Alcohol synthesis based on the SN2 reactions of alkyl halides with the squarate dianion.

A convenient method has been developed for transforming alkyl halides into the corresponding alcohols via an SN2 reaction. Treatment of an alkyl halide with the squarate dianion at high temperature produces mono-alkyl squarate, and a one-pot basic hydrolysis of the intermediate affords the alcohol in good yield.

[Vaccination in Workplace and Compensation for Adverse Events].

Several types of SARS-Cov-2 vaccine have been quickly developed and officially approved for emergency use in accordance with the Pharmaceutical Act. Mass vaccination in workplaces in Japan was subsequently promoted, targeting health care workers and senior citizens. We overviewed the pathophysiology of COVID-19 and reviewed reports containing fatal outcomes, compensation programs, and remedial measures for health damage after vaccinations, in relation to their relevant legislations. The Immunization Act was amended prior to the mass vaccination to authorize the indemnity agreement between the government and pharmaceutical companies to compensate for losses based on health damages after vaccination. Pursuant to the Civil Code and the State Redress Act, employers reserve the right to obtain reimbursement when they are liable to pay compensation for damages inflicted on a third party. There are no provisions to exclude healthcare workers and occupational health staff who participated in practical procedures from lawsuits and liability. We propose legislative reformation and careful contracts with responsible organizations concerned with emergency vaccinations in order to confront forthcoming new or re-emerging infections beyond this pandemic.

A maternal high-fat diet may accelerate adipo-immunologic aging in offspring.

AIM: Maternal obesity and improper nutrition predispose offspring to chronic metabolic diseases. Although the frequency of these diseases increases with aging, the effect of a maternal high-fat diet on aged offspring remains elusive. MAIN METHODS: C57BL/6J female mice were fed a high-fat (HF) diet or a control (CON) diet and then mated. All offspring remained with their birth dam until weaning at 3 weeks. After weaning, the offspring from the HF and CON diet-fed dams were given either the HF diet or CON diet, which resulted in four groups: CON/CON, CON/HF, HF/CON, and HF/HF. All mice were immunized with ovalbumin and then sacrificed at 70 weeks. KEY FINDINGS: The body weights in offspring from dam exposed to a HF diet were significantly higher than those in offspring from dam fed a CON diet in the early stage of life but then became lower in the later stage of life. The serum adiponectin levels were lower in offspring from dam exposed to a HF diet and were correlated with adiposity measured by visceral and subcutaneous fat mass. Non-alcoholic fatty liver disease was much more severe in the livers of offspring from the maternal HF groups. In particular, lobular inflammation and fibrosis were prominent in the HF/HF group. Regarding immunological parameters, senescence-associated T cells were increased, and natural killer T cells were decreased by the effect of both maternal and offspring HF diet. SIGNIFICANCE: We have demonstrated that a maternal high-fat diet may accelerate the adipo-immunologic aging process.

The Influence of LPS-Induced Maternal Inflammation on Postnatal Collagen-Induced Arthritis.

Maternal health and nutritional status influence offspring health and the diseases that may develop in them. The effects of maternal inflammation on offspring from the perspective of the inflammatory response and immune changes are not fully understood. We hypothesized that maternal inflammation modulates immune and metabolic functions, affecting the pathophysiology of inflammatory diseases in offspring. This study investigated whether maternal inflammation affects the onset of collagen-induced arthritis (CIA), a murine model of human rheumatoid arthritis. Female DBA/1J mice received a single intraperitoneal injection of lipopolysaccharide (LPS) 5 days before conception. Male offspring of LPS-treated dams were placed in the maternal LPS group (MLG). To induce CIA, type II collagen (CII) was emulsified with Freund's complete adjuvant and injected twice into each mouse, at 13 and 16 weeks. The offspring were sacrificed at 26 weeks to analyze immunological and metabolic parameters. The degree of joint swelling at an early stage of CIA was lower in the MLG than in the control group. From histological analysis, the severity of joint destruction (severity of arthritis score) and CII-specific IgG titer were significantly lower in the MLG. However, at 26 weeks, serum interleukin (IL)-6 levels, an index of CIA disease activity, were significantly higher in the MLG. Moreover, serum leptin levels were lower in the MLG, and a negative correlation between leptin and serum IL-6 was observed. In conclusion, maternal inflammation does not merely suppress inflammation; it may delay CIA in offspring. The analysis of inflammatory cytokines and leptin concentrations at 26 weeks suggests that the pathophysiology of arthritis was worsening. This study also suggests that maternal inflammation modulates postnatal inflammatory response patterns in offspring.

