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Aims: This cohort study investigated the association between treatment cessation and incidence/progression of diabetic retinopathy (DR) in Japanese patients with type 2 diabetes mellitus (T2DM). Materials and methods: Data were extracted from electronic medical records at the University of the Ryukyu Hospital and the Tomishiro Central Hospital of Okinawa, Japan. We enrolled 417 diabetic patients without DR (N = 281) and with nonproliferative DR (N = 136) at the baseline. Treatment cessation was defined as failing to attend outpatient clinics for at least twelve months prior to the baseline. After a median follow-up of 7 years, we compared the incidence/progression rate of DR including nonproliferative and proliferative DR between patients with and without treatment cessation and calculated the odds ratio (OR) in the treatment cessation group using a logistic regression model. Results: The overall prevalence of treatment cessation was 13% in patients with T2DM. Characteristics of treatment cessation included relative youth (57 ± 11 years vs. 63 ± 12 years, P < 0.01). Treatment cessation was tightly associated with the incidence of DR (OR 4.20 [95% confidence interval [CI] 1.46-12.04, P < 0.01) and also incidence/progression of DR (OR 2.70 [1.28-5.69], P < 0.01), even after adjusting for age, sex, BMI, duration of T2DM, and HbA1c level. Conclusions: By considering major confounding factors, the present study demonstrates an independent association between treatment cessation and incidence of DR in patients with T2DM, highlighting treatment cessation as an independent risk for DR in T2DM. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-024-00724-7.
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AIM: This study investigated the associations of the surface charge of low-density lipoprotein (LDL) with the serum LDL-cholesterol and atherosclerosis levels in a community-based Japanese population. METHODS: The study had a cross-sectional design and included 409 community residents aged 35-79 years who did not take medications for dyslipidemia. The potential electric charge of LDL and the zeta potential, which indicate the surface charge of LDL, were measured by laser Doppler microelectrophoresis. The correlations of the zeta potential of LDL (-mV) with the serum LDL-cholesterol levels (mg/dL), cardio-ankle vascular index (CAVI), and serum high-sensitivity C-reactive protein (hsCRP) levels (log-transformed values, mg/L) were examined using Pearson's correlation coefficient (r). Linear regression models were constructed to examine these associations after adjusting for potential confounding factors. RESULTS: A total of 201 subjects with correctly stored samples were included in the primary analysis for zeta potential measurement. An inverse correlation was observed between the LDL zeta potential and the serum LDL-cholesterol levels (r=-0.20; p=0.004). This inverse association was observed after adjusting for sex, age, dietary cholesterol intake, smoking status, alcohol intake, body mass index, and the serum levels of the major classes of free fatty acids (standardized ß=-6.94; p=0.005). However, the zeta potential of LDL showed almost no association with CAVI or the serum hsCRP levels. Similar patterns were observed in the 208 subjects with compromised samples as well as all the original 409 subjects. CONCLUSION: A higher electronegative surface charge of LDL was associated with lower serum LDL-cholesterol levels in the general Japanese population.
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AIM: The present cohort study explored whether specific gut microbiota (GM) profile would predict the development of impaired glucose tolerance (IGT) in individuals with normal glucose tolerance (NGT). METHODS: A total of 114 study subjects with NGT in Kumejima island, Japan participated in the present study and underwent 75 g oral glucose tolerance tests at baseline and one year later. We compared the profile of GM at baseline between individuals who consistently maintained NGT (NRN, n = 108) and those who transitioned from NGT to IGT (NTI, n = 6). RESULTS: Within-individual bacterial richness and evenness as well as inter-individual bacterial composition showed no significant differences between NRN and NTI. Of note, however, partial least squares discriminant analyses revealed distinct compositions of GM between groups, with no overlap in their 95 % confidence interval ellipses. Multi-factor analyses at the genus level demonstrated that the proportions of CF231, Corynebacterium, Succinivibrio, and Geobacillus were significantly elevated in NTI compared to NRN (p < 0.005, FDR < 0.1, respectively) after adjusting for age, sex, HbA1c level, and BMI. CONCLUSIONS: Our data suggest that increased proportion of specific GM is linked to the future deterioration of glucose tolerance, thereby serving as a promising predictive marker for type 2 diabetes mellitus.
