Usefulness of assessment of the Clinical Frailty Scale and the Dementia Assessment Sheet for Community-based Integrated Care System 21-items at the time of initiation of maintenance hemodialysis in older patients with chronic kidney disease

INTRODUCTION

We examined whether the Clinical Frailty Scale (CFS), a widely adopted tool for stratifying the degree of frailty, and the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21), a simple tool for simultaneous assessment of impaired cognition and impaired ADL, at the time of initiation of hemodialysis is useful tool of older patients for the outcome and prognosis.

METHODS

Data for 101 patients aged 75 years or older (mean age, 84.3 years) with ESRD who were initiated on hemodialysis and could be followed up for a period of 6 months were reviewed.

RESULTS

The 6-month survival curves showed a significantly higher number of deaths in the frailty (CFS≥5) group than in the normal to vulnerable (CFS<5) group (p<0.01). The CFS level was also significantly higher (6.5±1.5) in patients who died within 6 months of dialysis initiation as compared with that (4.6±1.7) in patients who survived (p<0.01). On the other hand, the total score of DASC-21 was related to need for inpatient maintenance dialysis (p<0.01). The total score on the DASC-21 were found as showing significant correlations with the CFS level. The IADL outside the home was identified in the DASC-21 sub-analyses as being correlated with CFS.

CONCLUSIONS

The CFS and the DASC-21 appeared to be a useful predictive tool of outcome and prognosis for older patients being initiated on hemodialysis. Assessment by the CFS or the DASC-21 might be useful for selecting the renal replacement therapy by shared decision-making and for advance care planning.

Anti-glomerular basement membrane disease developing 3 years after the development of Sweet syndrome and 1 year after the development of anti-neutrophil cytoplasmic antibody-associated vasculitis: a case report

A 73-year-old Japanese woman, with a history of Sweet syndrome diagnosed 3 years earlier and anti-myeloperoxidase (MPO) antibody anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis diagnosed 1 year earlier, presented with an episode of rapidly progressive glomerulonephritis (RPGN) with anti-glomerular basement membrane (GBM) disease. At the time of diagnosis of the ANCA-associated vasculitis 1 year earlier, serological testing yielded a negative result for anti-GBM antibody. However, at the present visit, serology for anti-MPO antibody was negative, while that for anti-GBM antibody was positive. This is the first report of anti-GBM disease developing sequentially after Sweet syndrome and ANCA-associated vasculitis. This case may provide clues to the potential immunological links among these three distinct conditions.

Selective formation of acetate intermediate prolongs robust ethylene removal at 0 °C for 15 days

Efficient ethylene (C₂H₄) removal below room temperatures, especially near 0  °C, is of great importance to suppress that the vegetables and fruits spoil during cold-chain transportation and storage. However, no catalysts have been developed to fulfill the longer-than-2-h C₂H₄ removal at this low temperature effectively. Here we prepare gold-platinum (Au-Pt) nanoalloy catalysts that show robust C₂H₄ (of 50 ppm) removal capacity at 0 °C for 15 days (360 h). We find, by virtue of operando Fourier transformed infrared spectroscopy and online temperature-programmed desorption equipped mass spectrometry, that the Au-Pt nanoalloys favor the formation of acetate from selective C₂H₄ oxidation. And this on-site-formed acetate intermediate would partially cover the catalyst surface at 0 °C, thus exposing active sites to prolong the continuous and effective C₂H₄ removal. We also demonstrate, by heat treatment, that the performance of the used catalysts will be fully recovered for at least two times.