Effects of in vitro heat shock on immune cells in diet-induced obese mice.

Obesity has been associated with impaired immune responses and inflammation. The mechanisms underlying these immune disturbances in obesity are not yet clarified. This study investigated the effects of in vitro heat shock (HS) on immune cells from the point of view of thymocyte apoptosis and T-cell mitogen-stimulated splenocyte cytokine production as well as the heat shock protein 70 (HSP70) protein levels in diet-induced obese mice to explore a possible association between the disturbance of T cell immunity and HS response in obesity. Obese mice had increased apoptotic and necrotic thymocytes populations and increased splenocyte cytokine production of both proinflammatory and anti-inflammatory cytokines compared with lean mice. The in vitro HS at 42°C decreased the rate of live cells in thymocytes, and the degree of the decrease was larger in obese mice compared with lean mice. The in vitro HS increased the intracellular and extracellular HSP70 protein levels in thymocytes and splenocytes, while the effects of obesity on the HSP70 protein levels were not obvious. The in vitro HS prior to T cell mitogen stimulation decreased IFN-γ and IL-10 production by mitogen-stimulated splenocytes. This change in cytokine production due to HS was not affected by obesity. The obvious alteration of the HSP70 protein levels and association between cytokine production and the HS response in obesity were not found in this obesity model; however, our results indicate an association between the viability of thymocytes and an altered HS response in obesity and provide evidence that the increase in thymocyte apoptosis and acceleration of thymus involution in obesity could be, in part, due to the alteration of the HS response.

Inducing maternal inflammation promotes leptin production in offspring but does not improve allergic symptoms in a mouse model of allergic rhinitis.

AIMS: The intrauterine environment is considered to affect immunological development in fetus, leading to an increased risk of developing allergy. In particular, maternal lipopolysaccharides (LPS) administration might regulate the development of allergic disease in offspring. Several studies have shown that being obese relates to a higher prevalence of allergic diseases compared to normal weight. The present study explored the effects of inducing maternal inflammation with LPS before pregnancy on body weight, physical composition including body fat, adipokine production, and pathology of allergic rhinitis in offspring. MAIN METHODS: Female mice received a single intraperitoneal injection of LPS (2 µg/g BW). After 5 days of LPS administration, female mice were mated with males, and experimental allergic rhinitis was induced in female offspring. Immunization and nasal challenge with ovalbumin (OVA) were performed at 7 and 8 weeks of age. Allergic rhinitis-like symptoms, OVA-specific IgE and adipokines in sera, body weight, fat pad weight, and cytokine production by splenocytes in these 9-week-old offspring. KEY FINDINGS: Maternal LPS administration results in a significant increase in body weight, visceral fat accumulation, and serum leptin concentration, and the dominance of Th1 in Th balance. Nevertheless, there was no statistical difference in OVA-specific IgE titer and allergic-like symptoms between the groups. SIGNIFICANCE: In conclusion, maternal LPS promoted leptin production and altered Th balance in mice offspring, but not improved allergic symptoms in a mouse model of allergic rhinitis. It might suggest that inflammation during pregnancy plays a role in the adipose tissue function which could diversely influence allergic inflammation in offspring.

Daily rhythm and heat shock protein expression in obese ob/ob mice.