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Microbioma Gastrointestinal , Intolerancia a la Glucosa , Prueba de Tolerancia a la Glucosa , Humanos , Intolerancia a la Glucosa/microbiología , Intolerancia a la Glucosa/sangre , Femenino , Masculino , Microbioma Gastrointestinal/fisiología , Persona de Mediana Edad , Estudios de Cohortes , Japón/epidemiología , Glucemia/metabolismo , Glucemia/análisis , Adulto , Anciano , Diabetes Mellitus Tipo 2/microbiología , Diabetes Mellitus Tipo 2/sangreRESUMEN
BACKGROUND AND OBJECTIVES: To elucidate current epidemiologic, clinical, and immunologic profiles and treatments of stiff-person syndrome (SPS) in Japan. METHODS: A nationwide mail survey was conducted using an established method. Data processing sheets were sent to randomly selected departments of internal medicine, neurology, pediatrics, psychiatry, and neurosurgery in hospitals and clinics throughout Japan to identify patients with SPS who were seen between January 2015 and December 2017. RESULTS: Thirty cases were identified as glutamic acid decarboxylase 65 (GAD65)-positive SPS cases on the basis of detailed clinical data of 55 cases. Four patients had α1 subunit of glycine receptor (GlyR) antibodies, and 1 patient had both GAD65 and GlyR antibodies. The total estimated number of patients with GAD65-positive SPS was 140, and the estimated prevalence was 0.11 per 100,000 population. The median age at onset was 51 years (range, 26-83 years), and 23 (76%) were female. Of these, 70% had classic SPS, and 30% had stiff-limb syndrome. The median time from symptom onset to diagnosis was significantly longer in the high-titer GAD65 antibody group than in the low-titer group (13 months vs 2.5 months, p = 0.01). The median modified Rankin Scale (mRS) at baseline was 4, and the median mRS at the last follow-up was 2. Among the 29 GAD65-positive patients with ≥1 year follow-up, 7 received only symptomatic treatment, 9 underwent immunotherapy without long-term immunotherapy, and 13 received long-term immunotherapy such as oral prednisolone. The coexistence of type 1 diabetes mellitus and the lack of long-term immunotherapy were independent risk factors for poor outcome (mRS ≥3) in the GAD65-positive patients (odds ratio, 15.0; 95% CI 2.6-131.6; p = 0.001; odds ratio, 19.8; 95% CI 3.2-191.5; p = 0.001, respectively). DISCUSSION: This study provides the current epidemiologic and clinical status of SPS in Japan. The symptom onset to the diagnosis of SPS was longer in patients with high-titer GAD65 antibodies than in those with low-titer GAD65 antibodies. The outcome of patients with SPS was generally favorable, but more aggressive immunotherapies are necessary for GAD65-positive patients with SPS.
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Síndrome de la Persona Rígida , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Anticuerpos , Pueblos del Este de Asia , Glutamato Descarboxilasa , Inmunoterapia , Prevalencia , Pronóstico , Síndrome de la Persona Rígida/diagnóstico , Síndrome de la Persona Rígida/epidemiología , Síndrome de la Persona Rígida/terapiaRESUMEN
The Japanese diet has attracted attention as a factor contributing to the Japanese population's longevity. A typical Japanese meal, traditionally called "ichiju-sansai," is composed of various dishes. This study assessed the nutritional adequacy of the Japanese diet using the number of dishes in all meals (NDAM) compared to existing dietary diversity indices (DDIs). This cross-sectional study used data from the 2012 National Health and Nutrition Survey. A total of 25,976 participants aged ≥20 y were included in this study. NDAM was calculated for whole dishes or single foods (except supplements and beverages) from one-day weighted dietary records. The food variety score (FVS), number of foods, dietary diversity score (DDS), and number of food groups are some of the existing DDIs. NDAM had relatively high positive correlation coefficients with potassium, magnesium, and dietary fiber. The partial correlation coefficients with an indicator of the overall nutrient adequacy of NDAM was 0.42 for men and 0.42 for women. It was almost the same as that of the FVS (men: 0.44, women: 0.42) and DDS (men: 0.44, women: 0.43). On the other hand, NDAM, similar to existing DDIs, was also positively correlated with nutrient restriction in both sexes. These findings indicate that the nutrient adequacy of NDAM is similar to that of the existing DDIs. Because of the higher sodium intake and cholesterol intake in higher NDAM and existing DDIs, the effect of higher NDAM on health outcomes must be investigated in future studies.
