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Background This study investigated the prevalence of sarcopenia or sarcopenic obesity and their association with frailty and protein-energy wasting (PEW) in hemodialysis patients. Methods The present study enrolled 117 adult hemodialysis patients (35% female, 64 ± 12 years old) from single units of a hemodialysis center. The patients were divided into four groups: normal, obese, sarcopenia, and sarcopenic obesity. Sarcopenia was diagnosed by Asian Working Group for Sarcopenia (AWGS) criteria, and obesity was defined as an extensive percent body fat mass greater than 40% in females and 30% in males. Skeletal muscle mass and percent fat mass were evaluated by multifrequency whole-body bioimpedance electrical analysis after a midweek dialysis session. Handgrip strength and a short physical performance battery (SPPB) were assessed before a dialysis session as indicators of muscle strength and physical performance. Moreover, participants completed the Kihon Checklist and the criteria proposed by the International Society of Renal Nutrition and Metabolism expert panel to classify frailty and PEW. We performed multivariate logistic regression analysis to identify the clinical risk of frailty and PEW in patients with sarcopenia or sarcopenic obesity. Results Forty-six (39.3%) patients were classified as normal; 18 (15.4%), as obese; 35 (29.9%), as having sarcopenia; and 18 (15.4%), as having sarcopenic obesity. The sarcopenia or sarcopenic obesity group had significantly lower handgrip strength than the normal or obesity group (all p < 0.05). In addition, the sarcopenia and sarcopenic obesity groups had significantly lower SPPB scores than the normal group (p < 0.05, respectively). In the multivariate analysis, the sarcopenic obesity group had a significantly higher risk of frailty than the normal group in the multivariate analysis after adjusting for age and gender (OR 4.518, 95%CI 1.218–16.752, p = 0.024). However, sarcopenic obesity was not associated with a higher likelihood of PEW, and sarcopenia imposed a significantly higher risk of PEW (OR 4.272, 95%CI 1.157–15.778, p = 0.029) than that in the normal group after adjusting for confounding factors. Conclusion Sarcopenic obesity was closely associated with frailty compared with the normal condition in HD patients. However, sarcopenic obesity was not associated with a higher likelihood of PEW.

Background To evaluate the relationship between phase angle (PA) measured by bioimpedance electrical analysis and protein-energy wasting (PEW) or frailty, and its impact on 2-year mortality in patients with hemodialysis (HD). Methods This retrospective observational study included 116 adult HD patients (35% female, 64 ± 12 years of age) in a single dialysis center. Patients were classified according to the PA quartiles into four groups (quartile 1, lowest; quartile 4, highest). International Society of Renal Nutrition and Metabolism (ISRNM) criteria and Japanese version of Cardiovascular Health Study (J-CHS) criteria were used to identify PEW and frailty. Results The lower PA group was associated with a greater risk of PEW (35% vs. 24% vs. 21% vs. 3%; p = 0.032), frailty (59% vs. 40% vs. 21% vs. 3%; p

Background Phase angle (PA), measured by bioelectrical impedance analysis (BIA) has been studied as indicator of nutritional status or muscle function in hemodialysis (HD) patients. It remains unclear if the phase angle is associated protein-energy wasting (PEW) or frailty, which are common complication in hemodialysis patients. The aim of this study is to determine whether BIA-derived PA is a marker of PEW or frailty in HD patients. Methods This retrospective observational study included 116 adult HD patients (35% female, 64 ± 12 years of age) in a single dialysis center. Patients were classified according to the PA quartiles into four groups; 1) first quartile: PA Results The lower PA group was associated with a greater risk of PEW (35% vs. 24% vs. 21% vs. 3%; p = 0.032), frailty (59% vs. 40% vs. 21% vs. 3%; p Conclusions Lower PA was associated with a greater risk of PEW and frailty in HD patients.