OBJECTIVES: This study examined heat shock protein (HSP) 70 expression and rhythms of drinking behavior and locomotor activity in obesity, in order to clarify the involvement of HSPs in obesity-induced disturbance of circadian rhythms. METHODS: C57BL/6J ob/ob mice were used as a murine model of severe obesity. Drinking behavior and locomotor activity of male C57BL/6J (control) mice and ob/ob mice were recorded with the behavioral analyzing system. HSP70 concentration in the homogenized supernatant of each tissue, including the brain, liver, and kidney, was measured by an enzyme-linked immunosorbent assay. RESULTS: We observed an attenuated locomotor activity rhythm in the ob/ob mice compared with the control mice at 13 weeks of age and especially at 27 weeks of age. The drinking rhythm was little affected by obesity. HSP70 protein expression was reduced in the brain and kidney of the ob/ob mice compared with the control mice. However, HSP70 expression in the liver was not altered. DISCUSSION: This study suggests that the obesity-induced reduction of HSP70 expression in the brain and kidney can be directly or indirectly associated with disturbance of rhythms of the master clock and peripheral clocks. The study provides a link between circadian rhythm and HSP expression in obesity; the disturbance of these factors may lead to the progression of metabolic disorders.

Effects of reduced dialysis fluid flow in hemodialysis.

BACKGROUND: Hemodialysis is a treatment in which uremic toxins and excess water content are removed from the blood with a dialyzer and dialysis fluid. The efficiency of hemodialysis is strongly influenced by the following 3 parameters: the blood flow rate (QB), the dialysis fluid flow rate (QD), and the overall mass transfer area coefficient (K0A), an index of a dialyzer's performance. The flow ratio (QB : QD) to obtain a well-balanced dialysis efficiency is generally said to be 1 : 2. In Japan, the QB is controlled independently (from 200 to 250 mL/min) depending on individual conditions. However, the QD is usually set at around 500 mL/min regardless of the QB. MATERIALS AND METHODS: To investigate the effect on dialysis efficiency of decreasing the QD from 500 to 400 mL/min, 12 patients were divided into two groups: one in which the QB was 150 mL/min, with 1.3-m(2) membranes; and another in which the QB was 200 mL/min, with 1.6-m(2) membranes. We defined the conditions with the QD of 500 mL/min as condition A, and that with the QD of 400 mL/min as condition B. Each operating condition was assigned for 2 weeks as crossover trials. To evaluate solute removal, we calculated clearance, reduction rate, removal amount, clear space, the clear space rate, and albumin leakage. Furthermore, when dialysis efficiency decreased in condition B, we performed a supplementary test: we calculated the QB with the K0A equation to achieve a dialysis efficiency equivalent to that in condition A, defined as condition B', as the operating condition with the calculated QB and a QD of 400 mL/min, and re-evaluated. RESULTS: In condition B, a QB of 150 mL/min had no effect on the dialysis efficiency;whereas with a QB of 200 mL/min, slight yet significant differences were observed in the clearance of small molecular weight solutes. Condition B' (QB=210 mL/min) showed an equivalent or greater dialysis efficiency and demonstrated an association with theoretical values. CONCLUSIONS: In hemodialysis, the flow ratio (QB : QD) should be maintained at 1 : 2 to obtain a well-balanced dialysis efficiency. The present study has shown that the QD can be decreased while maintaining this flow ratio. A well-balanced QD setting can be financially and environmentally conscious. In addition, use of the K0A equation is a highly effective method to calculate a QB that allows an expected dialysis efficiency to be achieved in case the QD needs to be decreased uniformly, as when dialysis fluid is in short supply during times of disaster.

Nutritional status in relation to adipokines and oxidative stress is associated with disease activity in patients with rheumatoid arthritis.