Relationship between the urinary Na/K ratio, diet and hypertension among community-dwelling older adults

The association between the urinary sodium (Na)/potassium (K) ratio and hypertension is well recognized. We investigated whether the urinary Na/K ratio might be associated with hypertension in community-dwelling older adults and whether the association was influenced by habitual dietary patterns. We enrolled a total of 684 older adults (mean age, 76.8 years) and conducted health examinations at Kusatsu, Japan, in 2021. The urinary Na/K ratio was found to be independently associated with systolic blood pressure (SBP) (p < 0.0001), years of education (p = 0.0027), number of cohabitants (p = 0.0175), estimated glomerular filtrate rate (eGFR) (p = 0.0244), and Geriatric Depression Scale short-version (GDS15) score (p = 0.0366). In addition, an unsupervised hierarchical clustering analysis revealed a spectrum of habitual dietary patterns for higher and lower values of the urinary Na/K ratio. The decision tree indicated that the urinary Na/K ratio was associated with the history of milk consumption. A positive history of daily milk consumption predicted a mean urinary Na/K ratio of 2.8, and a negative history of daily milk consumption predicted a mean urinary Na/K ratio of 3.3. Furthermore, the frequency of fruit and vegetable consumption also predicted the urinary Na/K ratio. The relationship between the urinary Na/K ratio and hypertension was influenced by the frequency of consumption of milk, fruits, and vegetables in the subjects. This finding might be due to the influence of education and/or depression. The results suggested the importance of nutritional education in the development of hypertension.

Preparation of Ordered Anodic Porous Alumina with Single-Nanometer-Order-Size Holes by Atomic Layer Deposition

Ordered anodic porous alumina with controlled-size holes on the order of a single-nanometer scale was obtained by the atomic layer deposition (ALD) of Al₂O₃ or TiO₂. The thin metal oxide layers of uniform thickness were formed successfully on the inner wall of the hole of the ordered anodic porous alumina with high aspect ratios by ALD. The hole diameter of the ordered anodic porous alumina could be controlled precisely by adjusting the number of cycles of ALD. The obtained anodic porous alumina with an ordered hole arrangement of reduced holes will be applied to various application fields requiring uniform-sized holes on the order of a single-nanometer scale, such as the starting material for preparing various types of quantum effect devices.

Efficacy and safety of low-dose corticosteroid with azathioprine in the treatment of elderly-onset IgA vasculitis with nephritis

The diagnosis of elderly-onset IgA vasculitis (IgAV) and its prognosis can be difficult to ascertain because of its rarity and the frequent presence of comorbidities. Furthermore, the treatment of elderly-onset IgAV remains controversial. We report a case of IgAV in an 87-year-old patient. Renal involvement was detected early during the IgAV follow-up. He was treated with low-dose corticosteroid and azathioprine, which led to a complete remission without any adverse effects. This suggests that precise intervention with early diagnosis and careful renal follow-up may prevent renal failure and that low-dose steroids with azathioprine can be an effective treatment for elderly-onset IgAV with nephritis.

Low-dose corticosteroid with mizoribine might be an effective therapy for elderly-onset ISKDC grade VI IgA vasculitis

Both the diagnosis of elderly-onset IgA vasculitis (IgAV) and its prognosis can be difficult because of its rarity and the likely presence of comorbidities. Furthermore, the treatment of elderly-onset IgAV remains controversial: the ideal dosages of corticosteroid and/or immunosuppressants have not been determined. In the elderly, corticosteroid adverse effects can lead to severe outcomes, and a consensus regarding its benefit and risk balance has not been reached. We report a case of IgAV in an 89-year-old patient who was admitted to our hospital to investigate a 30-day history of palpable purpura and pitting edema on her leg. A renal biopsy showed membranoproliferative glomerulonephritis with IgA deposits (The International Study of Kidney Disease in Children (ISKDC) grade VI), which is a predictor of a poor prognosis; these findings led to early intervention with low-dose corticosteroid (15 mg/day) and mizoribine. As a result, a complete remission without obvious adverse effects was obtained. Early intervention with low-dose corticosteroid and mizoribine based on renal histopathology results might be an effective treatment for elderly-onset ISKDC grade VI IgAV.

Citrullinated histone H3 expression in anti-neutrophil cytoplasmic antibody-associated vasculitis in older Japanese autopsy patients

AIM

Neutrophil extracellular traps play key roles in the necrotizing vasculitis associated with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). However, the relationships between neutrophil extracellular traps formation and the distribution and phase of vasculitis are not well understood. In the present study, we clarified the clinicopathological characteristics of older AAV patients, as well as the expression of citrullinated histone H3 (citH3), a marker of neutrophil extracellular traps, in autopsied AAV patients.

