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Bixalomer (Bix) is an amine-functional polymer, non-calcium-containing phosphate (P) binder, and has been clinically available in Japan recently. Bix is expected to cause fewer gastrointestinal (GI) side-effects as compared with sevelamer hydrochloride (SH), because of less expansion of Bix in the GI tract. In this prospective observational study, we evaluated changes in GI symptoms by the Gastrointestinal Symptom Rating Scale (GSRS) score in long-term hemodialysis (HD) outpatients with SH-associated GI symptoms who switched to Bix from SH. A total of 114 patients (age 63.7±10.8 year (mean±SD), female 65.5%, HD vintage 11.2±8.6 years, diabetes mellitus 27.4%) were enrolled. The GSRS score was checked at 0 and 12 weeks after the start of Bix. Bix was started at the initial dose of 750 mg/day, and then was titrated. Serum albumin, P and corrected calcium levels did not significantly change during Bix treatment. However, serum low-density lipoprotein-cholesterol and bicarbonate levels significantly increased during Bix treatment (P<0.001). In GSRS scores, total and domain-specific scores, including constipation, diarrhea, reflux and abdominal pain were significantly reduced at 0, 4, 12 and 24 weeks as compared with those at 0 weeks (P<0.05). This study shows that Bix was well tolerated and managed hyperphosphatemia effectively after switching from SH in Japanese patients on long-term HD. In addition, Bix might be less often associated with GI symptoms as compared with SH., (© 2014 The Authors. Therapeutic Apheresis and Dialysis © 2014 International Society for Apheresis.)

Objective: To determine the foot pressure pattern of individuals with medial knee osteoarthritis (OA) and to analyze its relation with knee flexion/extension range of motion., Design: Descriptive., Setting: Rehabilitation center., Participants: Individuals with unilateral, painful medial knee OA (n=50; mean age, 75y; OA group) were enrolled as subjects, and young, healthy persons (n=50; mean age, 28y; young group) and elderly persons (n=44; mean age, 74y; elderly group) without any pain, deformity, or apparent OA changes in either knee were enrolled as controls., Intervention: Walking 10m at a comfortable speed., Main Outcome Measures: Partial foot pressures as percentages of body weight (%PFP), anteroposterior length of the center of pressure (COP) path as a percentage of foot length (%Long), transverse width of the COP path as a percentage of foot width (%Trans), knee flexion/extension range of motion (in the OA group)., Results: The %PFP values for the heel and hallux, %Long, and %Trans were all significantly lower in the OA group than in controls (P<.001, all). Within the OA group, a limited range of knee extension was significantly associated with a short %Long (P<.001) but not with %Trans., Conclusions: Individuals with medial knee OA exhibited low pressure on the heel and hallux and short %Long of the COP path, and limitation of knee extension was associated with shortness of %Long. The shortness of %Long in the OA group likely resulted from insufficient knee extension during the heel-contact phase associated with low pressure on the heel. %Long is a useful parameter in gait analysis by using a foot pressure measurement system., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

[Purpose] Dysfunction of lower extremity muscles is one risk factor of falls for amputee patients. However, the change in muscle activity pattern and balance ability of amputees who have no experience in standing with prosthesis during the period from prosthesis fitting to regaining the ability to walk has never been studied. Therefore, the objectives of the present study were to elucidate changes over time in the muscle activity pattern and walking speed from first prosthesis fitting to hospital discharge. We also investigated the differences of muscle activity during standing between younger and elderly amputee patients. [Methods] Electromyography measurements were performed on the gastrocnemius of the intact leg during standing. The test subjects were asked to shift their center of gravity forward. [Results] Two unique patterns of gastrocnemius activities were observed over time. In a younger patient, the amount of muscular activity of the gastrocnemius gradually increased over time. In an elderly patient, however, the amount of muscular activity of gastrocnemius gradually decreased over time. [Conclusion] The time-dependent changes in gastrocnemius muscle activities are indicative postural control ability. Therefore, understanding the time-dependent changes in muscle activities during rehabilitation and the differences of postural control between younger and elderly patients would contribute to the development of effective rehabilitation programs for each patient.