OBJECTIVE: We assessed whether disease activity was associated with dietary habits, nutritional status, adipokines, and oxidative stress in patients with rheumatoid arthritis. METHODS: The subjects were 37 patients with RA. The assessment of the nutritional status included anthropometric and biochemical parameters. A food-frequency questionnaire and a 3-d diet record to assess dietary intake were used. The serum levels of adipokines and oxidative stress markers in sera and saliva were measured. The disease activity was determined using the 28 Disease Activity Score (DAS28). We divided the subjects into high (DAS28 ≥3.2) and low (DAS28 <3.2) disease activity groups. RESULTS: The serum leptin and albumin levels were significantly lower, whereas the inflammatory markers were increased, in the high disease activity group. The dietary intake assessment showed a lower intake of fish oil and a lower ratio of monounsaturated fatty acid intake in the high disease activity group. There was a negative correlation between the DAS28 and the dietary intake of the ratio of monounsaturated fatty acid to total fatty acid intake. The serum oxidative stress marker (reactive oxygen metabolites) showed a positive correlation to the DAS28. The salivary reactive oxygen metabolites also correlated with C-reactive protein and serum reactive oxygen metabolites. CONCLUSION: Altered serum adipokine levels with decreased albumin may reflect the deterioration that is associated with rheumatoid arthritis. An increased oxidative stress was observed in sera and saliva. Intakes of ω-3 polyunsaturated fatty acids, fish oil, and monounsaturated fatty acid seem to affect disease activity and may have beneficial effects by decreasing inflammation.

Randomized crossover study of the efficacy and safety of sevelamer hydrochloride and lanthanum carbonate in Japanese patients undergoing hemodialysis.

Insufficient control of serum calcium and phosphate levels in patients undergoing hemodialysis is associated with increased mortality. As commonly used calcium-containing phosphate binders can cause arterial calcification, newly developed calcium-free phosphate binders, such as sevelamer hydrochloride (SH) and lanthanum carbonate (LC), have received much attention. We assessed the efficacy and safety of SH and LC treatment in Japanese patients undergoing hemodialysis in a prospective randomized open blinded endpoint (PROBE) crossover study. Forty-two patients were randomized to receive SH or LC for 13 weeks, with the dosages adjusted every 2 weeks, followed by treatment with the other drug for another 13 weeks. The average daily doses of SH and LC were 2971 ± 1464 mg and 945 ± 449 mg, respectively. The mean dosage ratio of SH to LC was 3.05, which was maintained throughout the treatment period. SH and LC were similarly effective at controlling serum calcium and phosphate levels in the majority of patients (78-93%). A few serious adverse events (AEs) involving the biliary system occurred during the LC treatment period, but they were not considered to be treatment-induced. Although the incidence of constipation, the most common treatment-related AE, was higher during the SH period (27% vs. 5%; P < 0.05), no difference was observed in total treatment-related AEs. This study demonstrates that SH and LC are comparable treatments for controlling serum phosphate and calcium levels, and that both compounds are safe and well-tolerated in Japanese patients undergoing hemodialysis.

Analysis of adipose tissues and stromal vascular cells in a murine arthritis model.

PURPOSE: Changes in body composition in rheumatoid arthritis (RA), including a reduction in skeletal muscle mass and the accumulation of visceral fat, have been identified, and the interaction between immune abnormality and metabolic disorders has received much attention. The effect of a high-fat (HF) diet and the role of adipose tissue in an arthritis model were investigated. METHODS: The effect of an HF diet on the histopathology of joints in murine type II collagen-induced arthritis (CIA) was evaluated. The morphology and adipokine production of adipose tissues were analyzed, and macrophages in the stromal vascular fraction (SVF) were counted by flow cytometry. Serum adipokine levels were measured by ELISA. RESULTS: Significant exacerbation of joint destruction and aggravated pathological conditions were observed in CIA mice that were fed an HF diet. However, the boundary length of adipose tissue tended to decrease and the levels of adipokines (leptin and adiponectin) were lowered by the induction of arthritis. In HF/CIA mice, nevertheless, the production of MCP-1 in adipose tissues and the accumulation of macrophages in the SVF were significantly higher than CON/CIA group. The serum leptin/adiponectin (L/A) ratio was positively correlated with the number of macrophages in the SVF and MCP-1 production by adipose tissue, particularly in the CIA group. CONCLUSION: Functional alterations of adipose tissues could be originated from HF diet during developing arthritis. An abnormal activation of macrophages and an increased production of MCP-1 in adipose tissues might be both involved in joint destruction and inflammation.