METHODS

We reviewed autopsy cases that were carried out at Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan, from 2001 to 2018. The expression of citH3 was determined by immunostaining.

RESULTS

AAV patients (six cases) were elderly (aged 73-94 years; three men and three women; myeloperoxidase anti-neutrophil cytoplasmic antibody-positive, five cases; proteinase-3 anti-neutrophil cytoplasmic antibody-positive, one case; disease duration was 1.5-5.5 months; and patients were treated with steroids. All patients had necrotizing vasculitis in the medium-to-small-sized vessels in various organs, and also severe vasculitis-associated lesions including brain hemorrhage, alveolar bleeding, interstitial pneumonia, crescentic nephritis, acute pancreatitis and gastrointestinal bleeding. Expression of citH3 was associated with the activity of inflammation.

CONCLUSIONS

We report severe clinicopathological characteristics of AAV in older patients. Expression of citH3 was a useful marker to evaluate vasculitis severity. Identification of these features might aid in the diagnosis of AAV. Geriatr Gerontol Int 2019; 19: 259-264.

Socioeconomics of Administering Rituximab for Nephrotic Syndrome

Nephrotic syndrome is a type of intractable disease caused by a disorder in the kidneys, which produces swelling. Although some patients show rapid improvement and recover completely with conventional treatment, many others experience frequent recurrence (frequently relapsing nephrotic syndrome) while some remain dependent on the same high dose of steroids they were initially prescribed at the start of treatment (steroid-dependent nephrotic syndrome). In the latter cases, side effects of prolonged steroid use are a major issue. Some reports show that administering rituximab is effective in treating patients with steroid resistance. However, drugs like rituximab, directed at specific molecular targets, are generally expensive and therefore need to be evaluated from a health economics perspective before being approved for widespread use. The research team compared the number of relapses and total medical costs in the 24-month period before and the same period after patients took rituximab. We found that relapse decreased from a mean of 4.30 (±2.76) times to 0.27 (±0.52) times, and the total medical costs shrank from USD 2,923 to 1,280 per month (mainly the result of lower inpatient costs). The study also identified a correlation between lower urinary protein levels and a reduction in total medical costs. Rituximab, therefore, proved beneficial in both clinical and cost-effective terms. While rising healthcare costs are becoming a major social problem, we should expect that the development of new drugs with high cost performance will be encouraged from the vantage of socioeconomics.

Rituximab as a Therapeutic Option for Steroid-Sensitive Minimal Change Nephrotic Syndrome in Adults

Minimal change nephrotic syndrome (MCNS) usually responds to steroids but frequently relapses, requiring additional treatment with immunosuppressive agents. Rituximab is a chimeric murine/human monoclonal immunoglobulin G1 antibody that targets CD20, a B-cell differentiation marker. B-cell recovery begins at approximately 6 months following the completion of treatment. Rituximab has a beneficial effect, with the sustained remission or reduction of proteinuria in patients with steroid-dependent MCNS. Relapses are thought to be associated with an increase in CD19 cells. The mean serum half-life of rituximab was reported to be 10-15 days in patients with steroid-dependent MCNS. Only infusion reactions, such as rash and chills, occurred after single-dose rituximab infusion and can be managed by pre-medication or infusion rate adjustments. Even though severe adverse effects of rituximab are not expected, we must be aware of potentially life-threatening adverse effects. Controlled randomized trials that include adult patients with steroid-dependent MCNS are required to prove the efficacy and safety of rituximab and to evaluate the cost-effectiveness of rituximab treatment. In this review, we highlight recent studies and discuss the effects of these studies on the management of patients with MCNS in adults.

