To establish a scoring model to predict the risk of contrast-induced nephropathy (CIN) in elderly patients undergoing elective coronary angiography (CAG).

A total of 1286 patients aged > 65 years who had undergone elective CAG between August 2009 and February 2013 were enrolled in this study. They were randomly (3:2) assigned to a development (n = 756) or validation dataset (n = 530). Independent predictors of CIN were identified by using logistic regression and were assigned a weighted integer, which was used to establish a score model.

CIN incidence in the development set was 6.3%. The risk score model contained 3 variables (with the weighted integer): age > 75 years (1.5), creatinine clearance (CrCl) < 60 mL/minute (1), and congestive heart failure (CHF) (1.5). CIN incidence was 3.1%, 9.1%, and 29.0% in the low-risk group (≤ 1), moderate risk group (1 - 3), and high-risk group (≥ 3), respectively. The risk model demonstrated good prediction value in the development (c-statistic = 0.727) and validation (c-statistic = 0.695) datasets. Compared to the non-

, the had a significantly higher rate of inhospital major adverse cardiac events (P < 0.01).

The risk score model with 3 variables, namely age > 75 years, CrCl < 60 mL/minute, and CHF, is a clinical prediction tool for CIN in elderly patients before elective CAG. CIN is one of the independent risk factors of major adverse cardiac events (MACE).

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Objective:This study aimed to determine the perioperative predictors of contrast medium‐induced nephropathy (CIN) after endovascular aortic repair (EVAR). Materials and Methods:The data of 203 consecutive patients who underwent elective EVAR for thoracic and abdominal aortic aneurysm between January 2014 and September 2014 were retrospectively analyzed. CIN was defined according to the diagnostic criteria of the European Society of Urogenital Radiology. Results:Fourteen patients (6.9%) developed CIN after EVAR. Contrast medium volume (CV), preoperative serum creatinine, estimated glomerular filtration rate (eGFR), and the CV/eGFR ratio were significantly related with CIN development after EVAR. The CV/eGFR ratio was significantly higher in patients with CIN than those without CIN. Receiver operator characteristic curve analysis showed that the area under the curve of the CV/eGFR ratio was 0.782, indicating that it was the most important predictor. The appropriate CV/eGFR ratio cutoff was 1.62. Sensitivity and specificity were 85.7% and 65.6%, respectively. Conclusions:The CV/eGFR ratio was a useful predictor of contrast medium‐induced nephropathy after EVAR. It is possible that the score can be used in patients when managing the EVAR techniques and contrast medium volume. J. Med. Invest. 65:116‐121, February, 2018

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Objectives We examined oral N-acetylcysteine effects on contrast-induced nephropathy (CIN) and clinical events in patients undergoing primary angioplasty for acute myocardial infarction.
Background Recent studies have reported that N-acetylcysteine reduces CIN and improves the clinical outcome in patients undergoing primary angioplasty. However, additional investigations are warranted to further support these findings.
Methods We randomly assigned 76 patients undergoing primary angioplasty into two groups: 38 patients were assigned to N-acetylcysteine (NAC, 705 mg orally administration before and 12, 24, 36 hours after primary angioplasty), and 38 patients to placebo. CIN was defined as an increase in the serum creatinine concentration of 25 percent or more from baseline value within the 72-hour period after primary angioplasty.
Results CIN occurred in 7 patients (9.2%). In the NAC group, the incidence of CIN tended to be lower than in the placebo group (NAC; 2/38; 5.3% vs. Placebo; 5/38; 13.2%, p=0.21). The composite endpoints such as death, acute renal failure requiring temporary renal replacement therapy, or need for mechanical ventilation did not occur in either group.
Conclusion While N-acetylcysteine might have the possibility to reduce the incidence of contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction, the in-hospital mortality and morbidity were not significantly different between the two groups.

