Maintenance hemodialysis outpatients must limit salt and water intake to maintain electrolyte balance and blood pressure. In Kawashima Hospital, nationally registered dietitians provide hemodialysis ...patients with monthly nutritional counseling. We investigated whether nutritional counseling affects interdialytic weight gain (IDWG) and blood pressure. We investigated 48 hemodialysis patients whose monthly average IDWG ratio to dry weight exceeded 5.1% and who had not had a long-term hospital admittance of > 1 month. After the 48-month nutritional counseling period, the IDWG ratio had improved in 37 of the patients (77.1%), significantly decreasing from 6.0±0.7 to 5.3±0.9%. Estimated salt and water intake decreased significantly from 13.3±2.7 to 11.8±2.4 g/day and 2528±455 to 2332±410 ml/day, respectively. During the intervention period, normalized protein catabolic rate and body mass index did not change substantially. Pre-hemodialysis systolic and diastolic blood pressures had significantly decreased from 149±19 to 134±18 mmHg, and 82±13 to 75±10 mmHg for 48 months after study initiation, respectively. The dosage of antihypertensive drugs had significantly decreased in the group that experienced improvement in the IDWG ratio. Long-term nutritional counseling by nationally registered dietitians may improve the IDWG ratio and blood pressure of hemodialysis patients by decreasing their salt and water intake. J. Med. Invest. 64: 129-135, February, 2017
This cross sectional study was performed to find the adequate amount and combination of dietary protein and energy for maintaining better nutritional status for stable non-diabetic maintenance ...hemodialysis (MHD) patients. The body composition including body fat, total body water, body cell mass and body protein were measured by multifrequency bioelectrical impedance analysis in 200 stable MHD patients without diabetes (124 men, 76 women). Dietary energy intake (DEI) and dietary protein intake (DPI) were assessed by a brief self-administered diet history questionnaire (BDHQ), the DPI value being confirmed by calculating the normalized protein equivalent of total nitrogen appearance (nPNA). The nutritional status and the body composition were compared among 4 groups of patients in each gender that were divided by the combination of DEI and DPI, high energy (HE)/high protein (HP), HE/low protein (LP), low energy (LE)/HP and LE/LP groups. The mean DPI ranged between 1.17-1.23 and 0.89-0.95 g/kg IBW/d in the HP and LP groups, respectively for both genders, and the mean DEI was 35-37 and 24-25 kcal/kg IBW/d in HE and LE groups, respectively. BMI and serum albumin concentration were not different among the 4 groups. Body cell mass index (BCMI) was maintained in the HE groups regardless of DPI, and it was significantly higher in the HE/HP group than in the LE/LP group. Multiple regression analysis also showed that the BCMI was more greatly affected by DEI than DPI. These results indicated that a DPI of 0.89-0.95 g/kg IBW/d could be sufficient for maintaining BCMI, if DEI is kept over 35 kcal/kg IBW/d in stable non-diabetic MHD patients. This DPI level is lower than the recommended DPI proposed by dietary guidelines in the US and Japan.
A study was conducted on salt intake in hemodialysis patients. We studied 547 patients who had been undergoing maintenance hemodialysis treatment for over two years as of April 2005 to measure the ...distribution and fluctuation of their salt intake and examine the connection between age, weight and blood pressure. Using the calculation of salt intake at the start of the observation, which was stratified into five groups (less than 6 grams, 6 to 8 grams, 8 to 10 grams, 10 to 12 grams, over 12 grams), and the survival rates measured during the period of the observation, we performed a comparison of salt intake and survival rate in patients below the age of 66 as well as those over the age of 66. The salt intake declined with increase in age and was higher in patients with higher body mass index, but no correlation was found with blood pressure (average BP). The hazard ratio was lower at all levels of salt intake from 6 to 12 g than at less than 6 g by regression analysis. Therefore, it cannot be said that a better prognosis can be maintained by a salt intake of less than 6g. In the group aged over 66, patients with a lot of salt intake were not significantly different, but the survival rate was higher. The recommended salt intake for HD patients is less than 6 grams per day to prevent overflow; however, we believe it is necessary to set a target value for each individual considering age, weight, or level of physical activity, especially since salt intake is largely associated with diet. For elderly patients whose appetites are declining, nutritional guidance should focus on “maintaining the physical condition,” not on the “limitation” of salt and water intake.
The pronator quadratus muscle is composed of the superficial and deep heads. However, to date there is no consensus on the variations of each head. To add to this enigma, the innervation patterns of ...each head have not been thoroughly studied. The present study was conducted to clarify the structure and innervation of the pronator quadratus muscle by minute dissection of 46 forearms from 26 cadavers. The origin, insertion, shape, and direction of the muscle fascicles in each head were observed. The intramuscular distribution and the innervation patterns to each head were investigated. The attachment of the deep head was examined using Masson’s trichrome staining technique. Each head consisted of various muscle fascicles which differed in shape and direction. The most distal muscle fascicle extended toward the head of the ulna. On microscopic study, this most distal fascicle was observed to reach the base of the ulnar styloid process. The nerves innervating the superficial head penetrated through the deep head and ran on the anterior surface of the radius from medial to lateral. This tendency was common to all of the forearms studied. We confirmed that each head of the pronator quadratus muscle consisted of various muscle fascicles. The attachment to the base of the ulnar styloid process is considered to be an important structure that prevents the head of the ulna from impacting against the carpal bones. Knowledge of the innervation pattern to each head is critical for preserving the function of the pronator quadratus muscle during surgery for distal radial fracture.
Bud dormancy in temperate woody perennials is a complex process consisting of three different stages; paradormancy, endodormancy, and ecodormancy. Endodormant buds differ from the other types of ...dormant buds in that they cannot resume growth under favorable conditions. Because endodormant buds require a certain amount of chilling accumulation for the transition to ecodormancy, genes showing chilling-mediated differential expression patterns are candidates for internal factors controlling endodormancy. To search for genes controlling the endodormancy of Japanese apricot (Prunus mume Sieb. et Zucc.), we performed 454-pyrosequencing to examine gene expression patterns of the dormant leaf and flower buds of Japanese apricot at three different stages of dormancy. We also used buds from branches that had been collected at the endodormant stage and treated with cold or non-cold temperatures. From 485,376 reads generated, we obtained 28,382 contigs and 85,247 singletons, of which 47,401 (41.7%) were annotated by BLAST searches against the non-redundant NCBI protein/nucleotide database. Among them, only 2,530 sequences showed high sequence similarity to Prunus genes in the database, while the remaining 44,871 sequences showed similarity to known genes of other genera and were novel in Prunus. Functional classification by the gene ontology (GO) term indicated that the genes obtained in this study function in a relatively wide range of biological processes. We searched for up-regulated genes in endodormant leaf and flower buds and found that 74 and 82 genes, respectively, were up-regulated at the endodormant stage as compared with the paradormant stage. About one-third of them, 21 and 25 genes in the leaf and flower buds, respectively, were down-regulated at the ecodormant stage as compared with the endodormant stage. P. mume DORMANCY-ASSOCIATED MADS (PmDAM) genes were among those that were up-regulated preferentially in endodormant buds. From the EST data obtained, we constructed a “Japanese apricot dormant bud EST database” (JADB) for future studies on dormancy in Prunus.
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