Background: The aims of this clinical study were to investigate the associations of urinary free fatty acid (FFA) levels with tubulointerstitial damage, and to determine the clinical significance of urinary liver-type fatty acid binding protein (L-FABP) in diabetic nephropathy. Methods: Fifteen patients with nephrotic syndrome due to diabetic nephropathy and 12 patients with minimal-change nephrotic syndrome (MCNS) were studied. Urinary and serum FFA concentrations (palmitic, oleic, linoleic, and arachidonic acids) were measured by gas chromatography, and urinary L-FABP levels were quantified using an ELISA technique. Tubulointerstitial damage was assessed using renal biopsy specimens. Results: The levels of urinary linoleic and arachidonic acids were significantly elevated in diabetic nephropathy compared to MCNS patients, though serum FFA levels were lower in diabetic nephropathy than MCNS patients. The degree of tubulointerstitial damage was significantly severer in the patients with diabetic nephropathy than MCNS. Urinary L-FABP and 8-OHdG (8-hydroxydeoxyguanosine) concentrations were significantly higher in the diabetic nephropathy subjects. Conclusion: Elevated urinary excretion of FFA may be a reflection of FFA overload in the proximal tubules, and FFA may be an important promoter of tubulointerstitial damage in diabetic nephropathy patients. Urinary L-FABP levels may reflect the stress induced by FFA to the proximal tubules, leading to severe tubulointerstitial damage.
Preprandial administration provided a more stable absorption profile of cyclosporine compared with postprandial administration. From the correlation with AUC 0-4 , we concluded that C 2 , and not C 0 , is a reliable marker for monitoring cyclosporine exposure.
We herein report the case of a 14-year-old girl who had been experiencing chronic fatigue, febricula, and social withdrawal for 20 months. No notable abnormalities were identified during routine checkups at a general pediatric hospital; symptomatic treatments did not affect her condition. She was diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Based on the concepts of Japanese traditional medicine, she was administered shosaikoto-based treatment. After several weeks of treatment, all of the symptoms had been dramatically alleviated, consequently resolving the issue of non-attendance at school. Shosaikotobased medication may be a therapeutic option for treating ME/CFS in patients presenting with chronic febricula.
IntroductionLate referral to a nephrologist, the type of vascular access, nutritional status, and the estimated glomerular filtration rate (eGFR) at the start of hemodialysis (HD) have been reported as independent risk factors of survival for patients who begin HD. The aim of this study was to clarify the influence of the HD-free interval from the time of an eGFR of 10 ml/min per 1.73 m2 (IGFR10-HD) on patient outcome.MethodsWe enrolled 124 patients aged older than 20 years who had HD initiated in a general hospital. The predictive factor was the HD-free IGFR10-HD. The primary outcome was the relationship of the HD-free interval on death or the onset of a cardiovascular event. Survival analysis was performed using the Cox regression model.ResultsThe median IGFR10-HD was 159 days (range: 2–1687 days). The median eGFR at the initiation of HD was 5.48 ml/min per 1.73 m2. Sixty-seven of 124 patients (54.0%) reached the primary outcome. Of these, 29 died and 38 experienced a cardiovascular event. In univariate analysis, older age, a history of cardiovascular disease, nephrologic care for <6 months, higher modified Charlson comorbidity index score, poor performance status, temporary catheter, edema, diabetic retinopathy, and nonuse of erythropoiesis-stimulating agent were statistically related to the primary outcome. The unadjusted hazard ratio per log-transformed IGFR10-HD was 0.393 (95% confidence interval [CI]; 0.244−0.635; P < 0.001) and the hazard ratio adjusted for confounding factors was 0.507 (95% CI: 0.267−0.956; P = 0.036).DiscussionA longer HD-free IGFR10-HD was associated with a lower risk of death or a cardiovascular event. The interval could be considered an independent prognostic factor for outcomes in patients on HD.
Aim: Daisaikoto has been used for the treatment of shoulder stiffness and abdominal distention with constipation, which makes stool changes associated with the prescription a concern. The aim of this retrospective observational study was to investigate the effect of daisaikoto on shoulder stiffness and the relation between its effects on stiffness relief and stool condition. Methods: We reviewed the medical records of middle-aged women who were treated with daisaikoto for menopause-like symptoms and shoulder stiffness from December 2014 through November 2015 at Red Cross Maebashi Hospital. Two or 4 weeks after the prescription of daisaikoto, symptoms were evaluated and categorized as improved, no change, or worse. Stool condition was also evaluated and categorized as constipation, normal, or diarrhea. Change in symptoms from before to after treatment was analyzed using the Wilcoxon signed-rank test. The relationship between symptom changes and stool condition was analyzed using Spearman's rank correlation coefficient. Results: Of 24 patients who received daisaikoto, shoulder stiffness was relieved in 79% (P < 0.05). Diarrhea was reported in 8% of patients, all of whom were classified in the non-improvement group, which included depressed patients. Improvement of shoulder stiffness and stool condition had a correlation coefficient of 0.542. Daisaikoto did not worsen stool condition in the patients in whom it was effective. Conclusion: Daisaikoto effectively relieves shoulder stiffness in middle-aged women, and did not worsen stool condition in those with improvement in shoulder stiffness. Daisaikoto without Rhubarb or other formulas may be an alternative treatment choice for diarrhea patients with shoulder stiffness.
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