Self-quenching of the triplet excited state of thiobenzophenone ((3)TBP*) in molecular solvents, a sodium dodecyl sulfate (SDS) micellar solution, and ionic liquids (ILs) was measured using nanosecond laser flash photolysis. In the molecular solvents and ILs, (3)TBP* single-exponentially decayed, and the decay was accelerated with increasing TBP concentration. Self-quenching rate constants (k(SQ)) obtained in the ILs were smaller than those in the molecular solvents with similar solvent viscosities, indicating that molecular diffusion is inhibited in the ILs. In the SDS micellar solution, the decay of (3)TBP* showed two components. The fast decay component was attributed to self-quenching of (3)TBP* which presents inside micelles containing two or more TBP molecules, while the slow decay component was from deactivation of single (3)TBP*. The decay of (3)TBP* in an IL, N,N,N-trimethyl-N-propylammonium bis(trifluoromethylsulfonyl)amide (TMPA TFSA), had only one decay component, showing that unlike the micelles, the local structure of TMPA TFSA does not have a long lifetime. The cage lifetime of TMPA TFSA was estimated to be between 17 and 20 ns.

Background and Purpose: Recently, serum deoxyribonuclease I (DNase I) activity has been highlighted as a potential diagnostic marker for transient myocardial ischemia. To evaluate whether serum DNase I activity can be a useful biomarker for diagnosing unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI), we investigated serial changes in DNase I levels after chest pain in UAP and NSTEMI (UAP/NSTEMI) patients., Methods and Results: Thirty-three and ten patients classified into the UAP/NSTEMI and the chest pain syndrome (CPS) group, respectively, were enrolled. The serum DNase I activity levels within 3h after chest pain and the absolute median value of percentage differences in serum DNase I activity levels from admission to 3h after hospitalization in the UAP/NSTEMI patients was significantly higher than those in the CPS patients. We evaluated the patients to show positive results for DNase I activity if the serum levels or percentage differences exceeded the corresponding cut-off values. The sensitivity and specificity of DNase I within 6h after chest pain in the UAP/NSTEMI patients without elevated levels of cardiac troponin T and the MB isoenzyme of creatine kinase were 89% and 88%, respectively., Conclusions: Serum DNase I activity can be a useful marker for the early diagnosis of UAP/NSTEMI after the onset of chest pain, irrespective of the evidence of myocardial injury., (Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Magnetic field effects (MFEs) on the photoinduced hydrogen abstraction reaction of benzophenone with phenol were investigated in ionic liquids (ILs) with a short alkyl chain (N,N,N-trimethyl-N-propylammonium bis(trifluoromethanesulfonyl)amide (TMPA TFSA)) and long alkyl chains ((N,N,N-trimethyl-N-octylammonium bis(trifluoromethanesulfonyl)amide (TMOA TFSA) and N-decyl-N,N,N-trimethylammonium bis(trifluoromethanesulfonyl)amide (DTMA TFSA)) by a nanosecond laser flash photolysis technique. In each ionic liquid, escaped radical yield of a benzophenone ketyl radical rapidly increased with increasing magnetic field strength (B) of 0 T < B≤ 0.01 T. At 0.01 T < B≤ 0.4 T, the escaped radical yield almost saturated in TMPA TFSA or gradually increased in TMOA TFSA and DTMA TFSA. At much higher fields of 0.4 T < B≤ 30 T, the yield gradually decreased, resulting in 10-15% decrease at 30 T. The observed MFEs can be explained by the hyperfine coupling and Δg mechanisms together with the relaxation mechanism. On the time profiles of the transient absorption observed for the benzophenone ketyl radical, MFEs were generated in the time range of 0 < t < 0.6 μs. The cage lifetimes of TMOA TFSA and DTMA TFSA were estimated to be at least 120 ns.

Hydrogen abstraction reactions of thiobenzophenone with thiophenol in solutions of varying viscosities (η=0.29-42.0 cP) were studied by a nanosecond laser flash photolysis under magnetic fields of 0-15.5 T. In alcoholic solutions, the escaped radical yield (Y) of thiobenzophenone ketyl radical showed appreciable magnetic field effects (MFEs). The observed MFEs can be interpreted with the Δg mechanism through the triplet radical pair. The relative escaped radical yield (R(1.7T)=Y(1.7T)/Y(0T)) decreased with increasing η at 0<η≤3.33 cP, but then the yield increased with increasing η at 3.33 cP<η≤22.2 cP. At much higher viscosity 22.2 cP<η≤42 cP, R(1.7T) values become 1.0 within experimental errors. Such quenching of MFE was explained by the spin-orbit coupling recombination of close radical pairs associated with high viscosity. The MFEs on the present reaction is extremely sensitive to the solvent viscosity in the vicinity of the radical pairs. Using this probe reaction, microviscosities of sodium dodecyl sulfate (SDS) and Brij35 micellar solutions were estimated., (© 2011 American Chemical Society)

