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IgA 腎症における腎生検後 5 年間の治療反応性と腎予後の関連性
Get PDFBackground: Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis. Since most patients have a relatively benign renal prognosis, long-term follow-up is required. During such a long course of disease, relapse of IgAN is occasionally observed after upper respiratory tract infection or without any trigger. However, little is known about the impact of relapse on long-term renal outcomes.
Methods: In this retrospective cohort study of biopsy-proven primary IgAN, we analyzed the association of 5-year therapeutic responsiveness (relapse) with the subsequent development of end-stage kidney disease (ESKD) using a 5-year landmark analysis (Cox model) and explored predictors of relapse from histological and clinical data at baseline.
Results: Among 563 patients from the exploratory cohort, most relapses (13.7%) occurred within 5 years after treatment. Using 5-year landmark analysis, among 470 patients, 79 developed ESKD during a median follow-up period of 155 months. Even after adjustment for clinicopathological relevant confounders, hazard ratios (95% confidence intervals) in the relapse and non-responder groups compared with the remission group were 2.86 (1.41-5.79) and 2.74 (1.48-5.11), respectively. Among 250 patients who achieved remission within 5 years, proteinuria, eGFR, mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, and crescent, but not interstitial fibrosis/tubular atrophy, were independent predictors of 5-year relapse in multivariable logistic regression analysis, CONCLUSIONS: Both relapsers and non-responders had similarly strong association with ESKD in patients with IgAN. We also confirmed the predictors of relapse 5 years after renal biopsy, which may guide the treatment strategies for patients with IgAN who occasionally relapse after remission.博士（医学）・乙第1530号・令和5年3月15日This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s10157-022-02221-
血管内腔側から流入する頚動脈プラーク内新生血管の造影超音波及び病理学的検討
Get PDFObjective: This study was aimed at assessing intraplaque neovessels, focusing on neovascularization from the vascular luminal side using contrast-enhanced ultrasound (CEUS) and determining that this contrast effect indicates that the neovessel is connected to the vessel lumen histopathologically. Whether plaque vulnerability can be assessed more accurately was also investigated. Methods: We enrolled consecutive patients with internal carotid artery stenosis who underwent carotid endarterectomy (CEA) and pre-operative CEUS with perflubutane of the carotid arteries. We graded the contrast effect semi-quantitatively from the vascular luminal and adventitial sides. We compared the contrast effect with the pathological findings, especially the neovascularization of the CEA specimens. Results: In total, 68 carotid arterial atheromatous plaques (47 symptomatic) were analyzed. Symptomatic plaques were significantly correlated with stronger contrast effects from the luminal side than from the adventitial side (p = 0.0095). Microbubbles from the luminal side appeared to flow mainly into the plaque shoulder. The contrast effect value for the plaque shoulder and neovessel density were significantly correlated (ρ = 0.35, p = 0.031). Neovessel density was significantly higher in symptomatic than in asymptomatic plaques (56.2 ± 43.7/mm2 and 18.1 ± 15.2/mm2, respectively, p < 0.0001). Serial histological sections of CEA specimens in a symptomatic plaque with a strong contrast effect from the luminal side revealed multiple neovessels fenestrated to the vessel lumen with endothelial cells, consistent with the CEUS findings. Conclusion: Contrast-enhanced ultrasound can be used to evaluate neovessels originating from the luminal side, histopathologically confirmed in serial sections. Symptomatic vulnerable plaque is correlated more significantly with intraplaque neovascularization from the luminal side than with neovascularization from the adventitia.権利情報：© 2023 Published by Elsevier Inc. on behalf of World Federation for Ultrasound in Medicine & Biology
Nurses' Knowledge of High-Risk Drugs for and Questions About Medication Management From Perioperative Rheumatoid Arthritis Patients