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Dieta , Pueblos del Este de Asia , Femenino , Humanos , Masculino , Estudios Transversales , Japón , Comidas , Evaluación Nutricional , Encuestas Nutricionales , AdultoRESUMEN
This study investigated the relationship between obesity and hypertension from a public health perspective in a small remote island of Okinawa where obesity is prevalent. A cross-sectional study was conducted in 456 residents aged ≥18 years in Yonaguni island who underwent an annual health check-up and the Yonaguni dietary survey in 2022. Each participant responded to our original questionnaire and provided further dietary survey data via the Yonaguni municipal government. The odds ratio for hypertension was calculated in the obese group, using a logistic regression model with the non-obese group serving as the reference. Hypertension was defined as a systolic blood pressure ≥140 mmHg, a diastolic blood pressure ≥90 mmHg measured on an automated sphygmomanometer, and/or taking anti-hypertensive agents, while obesity was defined as a body mass index ≥25 kg/m2. The proportion of hypertension associated with obesity among all hypertensive subjects was calculated. The prevalence of obesity and hypertension was 54.3% and 49.0% in the 208 male subjects and 32.3% and 43.6% in the 248 female subjects, respectively. The odds ratio for hypertension in the obese group was 3.73 (95% confidence interval, 1.93-7.20) for men and 4.13 (2.06-8.29) for women after adjusting for age, alcohol drinking habit, behavior for lowering salt intake, and smoking habit. Hypertension in 49.5% (95% confidence interval, 29.4%-63.9%) of males and 37.9% (22.6%-50.2%) of females was associated with obesity in this island. Some areas of Japan could be urgently required to address obesity for preventing cardiovascular disease. A community-based, cross-sectional study in 456 residents aged ≥18 years in Yonaguni island, Okinawa prefecture, Japan.
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Hipertensión , Salud Pública , Humanos , Masculino , Femenino , Adolescente , Adulto , Japón/epidemiología , Estudios Transversales , Obesidad/complicaciones , Obesidad/epidemiología , Presión Sanguínea , Factores de Riesgo , Prevalencia , Índice de Masa CorporalRESUMEN
We report the unprecedented sergeants and soldiers (S&S)-type remote control of one-handed helicity in copolymers of chiral/achiral biphenylylacetylenes bearing amphiphilic oligo(ethylene glycol) (OEG) side chains. A small amount of chiral binaphthyl residues (≤10â mol %) introduced at the terminal of the achiral OEG spacers as many as 80â bonds away from the polymer backbones induced a complete one-handed helix in water through preferential intramolecular encapsulation of the binaphthyl groups within a cavity of the copolymers. A fully one-handed helix can be induced virtually independent of the OEG spacer length and concentrations. At a specific spacer length, however, its helix-sense was inverted. The copolymers also form an excess one-handed helix in organic solvents in an OEG spacer-length dependent manner, yet far from the polymer backbones. We show the superiority of the present covalent-bond driven S&S-type remote helicity control over the corresponding noncovalent helicity induction approach.
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Sleep is essential for our health. Short sleep is known to increase disease risks via imbalance of intestinal microbiota, dysbiosis. However, mechanisms by which short sleep induces dysbiosis remain unknown. Small intestinal Paneth cell regulates the intestinal microbiota by secreting antimicrobial peptides including α-defensin, human defensin 5 (HD5). Disruption of circadian rhythm mediating sleep-wake cycle induces Paneth cell failure. We aim to clarify effects of short sleep on HD5 secretion and the intestinal microbiota. Fecal samples and self-reported sleep time were obtained from 35 healthy middle-aged Japanese (41 to 60-year-old). Shorter sleep time was associated with lower fecal HD5 concentration (r = 0.354, p = 0.037), lower centered log ratio (CLR)-transformed abundance of short-chain fatty acid (SCFA) producers in the intestinal microbiota such as [Ruminococcus] gnavus group (r = 0.504, p = 0.002) and Butyricicoccus (r = 0.484, p = 0.003), and lower fecal SCFA concentration. Furthermore, fecal HD5 positively correlated with the abundance of these genera and SCFA concentration. These findings suggest that short sleep relates to disturbance of the intestinal microbiota via decreased HD5 secretion.
