Attribute-based medicine is essential for patient-centered medicine. To date, the groups of patients with chronic kidney disease (CKD) requiring urate-lowering therapy are clinically unknown. Herein, ...we evaluated the efficacy of febuxostat using a cross-classification, attribute-based research approach. We performed post hoc analysis of multicenter, randomized, double-blind, placebo-controlled trial data for 395 patients with stage 3 CKD and asymptomatic hyperuricemia. Participants were divided into febuxostat or placebo groups and subcohorts stratified and cross-classified by proteinuria and serum creatinine concentrations. In patients stratified based on proteinuria, the mean eGFR slopes were significantly higher in the febuxostat group than in the placebo group (P = 0.007) in the subcohort without proteinuria. The interaction between febuxostat treatment and presence of proteinuria in terms of eGFR slope was significant (P for interaction = 0.019). When cross-classified by the presence of proteinuria and serum creatinine level, the mean eGFR slopes significantly differed between the febuxostat and placebo groups (P = 0.040) in cross-classified subcohorts without proteinuria and with serum creatinine level ≥ median, but not in the cross-classified subcohorts with proteinuria and serum creatinine level < median. Febuxostat mitigated the decline in kidney function among stage 3 CKD patients with asymptomatic hyperuricemia without proteinuria.
Background. Chronic haemodialysis patients are at an increased risk of peripheral artery disease (PAD). Although percutaneous transluminal angioplasty (PTA) has become a widely used therapeutic ...intervention for PAD, its outcome in haemodialysis patients remains poorly understood. The aim of this study was to clarify the long-term outcome of PTA as a primary treatment for PAD in haemodialysis patients. Methods. Consecutive 118 haemodialysis patients with 205 lesions and 108 non-haemodialysis patients with 143 lesions who underwent successful PTA as a first-choice therapeutic option for PAD were enrolled. Outcome measures included primary patency, limb salvage and survival. Results. Incidence of diabetes, history of coronary artery disease and femoropopliteal lesion were significantly more frequent in haemodialysis patients (P = 0.008, 0.005 and 0.0001, respectively), but critical limb ischaemia and TransAtlantic Inter-Society Consensus (TASC) lesion types occurred with comparable frequency in both groups. No patients had in-hospital complications. The 5-year primary patency, limb salvage and survival rates were significantly lower in haemodialysis patients (P = 0.01, 0.029 and 0.0024, respectively). On Cox multivariate analysis, haemodialysis was strongly predictive of amputation and all-cause death, but not of restenosis. In haemodialysis patients, TASC C+D lesion and ulceration/gangrene were independent predictors for restenosis and amputation. Conclusions. The long-term outcome after PTA may be fully acceptable in haemodialysis patients who are at the highest risk of cardiovascular disease. PTA is a useful therapeutic strategy in haemodialysis patients with PAD, but PTA for TASC C+D lesions remains controversial.
Adiponectin is an adipocyte-derived protein with antiatherogenic properties. Chronic kidney disease (CKD) is one of the risk factors for cardiovascular disease. We investigated the potential ...association between adiponectin and carotid arteriosclerosis in patients with predialysis CKD.
We enrolled 95 CKD patients without dialysis and 81 non-CKD patients. Intima-media thickness (IMT) and plaque score (PS) in the common carotid artery were measured using an ultrasound system. Carotid arteriosclerosis was defined as IMT >1.2 mm and/or PS >5.0 mm.
The prevalence of CKD was independently associated with carotid arteriosclerosis after adjustment for other risk factors. Higher adiponectin levels were observed in CKD patients compared with non-CKD patients. Adiponectin levels were not independently correlated with the presence of carotid arteriosclerosis in all subjects. To evaluate the association between adiponectin and carotid arteriosclerosis among a CKD population, we divided the CKD patients into 2 groups according to a cutoff level of adiponectin determined by ROC analysis. The prevalence of carotid arteriosclerosis was significantly higher in the low-adiponectin group than in the high-adiponectin group among CKD patients. After adjusting for other risk factors, low levels of adiponectin were independently correlated with carotid arteriosclerosis in CKD patients.
Our data document that adiponectin is associated with increased risk of carotid atherosclerosis in a predialysis CKD population.
