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Introduction: While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and multidisciplinary care teams. Although it has been reported that multidisciplinary care teams contribute to the prevention of worsening renal functions and cardiovascular events, there are few studies on the effect of a medical cooperation system. Methods: We aimed to evaluate the effect of medical cooperation on all-cause mortality and renal prognosis in patients with CKD. One hundred and sixty-eight patients who visited the one hundred and sixty-three clinics and seven general hospitals of Okayama city were recruited between December 2009 and September 2016, and one hundred twenty-three patients were classified into a medical cooperation group. The outcome was defined as the incidence of all-cause mortality, or renal composite outcome (end-stage renal disease or 50% eGFR decline). We evaluated the effects on renal composite outcome and pre-ESRD mortality while incorporating the competing risk for the alternate outcome into a Fine-Gray subdistribution hazard model. Results: The medical cooperation group had more patients with glomerulonephritis (35.0% vs. 2.2%) and less nephrosclerosis (35.0% vs. 64.5%) than the primary care group. Throughout the follow-up period of 5.59 +/- 2.78 years, 23 participants (13.7%) died, 41 participants (24.4%) reached 50% decline in eGFR, and 37 participants (22.0%) developed end-stage renal disease (ESRD). All-cause mortality was significantly reduced by medical cooperation (sHR 0.297, 95% CI 0.105-0.835, p = 0.021). However, there was a significant association between medical cooperation and CKD progression (sHR 3.069, 95% CI 1.225-7.687, p = 0.017). Conclusion: We evaluated mortality and ESRD using a CKD cohor

Highlights • Study of wetland sediment in the easternmost Asian monsoon affected region. • Sediment on the Konsen Plateau has continuously deposited since ∼4.0 ka. • C/N and C/S ratios suggest environmental changes during the late Holocene. Abstract Wetland soils are among the largest carbon reservoirs in terrestrial ecosystems and are vulnerable to climate change. Here we elucidate the developmental history of a wetland soil located on the Konsen Plateau in Hokkaido, Japan, during the Holocene. Through radiocarbon dating of sediment samples, we revealed that continuous sedimentation persisted over the past 4000 years. This onset of peat sedimentation was simultaneous with those reported in other wetlands in eastern Hokkaido. We hypothesized that cooling associated with the end of climatic optimal may have contributed to peat preservation. Elemental analyses also confirmed the formation of a stable wetland condition during the late Holocene. The C/N ratios were approximately 15–25 throughout the core, indicating that the organic materials in the sediments were steadily derived from terrestrial plants. The C/S ratios of the core varied between 43 and 97, suggesting that the sediments are free from marine influences. Our results provided continuous and stable record of wetland sedimentary environment in eastern Hokkaido over the past 4000 years.

Introduction: While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and multidisciplinary care teams. Although it has been reported that multidisciplinary care teams contribute to the prevention of worsening renal functions and cardiovascular events, there are few studies on the effect of a medical cooperation system. Methods: We aimed to evaluate the effect of medical cooperation on all-cause mortality and renal prognosis in patients with CKD. One hundred and sixty-eight patients who visited the one hundred and sixty-three clinics and seven general hospitals of Okayama city were recruited between December 2009 and September 2016, and one hundred twenty-three patients were classified into a medical cooperation group. The outcome was defined as the incidence of all-cause mortality, or renal composite outcome (end-stage renal disease or 50% eGFR decline). We evaluated the effects on renal composite outcome and pre-ESRD mortality while incorporating the competing risk for the alternate outcome into a Fine-Gray subdistribution hazard model. Results: The medical cooperation group had more patients with glomerulonephritis (35.0% vs. 2.2%) and less nephrosclerosis (35.0% vs. 64.5%) than the primary care group. Throughout the follow-up period of 5.59 +/- 2.78 years, 23 participants (13.7%) died, 41 participants (24.4%) reached 50% decline in eGFR, and 37 participants (22.0%) developed end-stage renal disease (ESRD). All-cause mortality was significantly reduced by medical cooperation (sHR 0.297, 95% CI 0.105-0.835, p = 0.021). However, there was a significant association between medical cooperation and CKD progression (sHR 3.069, 95% CI 1.225-7.687, p = 0.017). Conclusion: We evaluated mortality and ESRD using a CKD cohor

Highlights • Study of wetland sediment in the easternmost Asian monsoon affected region. • Sediment on the Konsen Plateau has continuously deposited since ∼4.0 ka. • C/N and C/S ratios suggest environmental changes during the late Holocene. Abstract Wetland soils are among the largest carbon reservoirs in terrestrial ecosystems and are vulnerable to climate change. Here we elucidate the developmental history of a wetland soil located on the Konsen Plateau in Hokkaido, Japan, during the Holocene. Through radiocarbon dating of sediment samples, we revealed that continuous sedimentation persisted over the past 4000 years. This onset of peat sedimentation was simultaneous with those reported in other wetlands in eastern Hokkaido. We hypothesized that cooling associated with the end of climatic optimal may have contributed to peat preservation. Elemental analyses also confirmed the formation of a stable wetland condition during the late Holocene. The C/N ratios were approximately 15–25 throughout the core, indicating that the organic materials in the sediments were steadily derived from terrestrial plants. The C/S ratios of the core varied between 43 and 97, suggesting that the sediments are free from marine influences. Our results provided continuous and stable record of wetland sedimentary environment in eastern Hokkaido over the past 4000 years.