To clarify the differences in the clinical features between idiopathic interstitial pneumonia (IIP) and interstitial pneumonia associated with collagen vascular diseases (CVD-IP).Symptoms, radiographic findings, pulmonary function, blood chemistry data including autoantibody, and bronchoalveolar lavage fluid (BALF) findings were compared using multiple logistic regression analysis.The subjects were 44 patients clinically diagnosed with IIP and 33 patients with CVD-IP.The clinical features related to IIP were as follows: male sex, advanced age, past history of hypertension, presence of cough, exertional dyspnea, digital clubbing, an increased level of gamma-globulin, decreased lung volume on chest X-ray, and typical type according to the criteria for IIP on chest X-ray. Increased levels of rheumatoid factor and total cell number in BALF were related to CVD-IP.These findings are considered to be useful to differentiate IIP and CVD-IP.
Abstract Background Aggregation of solid-phase calcium–phosphate and fetuin-A form nanoparticles called calciprotein particles (CPP). Serum CPP levels are increased in CKD patients and correlated with vascular stiffness and calcification. In this study, we evaluated effects of lanthanum carbonate (LC) and calcium carbonate (CC) on serum CPP levels in hemodialysis (HD) patients. Methods Twenty-four (24) HD patients (50% men, age; 68 ± 12 years, dialysis period; 6.2 ± 4.8 years, K t/v; 1.74 ± 0.34) were treated with CC during 0–8 weeks and then switched to LC during 9–16 weeks. Blood samples were obtained at 0, 8, 16 weeks. Serum CPP levels (TCPP) were measured by the gel-filtration method. Low-density CPP (LCPP) levels were determined by centrifuging the serum samples at 16,000 g for 2 h and measuring CPP levels in the supernatant. The difference between TCPP and LCPP was defined as the high-density CPP (HCPP) level. We evaluated association of TCPP, LCPP, and HCPP with serum calcium (Ca), phosphorus (P), intact PTH, FGF23, Klotho, fetuin-A, aortic calcification index (ACI), LDL cholesterol, and hs-CRP. Results TCPP and LCPP levels were significantly decreased after switching CC to LC, whereas Ca and P levels were not changed. HCPP levels were below the lower limit quantification in all patients. The changes in P, Ca × P, LDL cholesterol, but not ACI and the changes in hs-CRP, were correlated with the change in TCPP levels. Conclusion The TCPP levels were significantly decreased after switching CC to LC. Non-calcium-containing phosphate binders may be preferable for lowering CPP levels.
Abstract Aim: The prevalence of underweight women, who have an increased risk for small‐for‐gestational‐age (SGA) birth, is increasing in Japan. We examined the associations of pre‐pregnancy body mass index and gestational weight gain (GWG) with SGA birth among Japanese women. Material and Methods: We conducted a prospective cohort study of 1391 women who delivered full‐term singleton babies. SGA was defined as below the 10th percentile of birthweight at each gestational age, baby sex, and parity. We calculated the 5th percentile of birthweight in the same way for another threshold for SGA. According to pre‐pregnancy body mass index, we divided the participants into three groups: underweight (<18.5 kg/m 2 ), normal weight (18.5–24.9 kg/m 2 ), and overweight and obese (≥25.0 kg/m 2 ). Results: SGA birth was observed most frequently among the underweight group (13.8%). Underweight was associated with an increased risk of SGA birth. The multiple‐adjusted odds ratio for underweight was 1.96 (95% confidence interval, 1.23–3.11) compared with normal weight. Sufficient GWG reduced the incidence and the multiple‐adjusted odds ratio for 1‐kg increase of GWG was 0.86 (0.81–0.92). The same tendency was observed for the delivery of infants below the 5th birthweight percentile. Women with underweight and normal weight who had 9.0 kg or less of GWG had a significantly higher risk of SGA birth than women with normal weight who had 9.1–11.0 kg of GWG. Conclusions: Underweight and poor GWG were associated with a higher incidence of SGA birth. However, the incidence of SGA birth among underweight women was not increased significantly if they had sufficient GWG.
Objective: The aim of this study was to evaluate the ovulatory performance and reproductive outcome after laparoscopic ovarian drilling using a harmonic scalpel in infertile women with clomiphene-resistant polycystic ovarian syndrome (PCOS).Patients: Twenty clomiphene-resistant anovulatery women with PCOS underwent laparoscopic ovarian drilling between March 2005 and December 2006.Results: After surgery, LH serum levels and the LH/FSH ratio showed statistically significant reductions, and ovulation occurred spontaneously in 70% (14/20) of the patients. The pregnancy rate was 50% (10/20) in < 1 year. Within 4 months postoperatively, 50% of all pregnancies had occurred.Conclusion: Laparoscopic ovarian drilling is an effective treatment in women with clomiphene-resistant polycystic ovarian syndrome, yet without major complications associated with medical treatment, such as ovarian hyperstimulation syndrome and, plural gestations.
We report our experiences of using multiplanar reconstruction(MPR)and 3-D CT scans in combination with a 3-D viewer, AquariusNET(TeraRecon eCo.), in spinal surgery of 44 patients from December 2010, and we evaluated the usefulness of this combined approach.