Background. Even in the drug-eluting stent (DES) era, the restenosis rate of the follow-up period after percutaneous coronary intervention (PCI) is higher in haemodialysis (HD) patients than in ...non-HD patients. Therefore, higher restenosis remains a clinical limitation in HD patients, and a simple clinical method to predict patients likely to have restenosis after stent implantation is attractive. The present study investigated the potential relationship between aortic valvular calcification (AVC) and angiographical restenosis at follow-up after DES implantation in patients on maintenance HD. Methods. In the study, 97 patients were enrolled. We prospectively performed echocardiography before elective PCI with DES implantation. Angiographic follow-up was scheduled between 6 and 8 months after PCI. Restenosis at follow-up was defined as a diameter stenosis of ≥50% by measuring quantitative coronary angiography. Results. Of the enrolled patients, 59 patients (60.8%) had AVC. Complete angiographical follow-up was obtained in 86 patients (88.7%). The angiographical restenosis rate during the follow-up period was 24.7% in patients with AVC and 8.9% in patients without AVC hazard ratio (HR) 3.36; 95% confidence interval (CI) 1.18–9.56, P = 0.023. Even after multivariate adjustment including covariates related to atherogenecity, AVC remained an independent predictor of restenosis after implanting DES (HR 3.83; 95% CI 1.14–12.9, P = 0.029). Late lumen loss suggesting neointimal growth after DES implantation was 0.28 ± 0.70 mm in the non-AVC group and 0.64 ± 0.90 mm in the AVC group (P = 0.013). Conclusions. AVC provides predictive information regarding DES implantation in patients on maintenance HD.
Unit developed: As a part of the curriculum HUMAN BEING, integrated unit THE BIRTH OF HUMANITY was developed. It was consisted of NHK-TV program HUMAN FAMILY Birth of the Baby, other programs for ...adults, OHP-materials, photographs, and books for children of 4-7 grades. The objects of this unit were to make students (1)feel the divinity and dignity of the birth of human life, and appreciate the precious value of human growth, (2)feel the strength of relationship between mother and child by learning MOTHER CHILD INTERACTION PHENOMENA and appreciate this relationship as an indispensable condition for the birth of humanity, (3) be grateful and sympathetic to one's own mother, family, and friends. Objects of the study: To develop several methods of evaluation of affective and value-oriented objectives in learning. Method and results: Two classes of 4 th graders and a class of 7 th graders learned this unit under the instructions of their homeroom teachers who were the members of writers. Each class spent 4 or 5 school hours for the unit. These classes finished the unit during two months, Feb. and Mar. in 1986. To measure the changes of children in affective and value-oriented dimension, several methods were adopted or invented. (1) All of the classroom interactions in learning the unit were recorded on video-tapes, coded, and analysed along the affective and value-oriented dimension. (2) As a tool, Affective and Value-Oriented Category System (AVOCS) was developed under the reference of N, Flanders' and other counselor's category systems. The characteristic categories of AVOCS were followings. (a) categories asking affective and value-oriented responses including PROVOKE, REQUEST AGREEMENT, REQUEST SYMPATHY. (b) categories accepting affirmatively, CONTACT, REFLECT, AGREE, SYMPATHY. (c) categories rejecting others, NEGLECT, RESIST, CRITICIZE, DENY, REFUSE. (3) AVOCS revealed the fact that teaching and learning processes of three classes were nearly identical and permissive. But the analysis of sequences found the subtle difference in strategies of argument in three classes. (4) At the same time, every verbal move was classified into five levels settled by B, Bloom's taxonomy of educational objectives, affective domain. The application of Bloom's five levels to verbal classroom interaction seemed to be possible and effective. (5) In several cases of pupils, all of the data mentioned in this and former article were synthesized and characteristics of each case were deliberately depicted.
Spatial distributions of electron density, electron temperature and plasma potential were measured in an energetic are with rotating electrostatic probe on the condition of 1000-4000 gauss magnetic ...field strength, 3x10-2-3x10-5 torr argon gas pressure and 50-200 A discharge current. The density and temperature obtained at the axis of arc plasma column were about 1014 cm-3 and 2x105 K, respectively. At the pressure lower than 10-4 torr the spatial distribution of plasma potential were connected with ion Larmor radius. The density and temperature distributions were examined for the fully ionized plasma. At the higher pressure the effects of collisions between the charged particles and gas molecules on the characteristics of plasma were investigated.
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