This study investigated whether dual tasks comprising cognitive tasks and occupations related to daily living can improve the mental and cognitive function of Japanese community-dwelling older ...adults. Participants included 30 older adults, equally divided into intervention and control groups. The outcome measures were memory, attention, depression, and health-related quality of life. No adverse effects of the intervention were observed in any participant in the intervention group. Logical memory I, logical memory II, and Center for Epidemiologic Studies Depression Scale scores showed a significant interaction. Dual tasks combining cognitive tasks and occupations may help improve delayed recall and alleviate depression. A novel attempt to integrate cognitive stimulation and activities valued by individuals may help mediate age-related cognitive function decline and reduce depressive symptoms in community-dwelling older adults.
Recently, more and more generic drugs have been used for immunosuppressive drugs in the field of organ transplantation. Some reports have indicated that blood concentration of most generic drugs is ...difficult to maintain stability, and it may cause the difference in graft survival of transplanted organs between original drugs and generic drugs. In this article, we report the cases could not maintain blood concentration of generic drugs of mycophenolate mofetil (MMF).
In 4 cases out of 5 cases that we had to change original MMF to generic MMF, there were cases that blood concentration level was not stabilized. There were possibility that the lowered blood concentration level of MMF caused a rejection, in two cases. Mean MMF trough level was decreased from 3.6 ± 1.9 μg/mL to 0.6 ± 0.4 μg/mL. Due to the early detection, it did not become severe or failure of graft function, however, we cannot deny the possibilities that side effects were increased and rejection rose. In these cases, we discontinued to use the generic drugs thereafter due to unstable plasma concentration of MMF.
Some reports have indicated that failure to maintain plasma concentration of MMF leads to rejection. Therefore, maintenance of effective plasma concentration and prevention of rejection are essential to long-term graft survival in kidney transplant.
Generic drug formulations may exhibit differences in effects and absorption compared to the brand-name drug. If the generic drug should be used, patients should be closely monitored.
•We report 4 cases in which patients treated with generic MMF did not maintain sufficient MMF blood concentration levels.•Conversion to the generic drug may cause differences in effects and absorption.•If the generic drug should be used, patients should be closely monitored.
We investigated the disease-free survival (DFS) of HER2-positive primary breast cancer patients treated with neoadjuvant chemotherapy plus trastuzumab, as well as predictive factors for DFS and ...pathologic response. Data from 829 female patients treated between 2001 and 2010 were collected from 38 institutions in Japan. Predictive factors were evaluated using multivariate analyses. The 3-year DFS rate was 87 % 95 % confidence interval (CI) 85–90. The pathologic complete response (pCR: ypT0/is + ypN0) rate was 51 %. The pCR rate was higher in the ER/PgR-negative patients than in the ER/PgR-positive patients (64 vs. 36 %,
P
< 0.001). Patients with pCR showed a higher DFS rate than patients without pCR (93 vs. 82 %,
P
< 0.001). Multivariate analysis revealed three independent predictors for poorer DFS: advanced nodal stage hazard ratio (HR) 2.63, 95 % CI 1.36–5.21,
P
= 0.004 for cN2–3 vs. cN0, histological/nuclear grade 3 (HR 1.81, 95 % CI 1.15–2.91,
P
= 0.011), and non-pCR (HR 1.98, 95 % CI 1.22–3.24,
P
= 0.005). In the ER/PgR-negative dataset, non-pCR (HR 2.63, 95 % CI 1.43–4.90,
P
= 0.002) and clinical tumor stage (HR 2.20, 95 % CI 1.16–4.20,
P
= 0.017 for cT3–4 vs. cT1–2) were independent predictors for DFS, and in the ER/PgR-positive dataset, histological grade of 3 (HR 3.09, 95 % CI 1.48–6.62,
P
= 0.003), clinical nodal stage (HR 4.26, 95 % CI 1.53–13.14,
P
= 0.005 for cN2–3 vs. cN0), and young age (HR 2.40, 95 % CI 1.12–4.94,
P
= 0.026 for ≤40 vs. >40) were negative predictors for DFS. Strict pCR (ypT0 + ypN0) was an independent predictor for DFS in both the ER/PgR-negative and -positive datasets (HR 2.66, 95 % CI 1.31–5.97,
P
= 0.006 and HR 3.86, 95 % CI 1.13–24.21,
P
= 0.029, respectively). These results may help assure a more accurate prognosis and personalized treatment for HER2-positive breast cancer patients.
Much controversy exists over the performance of elderly living donor kidney transplantation. We report the safety of 2 cases of elderly living kidney donations in our hospital.
An 82-year-old man was ...a living kidney donor for his 56-year-old son. The donor suffered from hypertension, but has successfully managed his blood pressure with only one medication. His serum creatinine was 0.7 mg/dL and inulin clearance was 122.5 mL/min, which met the usual criteria for living kidney donors. This was his son's secondary kidney transplantation, and no other donors existed.
An 80-year-old woman was a living kidney donor for her 45-year-old son. Her serum creatinine was 0.61 mg/dL and inulin clearance was 71.7 mL/min, which met the marginal kidney donor criteria.