Patients under hemodialysis present protein-energy wasting (PEW), which is related with higher mortality rates. The study aimed to determine whether intradialytic resistance exercise training could improve physical performance, physical activity, and PEW in hemodialysis patients. In single center study, 75 hemodialysis patients were enrolled in an intradialytic resistance exercise training consisting of 20 min of adapted leg press, with a gymnastic ball, 3 days/week, during 9 months on the same day of hemodialysis therapy. Physical performance by short physical performance battery (SPPB), physical activity by life space assessment (LSA), and PEW score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008 were assessed at baseline and after 9 months. Intradialytic resistance exercise training significantly improved SPPB score, LSA score, and PEW score (all, P

A newly developed prototype of zero-voltage soft-switching (ZVS) high-frequency resonant for inductive power transfer (IPT) applications is presented in this paper. By adopting the burst mode pulse-density-modulation (PDM) scheme with resonant frequency tracking, the load power can be continuously regulated under the conditions of full-range soft-switching due to the undamped resonant currents through the coils, thereby the current surges which appears with the conventional PDM scheme can be eliminated effectively. The essential performances on the output power regulation and soft-switching operations are demonstrated in experiment using a class of 400 W-500 kHz prototype, and the validity is evaluated from the practical point of view.

Patients under hemodialysis present protein-energy wasting (PEW), which is related with higher mortality rates. The study aimed to determine whether intradialytic resistance exercise training could improve physical performance, physical activity, and PEW in hemodialysis patients. In single center study, 75 hemodialysis patients were enrolled in an intradialytic resistance exercise training consisting of 20 min of adapted leg press, with a gymnastic ball, 3 days/week, during 9 months on the same day of hemodialysis therapy. Physical performance by short physical performance battery (SPPB), physical activity by life space assessment (LSA), and PEW score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008 were assessed at baseline and after 9 months. Intradialytic resistance exercise training significantly improved SPPB score, LSA score, and PEW score (all, P 0.05). In addition, intradialytic resistance exercise training improved SPPB score in patients with moderate and severe PEW subgroups (P 0.05), associated with reduced prevalence of the patients with moderate to severe PEW (53% vs. 36%, P 0.05). Intradialytic resistance exercise training was safe and effective to improve physical performance, physical activity, and PEW in hemodialysis patients.

We have developed a novel ozone generator which can produce high concentration ozone up to 300 g/Nm3 (20 wt%). The ozone production efficiency is significantly improved in comparison with a conventional ozone generator ; the energy consumption is 10 kWh/kgO3 at a ozone concetration of 240 g/Nm3 (16 wt%) In addition, the novel ozone generator is much smaller in size. The development of the novel ozone generator is expected to extend ozone applications for various purposes, such as pulp bleaching.

The effect of therapeutic double filtration plasmapheresis (DFPP) was clinically investigated for drug refractory neurological disorders. DFPP therapy was performed 181 times for 10 patients who were treated with medical therapy of steroid or immunosuppressive drugs without any improvement of their symptoms. After the induction of DFPP therapy the neuromuscular disturbances were soon ameliorated in 9 cases of them. After DFPP, serum levels of IgG, IgA or IgM were decreased as follows: IgG 0.53 +/- 0.16; IgA 0.60 +/- 0.11; IgM 0.59 +/- 0.09 (M +/- SD). After the DFPP therapy there was no relapse in improved 9 cases. But we could not regard the immunologic markers as the index of efficacy of DFPP. Because serum levels of IgG, IgA or IgM showed a tendency to decrease by using drugs, when we didn't observe any improvement of symptoms. These results suggest that DFPP is a beneficial therapy for neurological diseases who had no effect with drug therapy, however, serum concentrations of the immunologic markers were not necessarily correlated to the severity.