Photo-Fries rearrangement reactions of 1-naphthyl acetate (NA) in n-hexane and in cyclohexane were studied by the magnetic field effect probe (MFE probe) under magnetic fields (B) of 0 to 7 T. Transient absorptions of the 1-naphthoxyl radical, T-T absorption of NA, and a short-lifetime intermediate (τ = 24 ns) were observed by a nanosecond laser flash photolysis technique. In n-hexane, the yield of escaped 1-naphthoxyl radicals dropped dramatically upon application of a 3 mT field, but then the yield increased with increasing B for 3 mT < B≤ 7 T. These observed MFEs can be explained by the hyperfine coupling and the Δg mechanisms through the singlet radical pair. The fact that MFEs were observed for the present photo-Fries rearrangement reaction indicates the presence of a singlet radical pair intermediate with a lifetime as long as several tens of nanoseconds.

Alcohol concentration dependences of photoinduced charge separation (CS) reaction of zinc tetraphenyl-porphyrin (ZnTPP) and duroquinone (DQ) were investigated in benzonitrile by a nanosecond laser flash photolysis technique. The photoinduced CS reaction was accelerated by the addition of alcohols, whereas the addition of acetonitrile caused little effect on the CS reactions. The simple theory was developed to calculate an increase in reorganization energies induced by the hydrogen bonding interactions between DQ and alcohols using the chemical equilibrium constants for the hydrogen bonding complexes through the concerted pathway and the stepwise one. The experimental results were analyzed by using the Marcus equation where we took into account the hydrogen bonding effects on the reorganization energy and the reaction free energy for the CS reaction. The observed alcohol concentration dependence of the CS reaction rates was well explained by the formation of the hydrogen bonding complexes through the concerted pathway, demonstrating the increase in the reorganization energy by the hydrogen bonding interactions.

The magnetic field effects (MFEs), caused by the Delta g mechanism, on the photoinduced hydrogen abstraction reaction of benzopheneone with thiophenol were investigated in alcoholic solutions of varying viscosities (eta = 0.55 to 59.2 cP) by a nanosecond laser flash photolysis technique. The escape yield of benzophenone ketyl radicals ( Y) gradually decreased with increasing magnetic field strength ( B) from 0 to 1.6 T. The relative yield observed at 1.6 T, R(1.6 T) = Y(1.6 T)/ Y(0 T), decreased with increasing eta in the range of 0.55 cP < or = eta < or = 5 cP, and then increased with increasing eta in the range of 5 cP < eta < or = 55.3 cP. When eta was higher than 55.3 cP, the R(1.6 T) value became 1.0, and MFEs were completely quenched. The observed eta dependence of the MFEs was analyzed by the stochastic Liouville equation (SLE), in which the effects of spin-orbit coupling by a heavy atom such as sulfur were taken into account. The observed MFEs were reproduced fairly well by the SLE analysis. The diffusion coefficients of the radicals obtained by the SLE were about three times smaller than those expected from the macroscopic solvent viscosities. One can probe the microviscosity in the vicinity of the radical pairs by observing MFEs on the present photochemical reaction system.

The magnetic field effects (MFEs) on photoinduced hydrogen abstraction reactions between benzophenone and thiophenol in an ionic liquid, N,N,N-trimethyl-N-propylammonium bis(trifluoromethanesulfonyl) imide (TMPA TFSI), were studied by a nanosecond laser flash photolysis technique under ultrahigh fields of up to 28 T. Extremely large and anomalous stepwise MFEs were observed for the first time. The escape yield of benzophenone ketyl radical decreased with increasing magnetic field strength (B) at 0 T

Ion-pair formation constants (mol(-1) dm3 unit), K(MX) for a univalent metal salt (MX) and K(MLX) for its ion-pair complex (ML+X-) with a crown ether (L) in water, were determined at various ionic strengths (I) and 25 degrees C by potentiometry with ion-selective electrodes for MX=NaPic, NaMnO4, NaBPh4, KPic, and KMnO4; and MLX = Na(18C6)Pic, K(18C6)Pic, and Na(18C6)BPh4, where Pic- and 18C6 denote a picrate ion and 18-crown-6 ether, respectively. Equations for analyzing I-dependence of logK(MLX) and logK(MX) were derived and fitted well to the I-dependence using a non-linear regression analysis. The equilibrium constants at I = 0 mol dm(-3), K(MLX) degrees and K(MX) degrees, were simultaneously obtained from the analysis. The experimental values of K(MLX) and K(MX) were only in agreement with the values calculated from K(MLX) degrees and K(MX) degrees , respectively, in the ranges of higher I.