Use of ultrasonic cleansing in managing the couplers of dialyzer systems.

Dialysis-related complications have become a major concern as the number of patients receiving long-term maintenance dialysis increases. One cause of complications is contamination of the dialysis fluid. When dialysis fluid contaminated by bacteria or endotoxin (ET) or both has been used for a long time, cytokine production in vivo is enhanced and can lead to such complications as dialysis amyloidosis. The rate of dialysis-related complications might be reduced with a hemopurification method that uses a large amount of dialysis fluid as a substitution fluid (on-line hemodiafiltration) or an efficient dialyzer with enhanced internal filtration in which the dialysis fluid returns to the body as a replacement fluid; however, at the same time, there is an increased risk of ET entering the body because the dialysis fluid might be contaminated. Therefore, the dialysis fluid must be made aseptic, and the dialysis fluid line must be properly managed to prevent contamination of the dialysis fluid. A half-opened line is at great risk of contamination by living microbes, which can grow in dead spaces and where the flow of dialysis fluid is interrupted. The management of couplers is an important measure for maintaining cleanliness at the end of the dialysis fluid flow. We attempted to separate and regularly clean the main body of the coupler with ultrasonic equipment as a method of managing the conventional coupler. Using improved types of coupler, the water quality of the postcoupler flow was maintained at a level as high as that of the precoupler flow for the duration of the evaluation period without separate cleansing being done. Although separate once-a-week cleansing of the conventional coupler was able to keep ET values less than the detection limit, viable cell counts were unstable. On the other hand, twice-a-week ultrasonic cleansing eliminated almost all viable cells. No definite difference in ET values or viable cell counts was found between the cleansing groups, and ultrasonic cleansing was able, by itself, to provide a sufficient cleansing effect. We conclude that ultrasonic cleansing of conventional couplers is a useful method for maintaining the water quality of the postcoupler flow because the cleansing of the coupler twice or more a week is sufficient to keep the water quality of the postcoupler flow as high as that of the precoupler flow.

The performance evaluation of endotoxin retentive filters in haemodialysis.

BACKGROUND: Hemodialysis is a method for removing uremic toxins and water directly from the blood into a dialysis fluid through an artificial semipermeable membrane called a dialyzer. The ability of the dialyzer to remove uremic toxins has steadily improved, but the likelihood has also increased that bioactive substances, such as bacterial endotoxin (ET) fragments, can be transferred from the dialysis fluid into the patient's blood through the phenomena of back-diffusion and back-filtration in the dialyzer. Therefore, further efforts to improve the quality of water are required. In 2008, the Committee of Scientific Academy of the Japanese Society for Dialysis Therapy presented its new recommendations for the quality standards of dialysis fluid, but achieving and maintaining these standard values would seem difficult without installing an ET-retentive filter (ETRF). In the present study, we evaluated whether the standards for ultrapure dialysis fluid of the Japanese Society for Dialysis Therapy can be achieved and maintained by installing 3 types of ETRF for a period of 12 months. METHODS: To evaluate the quality of dialysis fluid, ET values were measured with nephelometry, and viable cell counts were determined with the membrane filter method. Changes in the basic performance of the ETRFs were evaluated by measuring their water permeability, ET-retentive capacity, and hollow-fiber membrane intensity. Moreover, the hollow-fiber membrane surfaces of the ETRFs were observed with scanning electron microscopy, and the elements of the adherent substances were identified by means of energy dispersive X-ray spectrometry. RESULTS: The ET concentrations were less than the limit of detection during the evaluation period for samples obtained at post-ETRF sites. The viable cell counts for pre-ETRF sites were approximately 10 colony-forming units/mL. However, colonies had not formed in samples obtained from the post-ETRF sites. The substances adhering to hollow fibers included the silicon from the dialysate powder, the iron from the fluid path, and the elements derived from stainless steel. Scanning electron microscopy of the ETRF hollow fibers showed no substances except the hollow fibers and the elements derived from the dialysis fluid. CONCLUSION: Installation of an ETRF is useful for achieving and maintaining the quality standards for ultrapure dialysis fluid and for preventing the entry into the blood of ETs, viable cells, and such substances as silicon and metals.