1966年9月より1989年6月まで当施設で慢性維持透析患者の併存病変に対して施行した緊急手術72例, 待期手術164例について比較検討した. 手術死亡率は, 緊急手術で22%, 待期手術で0.6%であり, 術後合併症も緊急手術で多かった. 最近, 糖尿病性腎症例の緊急手術例を3例経験したが, 全例に術前合併症を認め, 術後合併症も心不全や感染症を全例に認めた. 糖尿病性腎症緊急手術例では, 特に水分管理と院内感染予防が重要である. 低分子ヘパリンを用いた術後初回透析で凝固時間の延長と後出血を認めず十分に施行できた. 術後透析および術直前透析では, 低分子ヘパリンやnafamostat mesilateを用いた透析か, EVA膜少ヘパリン透析が有用である. 汎発性腹膜炎等では手術にて感染および壊死巣を除去し, その後透析を行い, 上部消化管穿孔等では, 前日透析してあれば即手術を, 前々日の透析であれば透析後に手術をするのがよいと考えている.

急性肝不全 (AHF) に対する血漿交換 (PE) の効果と限界について検討した. 1975年9月から1987年2月までに当科でAHFで血液浄化法を施行した44例をPE中心治療群26例と血液吸着 (HA) 治療群18例に分け検討した.救命率はそれぞれ27%, 22%と両群に差がなく, 剖検時肝重量にも差を認めなかった. PE施行平均回数は, 死亡例で救命例の2倍であった. PE前後でビリルビン, 胆汁酸は除去され, アンチトロンビンIII, C4は補充されるが正常値まで改善しなかった. PEはAHF治療に対し延命効果があるが, 除去, 補充療法としては不十分であった. PE施行例の中に長期間覚醒後肝不全で死亡した4例を経験した. その剖検時肝病理組織像はimpaired regeneration syndrome (IRS) に類似していた. AHFのIRS類似例の肝再生不良像に注目し, 肝再生を促す人工補助肝の開発が必要と思われた.

In patients with renal failure on hemodialysis cardiovascular disease is a major cause of death. It has been reported that diminished heart rate variability (HRV) relates to the unfavorable prognosis in post-infarction and/or heart failure patients. However, the prognostic value of HRV in hemodialysis patients has not been fully established.Time- and frequency-domain analysis of HRV on 24-hour ambulatory electrocardiography recording was assessed prospectively in 383 chronic hemodialysis patients (220 men and 163 women, mean age 57+/-13 years, ejection fraction 65+/-12%). During 2110+/-903 days of follow up, 146 patients died (31 congestive heart failure, 13 fatal myocardial infarction, 13 sudden deaths, 26 stroke, and 63 non-cardiovascular deaths). A Cox univariate analysis identified the following factors as predictors of both all-cause and cardiovascular death: age, gender, ejection fraction, presence of diabetes, and HRV parameters calculated in the time- and frequency-domain. In multivariate analysis, a low standard deviation of all normal RR intervals (SDNN) value was the strongly associated with both all-cause and cardiovascular death (hazard ratios [95% confidence intervals] 0.988 [0.982-0.994] and 0.984 [0.974-0.993], respectively). From Kaplan-Meier survival curves, the incidence of all-cause and cardiovascular death was much greater in patients with a low SDNN (75 msec), even after adjusting for the presence of diabetes (P0.0001).Decreased HRV on 24-hour ambulatory electrocardiography is an independent predictor of mortality in chronic hemodialysis patients.

The surface recombination of nitrogen atoms on various materials was investigated at atmospheric pressure. The afterglows of pure nitrogen discharge are injected into a surface loss test unit, whose path wall is composed of the materials to be examined. Measurement of the nitrogen atom densities at several points in the flowing afterglows reveals the temporal decay characteristics. The results are compared with two-dimensional numerical simulations to obtain the surface loss probability γ. Among the seven materials we studied (stainless steel, aluminium, titanium, alumina, Pyrex glass, aluminium nitride and boron nitride), stainless steel was found to have the highest γ value: 1.8 × 10−3; the lowest was for boron nitride: 4.8 × 10−5. The dependence of γ on surface roughness and temperature was also examined.