Apoptosis induced in cancer cells by ionizing radiation, hyperthermia, and 5-fluorouracil (5-FU), termed "hyperthermochemoradiotherapy" (HCR), has been well studied in vitro; however, the role of apoptosis in the tumocidal effect of HCR for primary rectal cancers has not yet been clarified. Therefore, we examined the relationship between the therapeutic effect and induction rate of histological apoptosis in 16 patients with rectal cancers after HCR. Numerous Tunel-positive apoptotic cells were found in the tumor tissue after HCR, but few were found in the tumors which had not received HCR. The histological therapeutic effect was closely correlated to the rate of apoptosis. Thus, we suggest that HCR induces a therapeutic effect mainly through apoptosis in human rectal cancers.

In order to determine the actual distance between the active site and the substrate binding site, termed the basic protrusion, of Escherichia coli ribonuclease HI, synthetic oligonucleotide duplexes with gradually extended overhangs were used, in which the enzymatic cleavage was restricted to a single site with 2'-O-methylnucleosides. The affinity of the enzyme for each substrate was determined by kinetic analysis. It was found that the affinity increased markedly when one nucleotide was attached to the 3' end of the DNA strand of the nine-base-pair hybrid duplex and then increased slightly as the DNA strand was extended further, whereas elongation of the strand in the other direction caused no change. When a mutant enzyme, in which three lysine residues in the basic protrusion were altered to alanine, was used, no increase in the kcat/K(m) value was observed. The results indicate that, for the productive binding, the axis from the 3' to the 5' end of the RNA strand of the substrate duplex must be oriented in agreement with the direction from the active site to the basic protrusion of the enzyme. The distance between the active site and the basic protrusion in the enzyme-substrate complex was shorter than that anticipated in modeling studies. A dynamic structure refinement, referred to as the normal mode analysis, was carried out in order to simulate the fluctuations of the basic protrusion.

The effects of dialyzer membrane material and concurrent angiotensin converting enzyme (ACE) inhibitor on plasma bradykinin levels during hemodialysis were investigated by administration of 3 successive hemodialyses using a PAN DX membrane dialyzer and another 3 using a polysulfone membrane dialyzer with the order of the 2 sequences randomized, for 6 patients receiving concurrent treatment with ACE inhibitor and 6 others receiving no ACE inhibitor. With the PAN DX membrane dialyzer the plasma bradykinin concentration obtained from the dialyzer outlet was significantly higher than that from the inlet at 10 min, but not at 5 min after initiation of dialysis, whereas no significant difference between inlet and outlet bradykinin concentrations was observed at either time with the polysulfone membrane dialyzer. No significant difference was observed between the changes in plasma bradykinin concentration in cases involving concurrent ACE inhibitor and that in cases receiving no ACE inhibitor. The results suggest that the PAN DX membrane dialyzer stimulates bradykinin production, but also that its release of bradykinin is delayed, possibly because of adsorption and modified release of bradykinin by the PAN DX membrane, and that ACE inhibitor may have no significant effect on the change in plasma bradykinin levels.

We used predegenerated acellular grafts to bridge proximal and distal stumps of transected nerves and studied how the duration of predegeneration might affect axonal regeneration. Predegenerated acellular grafts were prepared by transecting the tibial nerve of donor rats and, after a period of degeneration, freeze-thawing a 40-mm long segment of the distal stump. Five degeneration periods were used: 0 days (for fresh grafts), 3 days, 1 week, 4 weeks, and 8 weeks. Fresh cellular grafts not treated with freeze-thawing were also used for comparison. Each graft was then transplanted to an isogeneic recipient rat, in which it was used to bridge the proximal stump of the transected left tibial nerve and the distal stump of the transected right tibial nerve. Six weeks were allowed for the regeneration of axons in all grafts. The regeneration was then assessed by studying transverse sections of the grafts, to determine the maximum length that the axons had regenerated, and the packing density of axons (percentage of sampled areas occupied by axons). The results show that axons had grown to the maximum length in the 4-week predegenerated grafts, and had the highest packing density in the 1-week predegenerated grafts. Regeneration in the fresh acellular (0-day predegenerated) and 8-week predegenerated grafts, especially the latter, was poor. We examine the results with reference to time-dependent events of Wallerian degeneration and propose that there are beneficial effects of multiple factors on the grafts during the first 4 weeks of predegeneration, causing a slow but significant improvement in their capability to support axonal growth. The subsequent rapid deterioration of such capability may be related to structural changes in the extracellular scaffold.