Get PDF研究目的:周術期の関節リウマチ(rheumatoid arthritis:RA)患者における看護師のハイリスク薬剤の知識および患者からの手術に関する服薬管理の質問状況について周術期経験のある看護姉(以下、経験群)と周術期看護の経験がない看護師(以下、非経験群)を比較し明らかにした。方法:対象は日本リウマチ財団登録医・看護師の在籍施設で過去3年間にRA患者の看護に従事した看護師とした。2,483施設にWebによる質問票調査を配布し、調査協力者368名であった。結果:分析対象者は、365名(経験群は183名、非経験群は182名)で、あったO。周術期RA患者のハイリスク薬剤管理に関する知識12項目中6項目について、経験群の方が非経験者に比べて有意に多かった。また、患者から手術による服薬に関する質問があった看護師は、経験群の方が非経験群に比べて有意に多かった。経験群における患者からの手術による服薬に関する質問内容は、休薬時期に関する質問が多かった。結論:RA患者の看護に従事する看護師に対して周術期RA患者のハイリスク薬剤管理の教育が必要である。Objectives: We investigated nurses' knowledge of high-risk drugs，including biological originator disease modifying anti rheumatic drugs (bDMARDs) and targeted synthetic DMARDs(tsDMARDs)，and questions about medication management from perioperative patients with rheumatoid arthritis (RA). Methods: The subjects were nurses registered with the Japan Rheumatism Foundation and working at hospitals for RA care in the last 3 years. An online questionnaire on medication management and symptom observation (2483 questionnaires) was distributed and 368 responses were received. We compared results from two groups of nurses: those with perioperative experience (group E; EG) and those with no perioperative experience (group NE; NEG). Results: 368 subjects (183 in EG and 182 in NEG) were included in the analysis. For 6 of the 12 questions, the knowledge of high-risk drug management was significantly higher for the EG group compared to the NEG group. The number of nurses who asked questions about drug management was significantly higher in the EG group compared to the NEG group. In the EG group，many questions were about the timing of drug withdrawal. Conclusions: We need to educate nurses about high-risk drug management for perioperative patients with rheumatoid arthritis
腰方形筋ブロック前方アプローチと大腿四頭筋筋力：前向きコホート研究
Get PDFThe decrease in quadriceps strength after anterior quadratus lumborum block (AQLB) has not been quantified. This prospective cohort study investigated the incidence of quadriceps weakness after AQLB. We enrolled patients undergoing robot-assisted partial nephrectomy, and AQLB was performed at the L2 level with 30 mL of 0.375% ropivacaine. We evaluated each quadriceps’ maximal voluntary isometric contraction using a handheld dynamometer preoperatively and postoperatively at 1 and 4 days. The incidence of muscle weakness was defined as a 25% reduction in muscle strength compared with the preoperative baseline, and “muscle weakness possibly caused by nerve block” was defined as a 25% reduction compared with the non-block side. We also assessed the numerical rating scale and quality of recovery-15 scores. Thirty participants were analyzed. The incidence of muscle weakness compared with preoperative baseline and the non-block side was 13.3% and 30.0%, respectively. Patients with a numerical rating scale ≥ 4 or quality of recovery-15 score < 122, which was classified as moderate or poor, had decreased muscle strength with relative risks of 1.75 and 2.33, respectively. All patients ambulated within 24 h after surgery. The incidence of quadriceps weakness possibly caused by nerve block was 13.3%; however, all patients could ambulate after 1 day.権利情報：© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)
Targeting Claudin-4 in Cancer Therapy
Get PDFThe overexpression of claudin-4 (CLDN4) in many cancers has drawn attention to this protein as a new molecular target. There have been a number of attempts to target CLDN4 for cancer therapy. Targeting of CLDN4 is expected to provide multi-layered effects by enabling direct attacks on CLDN4-overexpressing cancer cells, disrupting the intratumoral microenvironment, and facilitating drug delivery by impairing tight junctions. This article describes anti-CLDN4 antibodies, CLDN4 gene knockdown, CPE and C-CPE, and CLDN4 binding peptides and their potential for cancer therapy
[Case Reports]OPSOCLONUS-MYOCLONUS-ATAXIA SYNDROME AFTER ADRENOCORTICOTROPIC HORMONE THERAPY FOR INFANTILE SPASMS IN A BOY WITH DOWN SYNDROME
No full textIntroduction: Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare acquired autoimmune paraneoplastic movement disorder associated with neuroblastoma. Additionally, autoimmune diseases and infantile spasms are common comorbidities of Down syndrome (DS). Case report: A boy aged 1 year and 9 months with DS suffered from anti-seizure drug-resistant infantile spasms. We administered low-dose adrenocorticotropic hormone (ACTH; 0.0125 mg/kg/day) for 14 days, and the infantile spasms disappeared; however, he presented with limb myoclonus and involuntary conjugate multidirectional saccadic eye movements on day 3 after the end of ACTH therapy. OMAS was suspected and a complete workup was performed. No tumors, including neuroblastoma, were detected. Antibodies against glutamic acid decarboxylase 65 and Tr/Delta/Notch-like epidermal growth factor-related receptor were found. Two courses of intravenous methylprednisolone pulse therapy (30 mg/kg/day for three consecutive days), oral prednisolone (PSL) treatment (2 mg/kg/day for four consecutive days), and intravenous immunoglobulin treatment (2g/ kg/ 3days) were administered. OMAS symptoms resolved, and PSL tapering was initiated on day 17 after the start of immunomodulatory therapy. Conclusion: We present the case of a patient with DS who developed OMAS after ACTH therapy for infantile spasms. Paraneoplastic syndrome-associated antibody testing facilitated the early diagnosis of OMAS. The development of autoimmune diseases should be considered when ACTH therapy is used for DS