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Microbioma Gastrointestinal , Humanos , Persona de Mediana Edad , Adulto , Disbiosis/metabolismo , Sueño , Ácidos Grasos Volátiles , DefensinasRESUMEN
This study aimed to investigate the effect of hyperuricemia (HU) on the association of systolic blood pressure (SBP) with the prevalence of proteinuria and low estimated glomerular filtration rate (eGFR) in the general population. This cross-sectional study enrolled 24,728 Japanese individuals (11,137 men and 13,591 women) who underwent health checkups in 2010. The prevalence of proteinuria and low eGFR (< 60 mL/min/1.73 m2) among participants classified according to serum uric acid levels and SBP was compared. HU was defined as serum uric acid levels higher than the 75th percentile in male and female participants (> 7.2 and > 5.4 mg/dL, respectively). The odds ratio (OR) for proteinuria increased with elevated SBP. This trend was significantly evident in participants with HU. Moreover, there was an interactive effect of SBP and HU on the prevalence of proteinuria in the male (Pfor interaction = 0.04) and female (Pfor interaction = 0.04) participants. Next, we evaluated the OR for low eGFR (< 60 mL/min/1.73 m2) with and without proteinuria based on the presence of HU. The multivariate analysis revealed that the OR for low eGFR with proteinuria increased with elevated SBP, but that for low eGFR without proteinuria decreased. These trends of OR tended to be prevalent among those with HU. The association between SBP and the prevalence of proteinuria was more pronounced in participants with HU. However, the association between SBP and decreased renal function with and without proteinuria might be different regardless of HU.
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Hiperuricemia , Insuficiencia Renal Crónica , Humanos , Masculino , Femenino , Presión Sanguínea/fisiología , Hiperuricemia/complicaciones , Hiperuricemia/epidemiología , Ácido Úrico , Estudios Transversales , Factores de Riesgo , Proteinuria/epidemiología , Tasa de Filtración Glomerular/fisiología , Riñón/fisiologíaRESUMEN
Background: Although cardiac rehabilitation (CR) has been reported to be effective for improving the prognosis of acute myocardial infarction (AMI), more patients must participate in CR during admission and as outpatients. Factors contributing to, and countermeasures against, the low CR participation rate need to be identified. Here we describe the protocol for a study designed to evaluate the effectiveness and problems of CR for AMI from the Japanese Registry of All Cardiac and Vascular Diseases (JROAD) and the JROAD-Japanese Diagnosis Procedure Combination system (JROAD-DPC) database. MethodsâandâResults: This is a multicenter retrospective cohort study that will use the JROAD/JROAD-DPC database to evaluate the effectiveness of CR for AMI (JROAD-CR). Five thousand patients with AMI who were admitted to hospitals registered in the JROAD database in 2014 will be investigated with regard to their baseline characteristics, AMI severity and treatment, examination results, history of CR, and prognosis up to 5 years. We will also investigate the presence, quantity, and quality of CR, and evaluate the effectiveness of CR with respect to cost, exercise tolerance, and prognosis during admission and follow-up. Conclusions: The JROAD-CR study will seek to reveal the effectiveness of CR for AMI in the era of early reperfusion therapy and shortened hospitalization.
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Maternal diet may affect human milk macronutrients, but it remains to be elucidated whether this is also influential in infant growth. This study aimed to examine (1) how maternal diet influences human milk macronutrients, and (2) to what extent the variation in milk macronutrients affects infant growth during the first month of life. In 71 Japanese lactating women, maternal dietary information was collected from the brief-type self-administered diet history questionnaire, and anthropometry of mother-infant dyads was collected from medical records. Macronutrients in milk were analyzed by a Human Milk Analyzer. Maternal retinol intake was associated with the carbohydrate content in human milk at 1-month postpartum (standardized ß coefficient: 0.287; p = 0.038). Moreover, the energy content in human milk was associated with an increase in the weight standard deviation score based on the WHO growth standard at 1 month of age (standardized ß coefficient: 0.399; p = 0.046). Nevertheless, the milk macronutrient was not associated with the risk of infant growth abnormalities. In conclusion, a part of the maternal diet impacts macronutrient contents in human milk, but milk macronutrients have a limited effect on infant growth only within the normal growth curve during the first month of life.