We report cases of 2 patients who underwent posterior fusion (spinous process wiring and iliac bone grafting) for cervical instability. Two women aged 35 years and 43 years without a history of trauma had unilateral occipitalgia and neck pain refractory to physical or pharmacological therapy for several years. The women were unable to work because of the pain and were referred to our hospital. Neurological examinations revealed no motor or sensory impairment. In both cases, headache originated in the cervical region and was intensified by head movement. Routine radiography performed during flexion and extension of the cervical spine showed angulation of the spine at the C4/5 level in both cases. The source of the headache could not be identified on magnetic resonance imaging. Injection of 3 ml of 1% lidocaine and 4 mg of dexamethasone into the C4-5 interspinous space afforded temporary relief. On the basis of the assumption that the pain was associated with cervical instability, we performed posterior fusion at the C4/5 level by using spinous process wiring combined with iliac bone grafting. After the procedure, the pain was relieved, and both women have been free from pain for about 6 or more years. Although the pathophysiology of cervicogenic headache remains unclear, our findings suggest that cervical instability could be one of the causes. Hence, surgery should be considered for the treatment of cervical instability, particularly in patients with long-lasting headache refractory to conservative treatments.
Abstract Background and Aims Ischemia-reperfusion injury (IRI) is an unavoidable occurrence in kidney transplantation, and the inflammatory response associated with IRI significantly influences allogeneic immunity and transplant outcomes. Minimizing cold ischemia time is essential to reduce IRI, and anastomosis to the internal or external iliac artery is the preferred arterial anastomotic approach. The purpose of this study was to investigate the effect of anastomotic placement on renal function and whether mRNA levels are a factor that may predict renal function decline after transplantation. Method This study retrospectively encompassed 65 living kidney transplant procedures conducted from January 2019 to March 2023. The cohort was categorized into two groups using preoperative CT scan assessments of calcification: the internal iliac artery anastomosis group (consisting of 31 patients) with calcification rates below 10%, and the external iliac artery anastomosis group (comprising 34 patients) with calcification rates exceeding 10%. We conducted a comprehensive comparison of preoperative, intraoperative, and postoperative parameters for both groups. Furthermore, logistic regression analysis was employed to explore the factors influencing renal function. Given the absence of well-defined criteria for assessing renal function post-transplantation, we established a criterion based on the recipient's estimated glomerular filtration rate (eGFR) at discharge, relative to the preoperative donor eGFR. Patients were categorized into two groups, with divisions falling above and below the midpoint of this criterion, and subjected to comparative analysis. In addition, pathology and RNA-seq analysis were performed on protocol kidney biopsies at 3 months and 1-year post-transplant. Results Preoperative and intraoperative parameters displayed no significant differences between the two groups, and postoperative renal function remained consistent. Notably, in the external iliac group, one patient required reoperation due to anastomotic hemorrhages, while in the internal iliac group, one patient needed re-anastomosis to the external iliac bone due to insufficient blood flow post-anastomosis. No instances necessitated treatment for rejection. The logistic regression analysis revealed that a lack of prior experience with hemodialysis significantly influenced eGFR in the favorable outcome group. Moreover, RNA-seq analysis and pathology identified mutations in the immune system and TGFβ pathway associated with IRI. Conclusion Despite no discernible impact on postoperative renal function attributable to variances in anastomotic arteries, the group with external iliac artery anastomosis exhibited diminished activity in the TGFβ pathway and immune system components associated with fibrosis three months post-operation, hinting at a potentially reduced susceptibility to long-term renal damage. In light of these findings, anastomosing to the external iliac artery appears to be a safe option, and when feasible, it may be the preferable choice for anastomosis in kidney transplantation.
We previously raised a murine monoclonal antibody (mAb), OG-1, against human granulosa cells (GC) and reported that human GC express the OG-1 antigen with the highest immunoreactivity during the periovulatory phase. Later, we showed that the OG-1 antigen is identical to human integrin α6, and that human GC express integrinα 6β1, but notα 6β4. In the present study, we examined the expression of laminin (LN), the ligand for integrinα 6β1. Flow cytometry showed that LN was bound to the cell surface of some GC obtained from preovulatory follicles of patients undergoing in vitro fertilization. Immunohistochemistry showed that LN was detected between luteinizing GC in the early corpora lutea. To examine the effect of LN on steroidogenesis by human luteinizing GC, GC obtained from patients undergoing in vitro fertilization were cultured on mouse LN-coated or noncoated plastic dishes in medium containing 5% FCS for 24 h. In the absence or presence of hCG (1 IU/mL), GC cultured on LN-coated dishes produced 0.70- and 0.67-fold less progesterone than those on noncoated dishes, respectively (P < 0.05). We examined the effect of the interaction of integrinα 6β1 and LN on steroidogenesis by human luteinizing GC. We cultured GC with 5 μg/mL of the anti-α6 mAb GoH3, which inhibits the interaction between human integrinα 6β1 and mouse LN, or with a control rat mAb (TER199) on mouse LN-coated dishes in serum-free medium for 24 h. In the absence or presence of hCG (1 IU/mL), GC cultured with GoH3 produced 1.97- and 1.94-fold more progesterone than the control cells (P < 0.01 and P < 0.05, respectively). In contrast, when GC were cultured on dishes coated with type IV collagen, progesterone production was not enhanced by GoH3. Furthermore, the anti-α6 mAb OG-1, which does not inhibit the interaction between integrin α6β1 and LN, had no effect on the progesterone production by GC cultured on LN. These results indicate that LN suppresses the luteinization of human luteinizing GC via integrinα 6β1 and that integrinα 6β1 regulates the luteinization of human GC during the periovulatory phase.