Dietary intake is associated with human chronotype as assessed by both morningness-eveningness score and preferred midpoint of sleep in young Japanese women.

We analyzed the association between dietary intake and chronotype as assessed by both Morningness-Eveningness Questionnaire (MEQ) score and preferred midpoint of sleep in 112 young Japanese women. Dietary intake was assessed by a brief, self-administered diet history questionnaire. A lower MEQ score (evening-type tendency) showed a significant association with a lower energy-adjusted intake of protein, calcium, magnesium, zinc, vitamins (D, riboflavin, and B(6)), and vegetables, and with a higher intake of noodles. Furthermore, a later midpoint of sleep showed a significant association with a lower energy-adjusted intake of protein, cholesterol, potassium, calcium, magnesium, zinc, vitamins (D, riboflavin, B(6), and B(12)), soy, fish and shellfish, and eggs, and with a higher intake of noodles, bread, and confections. These data suggest that evening chronotype is associated with inadequate dietary habits such as low vitamin and mineral intakes.

Nutritional status is strongly correlated with grip strength and depression in community-living elderly Japanese.

OBJECTIVES: To evaluate the utility of the Mini-Nutritional Assessment (MNA) in assessing nutritional, physical and psychosocial functions in community-living elderly individuals. DESIGN: A cross-sectional study of elderly individuals investigated in August 2007 and August-September 2008. Nutritional status was assessed using serum biomarkers, anthropometric measurements and the MNA. Physical function was assessed by measuring grip strength and both usual and maximum walking speeds. The Geriatric Depression Scale (GDS) was used to measure the individual's depressive state. SETTING: Elder-care facilities in Tokyo, Japan. SUBJECTS: Community-living elderly individuals aged ≥65 years (n 130). RESULTS: The MNA evaluation classified twenty-seven (20·8 %) individuals as being at risk for malnutrition (MNA score ≤23·5); these at-risk individuals included a high proportion of the elderly aged ≥75 years. MNA scores correlated with nutritional biomarkers (total protein, albumin, cholinesterase, Hb) and anthropometric measurements (triceps skinfold, subscapular skinfold, mid-arm muscle area) and exhibited a strong correlation with grip strength and GDS score. Multivariate analysis revealed that grip strength, GDS score, marital status and maximum walking speed are strong predictors of MNA score. CONCLUSIONS: The MNA is considerably useful in providing a comprehensive assessment of nutritional status in elderly, community-living Japanese. However, larger-scale epidemiological studies are needed to determine the utility and the appropriate cut-off point of the MNA as a screen for risk of malnutrition.

The midpoint of sleep is associated with dietary intake and dietary behavior among young Japanese women.

OBJECTIVES: How human chronotype is correlated to nutrient and food-group intakes and dietary behavior remains to be elucidated. We cross-sectionally examined the association between the midpoint of sleep and these dietary variables in young Japanese women. A calculated halfway point between bedtime and rise time was used as midpoint of sleep. METHODS: The subjects were 3304 female Japanese dietetics students aged 18-20years from 53 institutions in Japan. Dietary intake during the previous month was assessed by a validated, self-administered diet history questionnaire. The midpoint of sleep was calculated using self-reported bedtimes and rise times. RESULTS: Late midpoint of sleep was significantly negatively associated with the percentage of energy from protein and carbohydrates, and the energy-adjusted intake of cholesterol, potassium, calcium, magnesium, iron, zinc, vitamin A, vitamin D, thiamin, riboflavin, vitamin B(6), folate, rice, vegetables, pulses, eggs, and milk and milk products. It was also significantly positively associated with the percentage of energy from alcohol and fat, and the energy-adjusted intake of noodles, confections, fat and oil, and meat. Furthermore, subjects with a later midpoint of sleep tended to begin meals later, eat for a longer time, skip meals more frequently, and watch TV at meals, not only at breakfast but also at lunch and dinner. CONCLUSIONS: The midpoint of sleep is significantly associated with dietary intake of certain nutrients and foods and other dietary behaviors in young Japanese women. This finding may contribute to consider the relationships between chronotype and dietary intakes and behaviors.