The effects of dialyzer membrane material and concurrent angiotensin converting enzyme (ACE) inhibitor on plasma bradykinin levels during hemodialysis were investigated. Six patients treated with an ACE inhibitor and 6 other patients not receiving an ACE inhibitor underwent three consecutive hemodialysis sessions with an AN-69 dialyzer and three sessions with a polysulfone dialyzer. The sequence of dialyzers (AN-69 followed by polysulfone or the reverse) was determined randomly. With the AN-69 membrane dialyzer, the plasma bradykinin level at the dialyzer outlet was significantly greater than that at the dialyzer inlet at 5 min but not at 10 min after initiation of dialysis, whereas no significant difference between inlet and outlet bradykinin concentrations was observed at either time with the polysulfone membrane dialyzer. The changes in plasma bradykinin level in patients with concurrent ACE inhibitor did not differ from those found in patients without ACE inhibitor. These results indicate that the AN-69 membrane stimulates bradykinin production at the initial stage of hemodialysis in patients with as well as without concurrent ACE inhibitor. Further study is necessary to clarify the exact role of ACE inhibitor in elevation of bradykinin levels during hemodialysis.

Nafamostat mesilate (NM), an ultrashort-acting multi-enzymatic inhibitor, is a useful anti-coagulant in high bleeding risk patients needing hemodialysis. We applied NM as a membrane plasmapheresis (MP) anti-coagulant in patients with high bleeding risk. Eleven patients, the majority with hepatic failure and active hemorrhagic foci or severe bleeding diathesis, could be treated with MP 22 times under anti-coagulation by 20-40 mg/h/NM by continuous infusion without any trouble. Celite-activated coagulation time (CCT) at the plasma separator inlet and outlet was adequately prolonged during MP, but CCT in systemic blood showed no prolongation throughout the procedure, because NM was rapidly inactivated. There was no observable blood coagulation in the extracorporeal circuit including the plasma separator. No adverse reaction or exacerbation of hemorrhage was noted throughout the MP. NM thus appears to be a useful and safe anti-coagulant not only for hemodialysis but also for MP in high bleeding risk patients.

We recently reported on an experimentally induced model of IgA nephropathy in mice by long-term oral immunization under the reticuloendothelial dysfunction, which was found to be effectively inhibited by the administration of the antiallergic agent sodium cromoglycate (SCG). On the basis of these findings, we investigated the participation of food antigens in patients with IgA nephropathy. We studied 24 patients with IgA nephropathy, 11 patients with primary glomerulonephritis (PGN) except IgA nephropathy and 11 healthy controls. Serum levels of immunoglobulins (IgG, IgA, IgE) and circulating immune complexes containing IgG (IgG-CIC) or IgA (IgA-CIC) were measured in the fasting state and 30, 60, 120 or 180 min after oral challenging with cow's milk (400 ml). After the oral challenge IgA-CIC levels remained within the normal range in healthy controls and in patients with PGN, while 3 out of the 24 patients with IgA nephropathy showed a transient elevation and 2 cases showed a significant rise of IgA-CIC levels. The levels of IgG, IgA, IgE and IgG-CIC remained uninfluenced by the challenge test in all subjects. In addition, we carried out the same challenge test under SCG administration. These cases indicating an oral-challenge-induced IgA-CIC elevation demonstrated an inhibition of this elevation, and in 3 out 7 patients who showed hyper-IgA-CIC-emia before and after oral challenge IgA-CIC levels returned to the normal range through SCG administration. These results suggest that food antigens participate strongly in the pathogenesis of some patients with IgA nephropathy, and that SCG is an effective agent for such patients.

A 74-year-old man had typical yellow nail syndrome, associated with pericardial effusion and hyperimmunoglobulinemia (IgG 3,179 mg/dl, IgM 402 mg/dl). A search of the literature fails to reveal a previously reported case of yellow nail syndrome associated with pericardial effusion.