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Lactancia , Leche Humana , Humanos , Lactante , Femenino , Japón , Lactancia Materna , DietaRESUMEN
Managing inflammatory bowel disease (IBD) is a major challenge for physicians and patients during the COVID-19 pandemic. To understand the impact of the pandemic on patient behaviors and disruptions in medical care, we used a combination of population-based modeling, system dynamics simulation, and linear optimization. Synthetic IBD populations in Tokyo and Hokkaido were created by localizing an existing US-based synthetic IBD population using data from the Ministry of Health, Labor, and Welfare in Japan. A clinical pathway of IBD-specific disease progression was constructed and calibrated using longitudinal claims data from JMDC Inc for patients with IBD before and during the COVID-19 pandemic. Key points considered for disruptions in patient behavior (demand) and medical care (supply) were diagnosis of new patients, clinic visits for new patients seeking care and diagnosed patients receiving continuous care, number of procedures, and the interval between procedures or biologic prescriptions. COVID-19 had a large initial impact and subsequent smaller impacts on demand and supply despite higher infection rates. Our population model (Behavior Predictor) and patient treatment simulation model (Demand Simulator) represent the dynamics of clinical care demand among patients with IBD in Japan, both in recapitulating historical demand curves and simulating future demand during disruption scenarios, such as pandemic, earthquake, and economic crisis.
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BACKGROUND: Both decreased insulin sensitivity and impaired insulin secretion are common in Asian populations with diabetes, in contrast to Western populations. There is limited evidence regarding the association between insulin response in diabetes in Asian populations and serum 25-hydroxyvitamin D3 (25[OH]D3) insufficiency. METHODS: The present cross-sectional study compared the prevalence of diabetes, defined as a fasting plasma glucose level ≥126 mg/dL and/or a HbA1c level ≥6.5%, among 480 participants aged 35-79 years not taking anti-diabetes medications, based on serum 25(OH)D3 levels. A logistic regression model was used to calculate the odds ratios for diabetes in each serum 25(OH)D3 group. Furthermore, this study examined the association between serum 25(OH)D3 levels and the index of homeostasis model assessment of insulin resistance (HOMA-IR) using a linear regression model. RESULTS: The prevalence of diabetes was 7.29% in the study population, and was higher in lower serum 25(OH)D3 quartile groups. The odds ratios for diabetes in the first, second, and third serum 25(OH)D3 quartile groups (25[OH]D3: ≤18.10, 18.11-22.90, and 22.91-28.17 ng/mL) were 4.02 (95% confidence interval [CI], 1.25-12.92), 2.50 (95% CI, 0.77-8.10), and 1.91 (95% CI, 0.60-6.09), respectively, with the fourth quartile group (⩾28.18 ng/mL) serving as the reference group, after adjusting for sociodemographic, lifestyle, physical and environmental factors. Serum 25(OH)D3 levels showed an inverse association with log-transformed HOMA-IR after adjusting for similar factors (standardized ß = -0.08; 95% CI, -0.14 to -0.02). CONCLUSION: Serum 25(OH)D3 levels were inversely associated with diabetes prevalence in a general Japanese population, with a slight inverse association between serum 25(OH)D3 levels and HOMA-IR.