Association between human metapneumovirus seroprevalence and hypertension in elderly subjects in a long-term care facility.

Recently, relations between hypertension and infections caused by several pathogens have been reported. However, few studies have examined the relationship between human metapneumovirus (hMPV) and hypertension in elderly inpatients. To assess the association between anti-hMPV-immunoglobulin G (IgG) titer and the prevalence of hypertension, we conducted a case-control study in a Japanese long-term care facility (LTCF). The participants included 84 hypertensive patients aged 65 years, and 84 age- and sex-matched normotensive controls (38 males and 46 females in each group; cases, 79.9±8.4 (s.d.) years; controls, 80.1±8.3 years). Data on underling chronic clinical conditions were collected. Titers were measured using an immunofluorescence assay kit. The significance of risk factor differences was analyzed using univariate and multivariate comparisons of cases and controls. All serum samples were positive for hMPV, and IgG titers ranged from 40-fold to more than 5120-fold. There were no significant sex- or age-related differences in log(2) (anti-hMPV-IgG titer/10) among the subjects. Compared with normotensive subjects, hypertensive patients presented significantly higher log(2) (anti-hMPV-IgG titer/10) values (P<0.001). After adjustment with multiple logistic analysis, the odds ratio for log(2) (anti-hMPV-IgG titer/10) was 1.42 (95% confidence interval 1.16-1.75, P=0.001) relative to normotensive subjects. In all subjects, stepwise multiple regression analysis revealed that both hypertension and a poor nutritional state independently contributed to increased log(2) (anti-hMPV-IgG titer/10). These observations suggest that an increased anti-hMPV-IgG titer was closely related to hypertension in elderly subjects in a Japanese LTCF.

Different clinical outcomes for cardiovascular events and mortality in chronic kidney disease according to underlying renal disease: the Gonryo study.

PURPOSE: Chronic kidney disease (CKD) can result from a wide variety of diseases, but whether clinical outcomes differ in the same CKD stages according to the underlying renal disease remains unclear. Clarification of this issue is important for stratifying risk of cardiovascular disease (CVD) and death in patients before dialysis. PATIENTS AND METHODS: The study comprised 2,692 patients recruited from 11 outpatient nephrology clinics, classified by underlying disease of primary renal disease (PRD) (n = 1,306), hypertensive nephropathy (HN) (n = 458), diabetic nephropathy (DN) (n = 283), or other nephropathies (ON) (n = 645). Risks of events such as ischemic heart disease, congestive heart failure, stroke, and all-cause mortality within 12 months were examined by logistic regression analysis in each group. RESULT: During the 12-months' observation from recruitment, 200 cases were lost to follow-up, and 113 cases were introduced to chronic dialysis therapy. A total of 69 CVD events occurred (stroke in 27 cases), and 24 patients died. In total, increased odds ratios (OR) for the events by CKD stage (cf. CKD1 + 2: unadjusted) were CKD3, 1.29 [95% confidence interval (CI), 0.70-2.17]; CKD4, 2.73 (1.55-4.83); and CKD5, 4.66 (2.63-8.23). Regarding events in respective groups, no significant differences were seen by CKD stage except for the group with HN, but significant differences were seen by underlying diseases (cf. PRD: adjusted for confounding factors, including estimated glomerular filtration rate): HN, 2.57 (1.09-6.04); DN, 12.21 (3.90-38.20); and ON, 4.14 (1.93-8.89). CONCLUSION: Risk of CVD and mortality due to CKD needs to be stratified according to the underlying renal diseases.