In both cases, we determined that the donor kidney function was acceptable. Though we explained the risks of the transplantation thoroughly, the patients' strong will to offer a kidney to their family member did not change. We decided to carry out the transplantation. At the time of publication, nearly 2 years have passed since the transplantation, but both donors and recipients are doing well.
In the future, it seems more likely that the number of elderly living donor kidney transplantation will rise. On one hand, there is no absolute contraindication for elderly donors, while on the other hand, the criteria for a living kidney donor must be strictly examined. Furthermore, careful observation of both donors and recipients after transplantation is required.
•We report on the safety of elderly living kidney donors in 2 cases.•Both donors and recipients were doing well approximately 2 years postoperation.•Our case series can contribute to expansion of the donor criteria.
Hydrogen (H2) and carbon monoxide (CO) gas are both reported to reduce reactive oxygen species and alleviate tissue ischemia-reperfusion (I-R) injury. The present study was conducted to evaluate the ...effects of a mixture of H2 gas and CO gas (dual gas) in comparison with hydrogen gas (H2: 2%) alone on I-R renal injury (composition of dual gas; N2: 77.8%; O2: 20.9%; H2: 1.30%; CO: 250 parts per million).
Adult male Sprague-Dawley rats (body weight 250–280 g) were divided into 5 groups: (1) sham operation control, (2) dual gas inhalation (dual treatment) without I-R treatment, (3) I-R renal injury, (4) H2 gas alone inhalation (H2 treatment) with I-R renal injury, and (5) dual treatment with I-R renal injury. I-R renal injury was induced by clamping the left renal artery and vein for 45 minutes followed by reperfusion, and then contralateral nephrectomy was performed 2 weeks later. Renal function was markedly decreased at 24 hours after reperfusion, and thereafter the effects of dual gas were assessed by histologic examination and determination of the superoxide radical, together with functional and molecular analyses.
Pathologic examination of the kidney of I-R rats revealed severe renal damage. Importantly, cytoprotective effects of the dual treatment in comparison with H2 treatment and I-R renal injury were observed in terms of superoxide radical scavenging activity and histochemical features. Rats given dual treatment and I-R renal injury showed significant decreases in blood urea nitrogen. Increased expression of several inflammatory cytokines (tumor necrosis factor-α, interleukin-6, intracellular adhesion molecule-1, nuclear factor-κB, hypoxia inducible factor-1α, and heme oxygenase-1) was attenuated by the dual treatment.
Dual gas inhalation decreases oxidative stress and markedly improves I-R-induced renal injury.
•Dual treatment with hydrogen and carbon monoxide significantly decreases oxidative stress and attenuated renal ischemia-reperfusion injury.•CO (250 ppm) has been shown to protect ischemia-reperfusion injury in transplanted organs, and the efficacy has been studied in a rat kidney transplantation model.•Superoxide (•O2−) production, detected by DHE labeling, was increased in ischemia-reperfusion rats and was significantly suppressed by treatment gases. Dual gas treatment attenuated superoxide production more effectively than only hydrogen gas.
The transition of the bacterial community structure and predominant bacteria in the ceca of chicks from hatching to 2 wk of age was investigated using denaturing gradient gel electrophoresis with the ...16S ribosomal RNA gene, followed by phylogenetic analysis. The results demonstrated that most of the cecal bacterial flora from hatching to a few days old consisted of Escherichia coli (sequence similarity: 100%), and the floral diversity was still low 2 wk posthatch. These findings will help contribute to the development of a novel competitive exclusion product.
The ultimate goal of organ transplantation is to establish graft tolerance where CD4+CD25+FOXP3+ regulatory T (Treg) cells play an important role. We examined whether a superagonistic monoclonal ...antibody specific for CD28 (CD28 SA), which expands Treg cells in vivo, would prevent acute rejection and induce tolerance using our established rat acute renal allograft model (Wistar to Lewis). In the untreated or mouse IgG‐treated recipients, graft function significantly deteriorated with marked destruction of renal tissue, and all rats died by 13 days with severe azotemia. In contrast, 90% of recipients treated with CD28 SA survived over 100 days, and 70% survived with well‐preserved graft function until graft recovery at 180 days. Analysis by flow cytometry and immunohistochemistry demonstrated that CD28 SA induced marked infiltration of FOXP3+ Treg cells into the allografts. Furthermore, these long‐surviving recipients showed donor‐specific tolerance, accepting secondary (donor‐matched) Wistar cardiac allografts, but acutely rejecting third‐party BN allografts. We further demonstrated that adoptive transfer of CD4+CD25+ Treg cells, purified from CD28 SA‐treated Lewis rats, significantly prolonged allograft survival and succeeded in inducing donor‐specific tolerance. In conclusion, CD28 SA treatment successfully induces donor‐specific tolerance with the involvement of Treg cells, and thus the therapeutic value of this approach warrants further investigation and preclinical studies.
A superagonistic monoclonal antibody specific for CD28 (CD28SA) expanded FoxP3+ Treg cells in vivo, and induced donor specific tolerance in rat acute renal allograft model (Wistar to Lewis).
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