownload PDF (488K) -
Omer Satiroglu, Huseyin Avni Uydu, Adem Demir, Mehmet Bostan, Mehtap A ...2011 Volume 224 Issue 4 Pages 301-306
Published: 2011
Released on J-STAGE: July 29, 2011
JOURNAL FREE ACCESSPeripheral artery disease occurs at advanced ages and accounts for substantial cardiovascular morbidity and mortality. Monocyte chemoattractant protein-1 (MCP-1), a member of the cysteine-cysteine family of chemokines, is one of the cytokines involved in the pathogenesis of atherosclerosis and is also known as cysteine-cysteine chemokine ligand 2 (CCL2). The aim of the current study was to investigate the association between the extent of atherosclerotic peripheral artery disease (PAD) and the increase in MCP-1 level. Eighty consecutive patients who had undergone peripheral angiography for suspected PAD were included. Of these patients, 48 (60%) had hypertension, 23 (28.8%) had type 2 diabetes mellitus, 39 (48.8%) had a family history of coronary artery disease, 23 (28.8%) were cigarette smokers, and 42 (52.5%) had hypercholesterolemia. Angiography revealed that the peripheral arteries of the lower extremity were normal in 41 (51.3%) patients, whereas 39 (48.7%) patients had varying degrees of PAD. The patients were queried regarding age, gender, and atherosclerotic risk factors. The plasma MCP-1 levels were significantly lower in the patients without PAD than those in the patients with PAD (172.27 ± 38.05 pg/mL vs. 200.87 ± 39.31 pg/mL, p = 0.001). Moreover, as the severity of PAD increases, MCP-1 levels also increase. Thus, the plasma MCP-1 level can be used in the diagnosis of PAD and in determining the extent of atherosclerotic PAD of the lower extremities, as in determining the extent of coronary artery disease.View full abstractDownload PDF (368K) -
Yukiko Saito, Yasushi Kudo, Akitaka Shibuya, Toshihiko Satoh, Masaaki ...2011 Volume 224 Issue 4 Pages 307-315
Published: 2011
Released on J-STAGE: August 05, 2011
JOURNAL FREE ACCESSIn medical education, it is important for medical students to develop their ethics to respect patients' rights. Some physicians might make light of patients' rights, because the increased awareness of such rights might make it more difficult for them to conduct medical practice. In the present study, predictors significantly associated with “a sense of resistance to patients' rights” were examined using anonymous self-administered questionnaires. For these predictors, we produced original items with reference to the concept of ethical development and the teachings of Mencius. The subjects were medical students at the Kitasato University School of Medicine, a private university in Japan. A total of 518 students were analyzed (response rate, 78.4%). The average age of enrolled subjects was 22.5 ± 2.7 years (average age ± standard deviation). The average age of 308 male subjects was 22.7 ± 2.8 years, while that of 210 female subjects was 22.1 ± 2.5 years. The item, “Excessive measures to pass the national examination for medical practitioners,” was significantly associated with “a sense of resistance to patients' rights.” However, other items, including basic attributes such as age and gender, were not significant predictors. If students spent their school time only focusing on the national examination, they would lose the opportunity to receive the ethical education that would allow them to respect patients' rights. That ethical development cannot easily be evaluated with written exams. Thus, along with the acquisition of medical knowledge, educational programs to promote medical students' ethics should be developed.View full abstractDownload PDF (390K)
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