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Diabetes Mellitus , Resistencia a la Insulina , Humanos , Calcifediol , Estudios Transversales , Pueblos del Este de Asia , Japón/epidemiología , Vitamina D , Insulina , Diabetes Mellitus/epidemiologíaRESUMEN
Numerous studies have revealed distinct differences in the profiles of gut microbiota between non-obese and obese individuals. To date, however, little is known if any disparities in the community of gut microbiota exist between metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) subjects. We therefore aimed to comprehensively characterize the gut microbiota and circulating metabolites in serum from both MHO and MUO residing in the remote island, Kumejima, where the prevalence of obesity is one of the highest in Japan, and explored possible correlations between the gut microbiota profile and markers of metabolic syndrome. Results revealed that MUO showed significantly higher levels of genera such as g_Succinivibrio, g_Granulicatella, g_Brachyspira, g_Oribacterium and g_Atopobium in comparison to MHO. Moreover, abundance of g_Succinivibrio, g_Brachyspira and g_Atopobium were positively correlated with value of fasting insulin, HOMA-R, circulating triglycerides, diastolic blood pressure, BMI, body weight, waist circumference and HbA1c. In addition, MUO compared to MHO showed an imbalance of serum metabolites, with a significant elevation in 2-oxoisovaleric acid, pyruvic acid, 2-hydroxybutyric acid, and creatine. Our data highlight unmet needs in precision approaches for the treatment of obesity, targeting the gut microbiota profile and serum metabolites in a distinct population affected by obesity.
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Microbioma Gastrointestinal , Insulinas , Síndrome Metabólico , Índice de Masa Corporal , Creatina , Hemoglobina Glucada , Humanos , Japón/epidemiología , Síndrome Metabólico/metabolismo , Obesidad/metabolismo , Ácido Pirúvico , TriglicéridosRESUMEN
Childhood obesity is rapidly increasing worldwide and is largely the consequence of adoption of unhealthy diets excessive in calories and salt (NaCl) as well as devoid in pivotal micronutrients such as potassium (K) and magnesium (Mg). Education-based programs aiming to encourage healthy food knowledge and behaviors are crucial at a young age, and for this purpose, convenient ways to assess daily dietary intake are warranted. We therefore attempted to evaluate the dietary intake of Okinawan schoolchildren in Japan by analyzing a series of biomarkers in morning spot urine samples and explore whether these biomarkers correlate with body weight and a series of metabolic parameters. We enrolled 98 third-grade elementary schoolchildren in Okinawa, Japan. Morning spot urine samples were collected and analyzed using high-performance liquid chromatography (HPLC) to assess dietary intake. We found that estimated daily NaCl intake was higher in obese/overweight children as compared to healthy-weight children (p = 0.0001). There was also a significant positive correlation between body mass index (BMI) and NaCl intake (Spearman) (ρ = 0.45, p < 0.0001) and a negative correlation between BMI and Mg/Cr (ρ = -0.27, p = 0.01). Furthermore, Na/K ratio was higher in samples collected on Monday (weekend) as compared to samples collected on Thursday or Friday (weekday) (p < 0.0001). CONCLUSION: Via the use of morning spot urine analyses, our results show that NaCl intake was associated with obesity, and Mg excretion negatively correlated with BMI in Japanese schoolchildren, highlighting the potential role of these micronutrients in maintaining a healthy body weight. WHAT IS KNOWN: â¢Overweight and obesity are largely due to excessive consumption of calories and positively correlated with salt (NaCl) intake. â¢Spot urine methods are convenient for assessing the nutritional needs and targeting prevention programs in children. WHAT IS NEW: â¢Utilizing morning spot urine analyses, estimated NaCl intake is positively correlated and Mg/Cr negatively correlated with BMI in Okinawan schoolchildren. â¢As estimated via morning spot urine samples, a greater proportion of children likely exceeds the recommended NaCl intake on the weekend as compared to weekday.
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Sobrepeso , Obesidad Infantil , Biomarcadores , Niño , Humanos , Japón , Magnesio , Micronutrientes , Obesidad Infantil/diagnóstico , Potasio/orina , Cloruro de Sodio , Cloruro de Sodio DietéticoRESUMEN
(1) Background: Evidence has accumulated regarding the etiology of lower urinary tract symptoms associated with obesity and metabolic syndrome. Therefore, the present study aimed to identify which subjectively and objectively measured voiding parameters were associated with obesity in a community-based population. (2) Methods: Voiding parameters on a self-administered questionnaire and a digital self-health monitoring system for urine excretion (s-HMSU) were compared between participants with and without obesity, defined as a body mass index ≥ 25 kg/m2 (n = 30 and 29, respectively), from a community in Okinawa, Japan. Logistic regression analysis was employed to calculate the odds ratios of abnormalities in voiding parameters for the obese group, with the non-obese group serving as a reference. (3) Results: The obese group had odds ratios of 5.17 (95% confidence interval: 1.33−20.0) for shortened hours of undisturbed sleep (<302 min) by s-HMSU and 7.65 (1.88−31.1) for nighttime urinary frequency by a questionnaire after adjusting for age and sex. In addition, the obese group had an adjusted odds ratio of 2.27 (0.76−6.78) for decreased maximum bladder capacity (<212 mL) by s-HMSU. (4) Conclusion: the results of the present study suggest that nocturia and shortened hours of undisturbed sleep are signs of obesity.