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The fields of antibiotic substances of streptomyces have been examined most in detail, and actinomycin, streptothricin, streptomycin, grisein, chloromycetin, actidione and aureomycin have been isolated and studied in detail. But there seem to be more other antibiotic substances. In general an antibiotic strain of streptomyces develops on the nutrient agar and produces the antibiotic substance which diffuses in the agar and inhibits the growth of bacteria near around its colony. But it is not always that streptomyces showing the inhibiting zone on the agar produces the antibiotic substance in the nutrient broth by shaking or stationary culture. Besides there is not any strict conformity between the kind of species and the kind of antibiotic substances produced. For example, both a streptomycin-producing and a grisein-producing strain chiefly belong to S. griseus, and streptothricin-group substances are produced by various kinds of streptomyces. In these circumstances, it is necessary to identify the kind of antibiotic substances by testing their antibacterial spectra on the nutrient agar, in order to find a new antibiotic substance.
Since many antibiotic strains had been isolated in our laboratory and some of their antibiotic substances had been determined, such as to be actinomycin, streptothricin-group substances, streptomycin, chloromycetin and grisein, so the antibacterial spectra of all the other strains were examined, in order to find whether there were some strains producing a new antibiotic substances. But it is not easy work to test the complete antibacterial spectrum of each strain against many kinds of bacteria. As shown in our previous report, a strain which resistance to one of the antibiotic substances was forcedly increased does not usually become more resistant to other antibiotic substances. streptomycin-fast strain of B. coli is more resistant to streptomycin than the normal strain, but not to streptothricin and other antibiotic substances.. A streptothricin-fast strain of B. coli increases its resistance only against streptothricin-group substances and streptomycin. A grisein-fast strain increases its resistance specifically against grisein. So if the resistances of the fast strains to an antibiotic are tested, then it can be simply determined to which kind of antibiotic substances it belongs.
In stead of testing resistances of many kinds of bacteria, the resistances of the above three fast strains and the normal strain of B. coli were tested against the antibiotic substances produced around the colonies of antibiotic strains of streptomyces. Moreover, as we had already found that B, subtilis is more resistant to streptomycin that B. anthracis and the latter is more resistant to streptothricin-group substances than the former, so the resistances of these two kinds of bancteria were also tested.
According to the antibacterial spectra, antibiotic strains were at first divided into two large groups, the first inhibiting the growth of B. coli and the second not inhibiting B. coli. Furthermore the first large group could be classified into five groups. In this paper the classification of the first group is described. The classification of the second group will be published later, though it is already found that there are more than two kinds of antibiotic substances which do not inhibit the growth of B. coli, that is, actinomycin and other antibiotic substances.

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Renal insufficiency secondary to contrast administration remains a prevalent and debilitating complication of angiographic procedures. Contrast-induced nephropathy (CIN) is a common clinical problem for which there is no effective medical treatment. However, agmatine has been shown to be effective against ischemia/reperfusion-induced acute kidney injury in rats, a similar condition to CIN. Our aim was to examine the protective effects of agmatine in a rat model of CIN and, based on those results, in a rabbit model of CIN. CIN in the rat model was induced by intravenous administration of indomethacin (10 mg/kg), N^ω-nitro-L-arginine methyl ester (L-NAME) (10 mg/kg) and iopamidol (OYPALOMIN, 7.4 g iodine/kg) at 2 weeks after a unilateral nephrectomy. CIN in the rabbit model was induced by intrarenal arterial injection of only iopamidol (BYSTAGE, 4.8 g iodine/kg). Intravenous injection of agmatine (0.1 and 0.3 mmol/kg) did not attenuate the CIN-induced renal insufficiency in the rat model. Intravenous injection of agmatine (0.3 mmol/kg) attenuated the CIN-induced renal insufficiency in the rabbit model such as increases in blood urea nitrogen and plasma creatinine levels. Renal histological damage was also improved by the agmatine administration. The difference in effects of agmatine injection between CIN rats and CIN rabbits was caused by indomethacin and L-NAME administrations. These results indicate that agmatine prevents the development of CIN-induced renal insufficiency in rabbits, and the effect is accompanied by activation of nitric oxide synthase and subsequent increase of blood flow.

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Background Contrast-induced nephropathy (CIN) frequently complicates cardiac catheterization, so the objectives of present study were to investigate the usefulness of cystatin C before catheterization and establish a cut-off level for CIN, and to examine the changes in cystatin C and several other markers in patients with and without CIN. Methods and Results Prospective study of consecutive 87 patients who underwent elective catheterization: moderate renal disease defined as glomerular filtration rate 30-59 ml · min^-1 ·1.73 mm^-2; cystatin C and creatinine (Cr), urinary liver-type fatty acid-binding protein (L-FABP), α₁, β₂ microglobulins, N-acetyl-β-D-glucosaminidase, and microalbumin were measured immediately before, and 1, 2, and 3 days after catheterization. CIN occurred in 18 patients and receiver-operating characteristic analysis showed a higher area-under-the-curve for cystatin C compared with serum Cr (0.933 vs 0.832 p=0.012). At a cut-off level of >1.2 mg/L, cystatin C before catheterization exhibited 94.7% (95% confidence interval: 0.851-1.015) sensitivity and 84.8% specificity for detecting CIN. Cystatin C levels were higher in CIN patients than in those without CIN, even before catheterization (cystatin C: 1.08±0.22 vs 1.36±0.28 mg/L, p=0.007). Urinary L-FABP was increased on days 1 and 2 in patients with moderate renal disease. Conclusion Cystatin C was useful for predicting the occurrence of CIN. Urinary L-FABP was the only marker of transient renotubular damage. (Circ J 2008; 72: 1499 - 1505)