Lasing characteristics of an 80 mm-bore copper vapor laser (CVL) are investigated experimentally to increase the laser output power and efficiency. The experiment is carried out at a constant temperature of the CVL discharge tube. It is found that the laser output power increases proportionally to the discharge voltage across the plasma in the CVL discharge tube and that the discharge voltage is more important for the increase of laser output power than the population density of the metastable lower laser level. Higher discharge voltage is obtained with a buffer gas of neon and hydrogen mixture rather than with neon gas only. This suggests that hydrogen is effective to increase the recombination rate of the charged particles. A laser output power of 210 W is obtained with the mixed buffer gas by applying the excitation pulses of 5 kHz to 80 mm-bore discharge tube of 2.1 m discharge length.© (1992) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

This study was undertaken to assort the group of posthepatectomy hyperbilirubinemia by occurring time for helping elucidate its indication of plasma exchange (PE). PE was carried out for 14 cases among 198 hepatectomized patients. The 14 cases were classified for 3 groups due to the period between operation and PE. 1: Early type (less than 2 weeks), 2:Intermediate type (2 less than-less than 8 weeks), 3: Late type (greater than 8 weeks). The results were as follows. Number (liver cirrhosis (LC)) [table: see text]. The effect was expected for the early groups since PE would remove overload against the regenerating residual liver. However, there were no survival cases among the early group or LC group. These results suggest that PE may be effective for the slowly increasing hyperbilirubinemia in not cirrhotic patients and that the state of hyperbilirubinemia is the terminal stage for LC patients even under the particular situation such as posthepatectomy.

A method has been developed for real-time measurement of nitrogen atom density in atmospheric pressure post-discharge flows. In this method, nitric oxide is supplied to the downstream of a nitrogen discharge as a reactant. Our chemical simulation has revealed that the injected nitric oxide is consumed mainly by reductive reaction with nitrogen atoms or oxidative reaction with oxygen atoms. The number density of atomic nitrogen is determined almost instantaneously through the measurement of nitric oxide and nitrogen dioxide densities with a gas analyser. The experimental verification was carried out with a dielectric barrier discharge unit as a nitrogen atom source, and the results showed good agreement with simulation predictions.

(1987). Control of deposition rates in hot wire TIG welding. Welding International: Vol. 1, No. 8, pp. 736-742.

The spattering in the pulsed GMA welding with a short arc length was investigated and a practical method for suppressing the spatter was presented. An arc length is usually kept short in order to raise the welding speed without a weld flaw. But, in such a case, the short circuit between the wire and the base metal frequently takes place. The spattering was observed with a highspeed framing camera and changes of the gas density around the arc were observed by the shadowgraph method. It was made clear that the spattering was resulted from the short circuit. The spatter was genearted by the rapid Jouleheating at the minimum cross-section of the molten metal.The practical method for suppressing the spatter was to control the current waveform so that the short circuit may take place during the base duration.With the inverter controlled power source, the amount of splashed spatter was decreased up to onetenth of that obtained with the conventional pulsed GMA welding power source.

The optimum relation between welding current and wire melting rate for the high-speed hot wire GTA welding is decided and a new power control system is developed.The new system has two merits, one is that the power source is simplified by using a part of the arc current as the wire heating current, and the other is that a stable melting of wire is realized by monitoring the voltage drop across the wire extension.The results in this study are as follows.(1) The welding speed can be increased by pre-heating the wire. The effect of speed-up is promoted especially in the case that the bead width is enlarged by adding the hot wire deposit.(2) The optimum relation between welding current and wire melting rate for high speed welding is almost independent of the plate thickness.(3) In the new control system, the welding speed can be raised up to two times of that obtained with the cold wire GTA welding without troublesome adjustments of the power source.

It has been a matter of controversy as to whether c-myc gene expression is activated in human hepatocellular carcinoma (HCC). We observed that the c-myc mRNA level in HCC was similar to that of the adjacent non-cancerous portion, as determined in freshly obtained specimens after a partial liver resection. However, the c-myc transcript was at a low level in non-cancerous tissue which was biopsied prior to surgery, whereas it was still at a high level in HCC obtained without performing hepatectomy. These results suggest that the high transcript level observed in the non-cancerous tissue from the excised liver relates to liver resection itself, and that the c-myc gene expression is enhanced in the HCC.

