Prediction of subsequent relapse in children with steroid-sensitive nephrotic syndrome.

Among nephrotic children with frequent relapses at risk for cumulative steroid toxicity, identification of children who may be at high risk for subsequent relapse is very important in making the decision to introduce cytotoxic drugs. We examined the clinical course of 467 relapses in 121 steroid-sensitive nephrotic children to elucidate the risk factors for subsequent relapse, using the Cox proportional-hazards regression model. Gender, age at onset, duration of illness from onset, prednisolone dosage at the most-recent relapse, and regimens of initial steroid therapy at onset were not associated with risk. Relapse within the 1st year was a powerful independent predictor of subsequent relapse irrespective of the duration of illness. The hazard ratio of patients with more than one relapse within the 1st year increased to 1.72-2.12 compared with those without a relapse within the 1st year. The remission period just before the most-recent relapse was also a significant predictor. The risk for patients with a 1-year or longer remission period decreased to 0.57. Patients treated with cyclophosphamide for 12 weeks had a significantly longer remission than those treated with prednisolone alone. Our results suggest that early relapse after onset and/or a short remission period just before recent relapse are independent risk factors for subsequent relapse. Cytotoxic therapy has serious adverse effects and its effect may be limited. Our results may be helpful in deciding on the suitability of cytotoxic drugs.

[A report on the effect of sheltered workshop activities on the social living activity of the mentally ill--analysis of research on workshop clients].

The effect of sheltered workshop activities on the social living activity of the mentally ill was studied in order to evaluate the role and level of function of workshop activities as a self support and employment system for clients, and to determine the future tasks of the workshop and rehabilitative services in the community. The following results were observed: 1) Clients' social living ability appears to be poor, especially in questions related to personal relationships and time distribution, where less than 50% of the clients answered "Possible without assistance". This appears to be characteristics of the living behaviors of mentally ill individuals. 2) Most of the families of the clients evaluated the sheltered workshop activities positively in terms of increasing the clients' social living ability. 3) A survey of families showed that by utilizing the workshop much progress has been made toward improving those living behaviors which are easily made into habits and lifestyle pattern. On the other hand, personal relationships and living behaviors which require coping flexibility, are much more refactory. Based on those results, the future task of sheltered workshops and the supportive role of the public health center need to be examined further.

[Effect of NH4+ on synaptosomal membrane potential in the rat brain].

The effect of NH4+ on synaptosomal membrane potential was examined using rat brains. The membrane potential was measured by the rhodamine 6G fluorescence method. Both NH4+ diffusion potential (NH4+-potential) and K+ diffusion potential (K+-potential) were observed in the synaptosomes. Upon replacement of medium Cl- with SCN-, both K+- and NH4+-potentials depolarized. On the other hand, replacement of medium Cl- with gluconate resulted in the hyperpolarization of K+-potential, but not of NH4+-potential. Ethacrynic acid (0.3 mM), a Cl- -ATPase inhibitor, depolarized both K+(Cl-)- and NH4+ (Cl-)-potentials. In the presence of ethacrynic acid, both of the potentials were further depolarized by replacement of medium Cl- with SCN-, but not with gluconate-. Picrotoxin (5 mM), a Cl- channel inhibitor, did not significantly affect either K+- or NH4+-potential. In the presence of picrotoxin, replacement of medium Cl- with SCN- depolarized both K+- and NH4+-potentials with or without ethacrynic acid. Gluconate depolarized the K+-potential with ethacrynic acid and the NH4+-potential with or without ethacrynic acid. These findings suggest that NH4+ forms a diffusion potential in nerve endings, and inhibits the anion-mediated hyperpolarization through mechanisms other than anion channels.