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Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury (AKI). Emerging evidence has revealed that soluble klotho (sklotho) could be a novel biomarker for early AKI diagnosis. The aims of this study were to assess the predictive role of sklotho for CIN and to develop a prediction nomogram in patients undergoing percutaneous coronary intervention (PCI). This study is registered on Clinicaltrials.gov (NCT 02650336).

Patients aged 18 years or older undergoing planned PCI were prospectively recruited between May 2014 and July 2015. CIN was defined as an increase in serum creatinine of 0.5 mg/dL within 48-72 hours after the procedure. Plasma sklotho was measured by enzyme linked immunosorbent assay (ELISA). Stratified analysis, interaction test, covariate screening, and curve fitting were performed to explore the association between sklotho and CIN. A nomogram was then developed and validated using the bootstrapped technique.

A total of 192 patients aged 54.75 ± 12.19 years were selected, 32 (16.7%) of whom were diagnosed with CIN. A logistic regression model indicated significant associations between CIN and sklotho, age > 75 years, diabetes, and the Mehran risk score. Saturation effects analysis detected a two-stage change between sklotho and CIN, with the inflection point was 477.4 pg/mL. The area under the ROC curve was 0.758 and the sensitivity and specificity of this point were 90.6% and 53.9%, respectively. A nomogram was developed for the prediction of CIN and showed a bootstrapped-corrected area under the curve value of 0.913. In addition, sklotho significantly increased the predictive value of the nomogram.

A strong association between sklotho and CIN was identified in patients undergoing elective PCI. A lower level of sklotho would be well correlated with CIN. The nomogram with sklotho is a useful tool to predict CIN in patients who will undergo PCI.

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Aim To compare the incidence, and risk factors, in-hospital and at the 18-month prognosis of contrast-induced nephropathy (CIN) according to the definition utilized: as an increase in serum creatinine (Scr) ≥0.5 mg/dL (CIN 1) or as an increase in Scr ≥25% above baseline values (CIN 2).
Methods and Results We prospectively evaluated CIN according to two different definitions in 150 patients who underwent percutaneous coronary intervention (PCI) in simple lesions employing a low-medium dose of contrast media. Incidence of CIN was higher using the CIN 2 definition than CIN 1 (9.3% vs. 4%; p=0.0133). Patients with CIN 1 had a higher incidence of chronic kidney disease (CKD) (66.7% vs. 13.9%; p=0.006), higher mean serum creatinine levels (1.35±0.42 vs. 0.98±0.35; p=0.001) and lower mean eGFR levels (58.3±19.6 vs. 84±25.9; p=0.002). Patients with CIN 2 had a higher incidence of anemia (57.1% vs. 30.9%; p=0.049) and a higher mean contrast media volume was used (142.6±62.2 mL vs. 110.6±57.2 mL; p=0.05). In the multivariate analysis the only significant variable associated with CIN (CIN 2) was a higher volume of contrast media (OR=1.01; p=0.04). There were no differences in the major in-hospital events, but patients with CIN (both definitions) had a longer in-hospital stay. A persistent rise in serum creatinine at discharge occurred in only one patient. There were no differences between patients with and without CIN in events at the follow-up, with the exception of an increased risk of new hospitalization in patients with CIN 2.
Conclusion After PCI employing low-medium dose of contrast media the incidence of CIN varied according to the definition used. Neither of the two definitions offers additional information compared with the other. Chronic kidney disease and baseline parameters of renal function are the risk factors associated with CIN 1; anemia and higher volume of contrast media are associated with CIN 2.