Cerebral, hepatic, renal cortical, and medullary tissue blood flows of the dog during hemorrhagic shock were measured continuously using the thermoelectrical method. The effects of blood replacement, adrenergic alpha-stimulator and -blockade and hydrocortisone on the tissue blood flows were studied. After hemorrhage, cerebral blood flow was well maintained while renal cortical blood flow was poorly maintained. Following retransfusion, the blood flow returned rapidly to the brain and slowly to the renal cortex. Norepinephrine, phentolamine, and hydrocortisone were not effective in maintaining the organ blood flows in shock. However, when norepinephrine was given systemically and phentolamine administered to the renal artery simultaneously during shock, both cerebral and renal flows were well maintained. After the blood replacement and administration of alpha-blockade or hydrocortisone, all the measured blood flows returned to normal levels.

千葉大学第2外科および千葉社会保険病院にて, 1969年から1985年までに血液透析に導入した症例のうち75例について, 骨関節に関する患者の訴えを聴取するとともに, 骨パラメーターの測定を行い, 骨関節痛の頻度, 骨関節痛と骨パラメーターの関連について検討した. 対象症例は, 男性50例, 女性25例で平均46.4±12.0 (M±SD) 歳, 平均透析歴は8.8±4.7年である. 原疾患は, 慢性糸球体腎炎51例, 糖尿病性腎症6例, その他18例であった。全症例の63%に骨, 関節痛を認めた. 運動痛の部位別頻度は, 膝31%, 肩27%, 手指15%, 足および腰12%, 肘11%, 股5%, 手首4%であった. 自発痛の部位別頻度は, 上肢15%, 下肢8%, 腰背部3%であった. 骨関節痛は, 透析歴とともに増加した. 40歳代の女性では有症状率82%と高率であった.有症状群では, 無症状群に比してβ2マイクログロブリンが高値を示し, C-PTH, INS-PTHおよびオステオカルシンは高値傾向を示した. 有症状群では, 続発性上皮小体機能亢進症が関与しているものと思われた.MD法総スコアとΣGS/Dスコアにおいて, 両群とも透析歴と正の相関が認められたが, MCIスコアにおいては, 有症状群に透析歴と正の相関を認めた. 総合評価で正常でも50%の有症状群を示し, III度では69%と高率となったが, 有意差はなかった.運動痛群では, 自発痛群に比しΣGS/Dスコアが高値を示し, MD法総スコア, MCIスコア, 血清Pi, C-PTH, INS-PTHは高い傾向を示し, 血清Ca値は低い傾向を示した. 運動痛群は, 続発性上皮小体機能亢進症が主体と思われた. 自発痛群のアルミニウム骨症との関連については不明であった.以上, 透析患者の骨関節痛については, 患者の微細な訴えまで耳を傾け, 早期より保存的治療を開始することが重要であると思われた.

A new technique is described for repeated intermittent access to the systemic circulation in fully conscious rats for infusion or extracorporeal circulation. The femoral artery and vein of each rat were cannulated. The cannulas were then passed subcutaneously and exteriorized through the skin of the tail 2 cm from its base. The exposed cannulas were protected by a special plastic device. This new approach did not immobilize the rat except during access to the circulation; even then, only the distal portion of the tail was immobilized, thus allowing the animal to move freely. This way repeated access to the systemic circulation was easily achieved in the fully conscious rat.