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OBJECTIVE: Renin-angiotensin system (RAS) might be associated with arteriolar remodeling. The present study aimed to explore the hitherto unknown relationship between renal RAS and renal arteriolar remodeling and to elucidate whether altered renal RAS subsequently affects renal function in patients with chronic kidney disease (CKD). METHODS: In this retrospective study, patients with various CKDs not using RAS inhibitors who underwent renal biopsy were included in cross-sectional and longitudinal analyses. Urinary angiotensinogen (UAGT) levels and wall/lumen ratio (WLR) were determined to evaluate renal RAS and renal arteriolar remodeling, respectively. The association between ln(UAGT) and ln(WLR) was cross-sectionally examined using a liner regression model. Furthermore, the association of ln(UAGT) with subsequent changes in estimated glomerular filtration rate (eGFR) per year were longitudinally examined in the largest subgroup of patients who were diagnosed with IgA nephropathy. RESULTS: In the overall cohort (nâ=â54), the median age, blood pressures, eGFR, and WLR were 37âyears, 120/73âmmHg, 85âml/min per 1.73âm2, and 0.93, respectively. Ln(UAGT) was significantly and positively associated with ln(WLR) even after adjusting for classical and nonclassical clinical renal risk factors. In patients with IgA nephropathy, higher ln(UAGT) was associated with higher ln(WLR). Ln(UAGT) also tended to be associated with a greater decline in eGFR per year over a median period of 8.7âyears, even after adjusting for potential confounding factors. CONCLUSION: In patients with CKD, renal RAS might be associated with renal arteriolar remodeling and future decline in eGFR, independent of potential risk factors.
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Angiotensinógeno , Insuficiencia Renal Crónica , Adulto , Biomarcadores/orina , Estudios Transversales , Tasa de Filtración Glomerular , Humanos , Riñón/metabolismo , Insuficiencia Renal Crónica/diagnóstico , Sistema Renina-Angiotensina/fisiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Evidence for what diseases occur more commonly in older people from a poor residential environment (PRE) is limited. OBJECTIVE: We investigated characteristics, especially the underlying reason (disease) for visiting an emergency department (ED), of older people from a PRE in ED settings. METHODS: A cross-sectional study was conducted on people aged ≥65 years who presented to the EDs of 2 hospitals in Okinawa, Japan, between 2015 and 2019. PRE cases were identified by searching relevant words, such as a house overflowing with garbage from hoarding or housing squalor (gomi-yashiki in Japanese), in electric medical records. Controls (2 controls per case) were randomly selected from those without a PRE, with both living at home and matching each PRE case for age and sex. Characteristics of interest between cases and controls were compared using a χ2 test. RESULTS: PRE cases (n = 67), compared with controls (n = 134), were more often transported by ambulance (79.1% vs. 61.9%; p = 0.01). A family member or relative (43.4%) or professional supporter (20.8%) called an ambulance for most PRE cases. PRE cases were more likely to visit the ED due to injury/fracture (16.4% vs. 8.2%), rhabdomyolysis (11.9% vs. 1.5%), undernutrition/dehydration (10.4% vs. 1.5%), and cancer (9.0% vs. 5.2%) than controls (p < 0.001). PRE cases had a higher prevalence of being underweight (35.4% vs. 14.9%), dementia (41.8% vs. 16.4%), decubitus ulcer (29.9% vs. 8.2%), living alone (73.1% vs. 23.1%), and receiving public welfare assistance (35.8% vs. 9.0%) than controls (all p ≤ 0.001). CONCLUSION: In EDs, older people from a PRE exhibited certain diseases and characteristics.