Background
Serum adiponectin circulates in three multimeric isoforms: high-molecular-weight (HMW), middle-molecular-weight (MMW), and low-molecular-weight (LMW) isoforms. Potential change in the ...circulating adiponectin levels in patients with nephrotic syndrome (NS) remain unknown. This study aimed to assess the levels of total adiponectin and the distribution of its isoforms in pediatric patients with NS.
Methods
We sequentially measured total adiponectin and each adiponectin isoform levels at the onset of NS, initial remission, and during the remission period of the disease in 31 NS patients. We also calculated the ratios of HMW (%HMW), MMW (%MMW), and LMW (%LMW) to total adiponectin incuding 51 control subjects.
Results
The median of total serum adiponectin levels in patients were 36.7, 36.7, and 20.2 μg/mL at the onset, at initial remission, and during the remission period of NS, respectively. These values were significantly higher than those in control subjects. The median values of %HMW, %MMW, and %LMW values were 56.9/27.0/14.1 at the onset, 62.0/21.8/13.4 at the initial remission, and 58.1/21.7/17.5 at during the remission period of NS, respectively. Compared with control subjects, %HMW at initial remission and %MMW at the onset were high, and the %LMW values at the onset and at initial remission were low.
Conclusions
In patients with NS, total serum adiponectin levels increase at the onset of the disease, and the ratio of adiponectin isoforms changes during the course of the disease. Further studies are needed to delineate the mechanisms between proteinuria and adiponectin isoforms change.
To validate the policy of administering cefazolin (CEZ) as a first-line antibiotic to children who are hospitalized with their first febrile urinary tract infection (UTI), we evaluated microbial ...susceptibility to CEZ and the efficacy of CEZ. The 75 enrolled children with febrile UTI were initially treated with CEZ. Switching CEZ was not required in 84% of the patients. The median fever duration, prevalence of bacteremia, prevalence of UTI caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, and median duration of hospitalization were significantly higher in the CEZ-ineffective group. The risks of vesicoureteral reflux, indication of operation, and renal scarring are not increased, even when CEZ is ineffective as a first-line antibiotic. CEZ is effective in more than 80% of pediatric patients with their first febrile UTI, but it should be switched to appropriate antibiotics considering sepsis or the ESBL-producing Enterobacteriaceae pathogen, when fever does not improve within 72 hours.
This report proposes a β3-adrenoceptor (AR) selective agonist, 2-2-chloro-4-(2-{(1S,2R)-2-hydroxy-2-(4-hydroxyphenyl)-1-methylethylamino}ethyl)phenoxyacetic acid (1a), as a novel agent for treating ...urinary bladder dysfunction. This compound and its relatives have a unique feature among β3-AR agonists: two chiral carbons are adjacently structured on the left side of the molecule. To study the relationship between the stereoconfiguration of the vicinal chiral carbons in 1a and β-AR agonistic activity, the four stereoisomers were synthesized via oxazolidinone prepared by intracyclization involving inversion of the β-hydroxy group. The in vitro assays using rat atria for β1-AR, rat uteri for β2-AR, and ferret detrusor for β3-AR showed that 1a possessed potent β3-AR agonistic activity (EC50 = 3.85 nM) and 3700- and 1700-fold selectivity for β3-AR relative to β1- and β2-AR, respectively. Comparison of the four isomers revealed that the (αS,βR)-compound (1a) was not only the most potent agonist but was also the most selective for β3-AR. In the anesthetized rat, intravenous administration of 1a brought about a sufficient decrement of the intrabladder pressure (ED50 = 12 μg/kg), and intraduodenal administration of 2a, which is the ethyl ester of 1a, led to same result (ED50 = 0.65 mg/kg). Moreover, no effects on the cardiovascular system were observed in either test.
Anomalous coronary arteries are considered to be benign, however coronary arteries originating from the opposite sinus are considered to be potentially fatal. Especially during exercise, compression ...of the coronary artery between the aorta and the pulmonary artery may result in myocardial ischemia and in some cases, death. We report an incidental finding of an anomalous right coronary artery originating from the left sinus, in a 5-year-old Kawasaki disease patient. Management of asymptomatic and incidentally diagnosed patients with anomalous right coronary artery remain a subject of debate.
A 9 month-old boy, referred to our hospital for fever, was diagnosed with upper urinary tract infection and started on intravenous ceftazidime. The antibiotic was switched to intravenous cefmetazole ...following isolation of CTX-M-3 extended-spectrum β -lactamase-producing Escherichia coli from urine culture and antimicrobial susceptibility testing and switched again to oral fosfomycin. Carbapenem antibiotics are generally recommended for upper urinary tract infections caused by extended-spectrum β -lactamase-producing Escherichia coli, but cefmetazole and fosfomycin are potentially effective alternatives.
We extracted and analyzed characteristics and issues of accidents related to pediatric care at Showa University Hospital. Of the incident reports related to pediatric care in the past 11 years input ...via the entry system of the Medical Safety Management Department in our hospital, 17 accidents which were classified as more serious than category 3b （required major medical or surgical intervention） were enrolled in this study. These accidents were analyzed and classified according to each written report. The male to female ratio of patients was 11：6. The age range of the patients was 0〜18 years; 12 cases （71％） were aged 0〜3 years and 11 （65％） of these had neither development delay nor malformation. Of all events, 15 cases （88％） were inpatient cases and five （29％） of these occurred at the neonatal intensive care unit （NICU） or intensive care unit （ICU）. Five events （29％） were related to nursing care, four （24％） to treatment/procedure, four （24％） to drainage tube of other tube, one （6％） to examination, two （12％） to others with unexpected sudden changes classified into category 5 （death）. Regarding the background of accidents, only two cases （12％） had neither development delay nor malformation, except for NICU and ICU cases. Of all accidents, 13 events （76％） were due to clinical practices or nursing by health-care professionals. In conclusion, effective measures can be taken to improve the quality of clinical practice and the medical system in approximately 80％ of all events at our hospital. However, approximately 10％ of accidents were due to underlying diseases or difficulty with response to an unexpected sudden change, indicating that there are limits to intervention in pediatric care safety management.
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