A newly developed low density lipoprotein (LDL) selective adsorption column from the separated plasma was applied to one patient of heterozygous familial hypercholesterolemia for 20 months at intervals of two weeks. LDL selective adsorption column, Liposorber LA-40, contains 400 ml of swollen dextran sulfate cellulose beads. The long-term, 20 month results of treatment with LDL selective plasma adsorption therapy are reported. LDL selective plasma adsorption therapy by Liposorber is useful in decreasing LDL-cholesterol of familial hypercholesterolemia and is more specific and produces a smaller loss of useful components of the serum than the double filtration plasmapheresis treatment. This treatment is effective in improving clinical conditions of familial hypercholesterolemia. In spite of our lengthy treatment with this therapy, no blood transfusion and no replacement of fluids was done in 20 months.

A new dialysis system using direct haemoperfusion with collodion-micro-encapsulated, albumin-coated, bead-shaped petroleum activated carbon and artificial kidney in series has been devised. This new system has been applied to the purpose of treatment of patients in chronic renal failure, fulminant hepatic failure and intoxication.

Serum osmolality gap (OG), the difference between measured and predicted serum osmolality, has been shown to be an excellent parameter to express the amount of conventionally unmeasurable middle-molecular-weight substances. OG was determined on 29 patients with multiple organ failure (MOF) treated with or without hemopurification. OG significantly increased in proportion to the increase in the number of failed organs and correlated well with APACHE II score. Nonsurvivors showed persistently high OG. OG decreased with plasma exchange and hemoadsorption, but not with hemodialysis, indicating that pathogenic factors can be removed effectively with plasma exchange and hemoadsorption. The patients with OG greater than 20 mOsm/kg-H2O had very little possibility of survival. These results indicate that OG is an easily determinable, effective parameter to evaluate the severity of the patients' condition, efficacy of hemopurification in removing pathogenic middle-molecular-weight substances, and the prognosis of the patient in the treatment of MOF.

The expression of oncogenes (c-myc, c-fos, c-Ki-ras, c-Ha-ras, and p53) was examined by Northern blot analysis using freshly isolated human colorectal and gastric cancers and noncancerous portions as the controls. Remarkably high levels of c-myc expression were found in colorectal cancers (eight of 11), but not in gastric cancers. High levels of c-myc expression were also detected in colorectal polyps and in metastatic liver tumors. In colorectal polyps, the transcript levels significantly correlated with the histologic malignancy and the size. In contrast, neither c-fos nor c-Ki-ras was overexpressed in colorectal and gastric cancers, and transcripts of c-Ha-ras and p53 were not evident in any tissue examined. In light of these observations the c-myc expression may be specifically associated with the evolution of colorectal cancer as well as progression and maintenance stages, hence may prove to be a useful marker to evaluate the malignant potential of colorectal polyps.

It has been reported that the survival of hemodialysis (HD) patients is poor, and the leading cause of death is cardiovascular disease. To identify high-risk patients and treat them carefully, we developed a scoring system to evaluate their 15-year prognosis in a prospective cohort study. We analyzed data from 312 and 310 patients to develop and validate the prediction model, respectively. The association of potential risk factors with death was tested by Cox proportional-hazards analysis, and a risk scoring model was developed. Then, the model was validated. Two hundred patients (64.1 %) in the cohort for model development died. Six independent prognostic factors were retained in the final model, and each was assigned a score proportional to its regression coefficient: 65 years or older, 3; diabetic nephropathy, 3; hypotension, 1; pre-HD cardiothoracic ratio ≥50 %, 1; pre-HD BNP ≥250 pg/mL, 1; and pre-HD numbers of abnormal findings on electrocardiograms = 0, 1, 2, or larger, 0, 1, 5. The patients were categorized as follows with their scores: group 1 (low risk), 0; group 2, 1 to 3; group 3, 4 to 5; and group 4 (high risk), 6 and higher. In the cohort for model validation, groups 2 to 4 showed a higher risk than group 1: group 2, hazard ratio 4.66 (95 % confidence interval 2.25, 9.64); group 3, 13.62 (6.48, 28.63); and group 4, 20.86 (9.60, 45.31). A new risk scoring system for predicting 15-year mortality was developed. This system may be useful for evaluating HD patients’ prognosis.