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Objectives We investigated the significance of urinary liver fatty acid-binding protein (U-L-FABP) monitoring during cardiac catheterization in patients with cardiovascular disease (CVD).
Methods The subjects included 27 consecutive patients with stable angina (SAP group) or acute coronary syndrome (ACS group) who had undergone successful percutaneous coronary intervention (PCI), and 12 patients were also enrolled as controls (C group). Urinary and serum parameters were measured immediately before and after and 1 day after PCI.
Results The ratio of U-L-FABP to U-creatinine (U-Cr) (U-L-FABP/U-Cr) in the ACS group was significantly higher than those in both the SAP and C groups before PCI. In addition, none of the patients in the SAP group showed contrast-induced nephropathy (CIN) based on the levels of serum (S)-Cr and U-L-FABP/U-Cr after PCI. Although none of the patients in the ACS group showed CIN according to S-Cr, the level of U-L-FABP/U-Cr was continuously high throughout the study period. Moreover, since there were significant differences in U-L-FABP/U-Cr, U-N-acetyl-β-D-glucosaminidase, S-uric acid and % medication with calcium channel blockers before PCI between the ACS and SAP groups, a multiple regression analysis was performed using these parameters. It showed that U-L-FABP/U-Cr was most closely associated with the classification of SAP and ACS (p<0.0001). The cut-off level for the greatest sensitivity and specificity for U-L-FABP for the diagnosis of ACS was 13.4 μg/g· Cr in all subjects (sensitivity 0.800, specificity 0.963).
Conclusions To the best of our knowledge, this is the first report incicating that the measurement of U-L-FABP can be beneficial for in the diagnosis of ACS.

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To elucidate the role of endogenous prostaglandin F_2αin spontaneous and induced labor, plasma concentrations of13, 14-dihydro-15-keto-prostaglandin F_2α (PGFM) were determined before the onset of labor, at onset of labor, during active labor, at the crowning of the fetal head, and 1 and 2 hours after delivery. Patients in spontaneous labor and labor induced by amniotomy, oxytocin, and prostaglandin E₂were studied. The levels of plasma PGFM in patients who entered spontaneous labor fell2to3weeks before delivery, whereas those in the induced labor group did not change until the time of induction. Although the levels of PGFM rose gradually with the progress of labor in all cases, the levels in the spontaneous labor were significantly lower in each stage than in the corresponding stage of induced labor. These results suggest that endogenous prostaglandin F_2α (PGF_2α) production decreases2-3 weeks prior to the spontaneous onset of labor and is increased again as labor progresses, that the patterns of PGF_2αproduction are similar to each other during spontaneous labor and labor induced by various methods. Therefore, it is felt that endogenous PGF_2α may participate in the progress of all kinds of labor.

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We investigated the effects of a single oral administration of capsiate, which is found in the fruits of a nonpungent cultivar of pepper, CH-19 Sweet, and has the same structure as capsaicin except for replacement of NH by O in the alkyl chain, on the thermogenesis and fat accumulation in mice. The oxygen consumption and serum adrenalin concentration were higher in both the capsaicin (10 mg/kg-body weight) and capsiate (10 mg/kg-body weight) groups than those in the control group. We also examined the effects of 2 weeks of administration of capsaicin and capsiate on body fat accumulation. Every day for 2 weeks administration of capsiate (10, 50 mg/kg-body weight/day) markedly suppressed body fat accumulation as well as capsaicin (10 mg/kg-body weight/day). These results suggest that capsiate promotes energy metabolism and suppresses body fat accumulation as does capsaicin.

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新生児集中治療施設収容の新生児から分離した49株のmethicillin耐性Staphylococcus aureus (MRSA) を用いて, teicoplanin (TEIC) あるいはvancomycin (VCM) と6種のβ-ラクタム系抗菌薬とのin vitro併用効果を検討した.
TEICとimipenem (IPM), meropenem (MEPM), panipenem (PAPM), cefpirome (CPR), flomoxef (FMOX) あるいはsulbactam (SBT)/ampicillin (ABPC) を併用したところ, 相乗作用を示した菌株数は16～48株であった. 特にIPM, MEPM, PAPMのカルバペネム系抗菌薬あるいはFMOXとの併用で多くの菌株で相乗作用を示すことが確認された. なお, CPRとの併用で不変が3株にみられたが, 拮抗作用を示す菌株はなかった. 一方, VCMでは相乗作用を示した菌株数は1～32株であり, 不変を示す株が1～17株, 拮抗作用を示す株が2～6株みられた.
以上の結果より, TEICは供試したβ-ラクタム系抗菌薬との併用では, VCMよりも優れた協力作用を示すことが確認された.

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