Deposition of a titania layer on spherical porous silica particles and their nanostructure-induced vapor sensing properties

A titania-stearic acid hybrid layer was deposited onto well-defined silica-hexadecyltrimethylammonium hybrid spherical particles with 854 nm size to obtain nanoporous particles with a useful hierarchical core-shell structure. The deposition of a 35 nm-thick titania layer was confirmed by transmission electron microscopy. The core-shell particles were washed with acidic ethanol (solvent extraction) and calcined at 550 °C for 5 h to remove the template, resulting in the formation of nanoporous titania coated nanoporous silica spherical particles, which have a bimodal pore size distribution attributed to the hierarchical porous core and porous shell structure. The nanoporous titania coated particles exhibited an unusual crystal phase transition; only anatase was present even after the calcination at 1000 °C for 1 h. This would be due to the interfacial bonding between the core silica and the shell titania, preventing the crystal phase transition from anatase to rutile. On the other hand, the direct calcination of the titania-stearic acid coated particles without solvent extraction led to a shell composed of both anatase and rutile. The transformation to rutile could be caused by the strong exothermic reaction during the oxidative decomposition of the occluded stearic acid. Furthermore, the intense exothermic reaction induced the formation of a yolk-shell structure, which played a role in the sensitive/selective sensing properties for acetic acid when the yolk-shell particles were coated onto a nanomechanical Membrane-type Surface stress Sensor (MSS).

Cost-Effectiveness of Administering Rituximab for Steroid-Dependent Nephrotic Syndrome and Frequently Relapsing Nephrotic Syndrome: A Preliminary Study in Japan

With regard to the use of rituximab for patients with steroid-dependent nephrotic syndrome and frequently relapsing nephrotic syndrome, not only has the regimen not been clinically verified but also there is a lack of health economics evidence. Therefore, we conducted a prospective clinical study on 30 patients before (with steroids and immunosuppressants) and after introducing rituximab therapy. Relapse rates and total invoiced medical expenses were selected as the primary endpoints for treatment effectiveness and treatment costs, respectively. As secondary endpoints, cost-effectiveness was compared before and after administering rituximab in relation to previous pharmacotherapy. The observation period was 24 months before and after the initiation of rituximab. We showed that there was a statistically significant improvement in the relapse rate from a mean of 4.30 events before administration to a mean of 0.27 events after administration and that there was a significantly better prognosis in the cumulative avoidance of relapse rate by Kaplan–Meier analysis (p < 0.01). Finally, the total medical costs decreased from 2,923 USD to 1,280 USD per month, and the pre–post cost-effectiveness was confirmed as dominant. We, therefore, conclude that treatment with rituximab was possibly superior to previous pharmacological treatments from a health economics perspective.

Joint Space of the Human Knee and Hip Joint under a Static Load

In order to study the joint contact and joint space of statically loaded human knee and hip joints, observations of serial slices of joint specimens which were frozen during the application of a load were carried out. In the intact joints, the articular cartilage surfaces did not come into direct contact with each other even under a load of more than twice that of the body weight. The minimum distance between cartilage surfaces in each specimen ranged from 0.2 to 0.6 mm. The Indian ink which was injected into the joints before the load application was squeezed out of some areas of the remaining joint space, but a dye-free fluid apparently remained in this space.

Based on our findings, the definition of joint contact and the lubrication mechanism in the intact human joint have been discussed.

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A, Schneider R, De Smet S, De Raedt S, Derom E, Depuydt P, Oeyen S, Benoit D, Decruyenaere J, Gobatto A, Besen B, Tierno P, Melro L, Mendes P, Cadamuro F, Park M, Malbouisson LM, Civantos BC, Lopez JL, Robles A, Figueira J, Yus S, Garcia A, Oglinda A, Ciobanu G, Oglinda C, Schirca L, Sertinean T, Lupu V, Kelly P, O’Sullivan A, Sweeney L, MacLoughlin R, O’Sullivan A, Kelly P, Sweeney L, Mukeria E, Wolny M, MacLoughlin R, Pagano A, Numis F, Visone G, Saldamarco L, Russo T, Porta G, Paladino F, Bell C, Liu J, Debacker J, Lee C, Tamberg E, Campbell V, Mehta S, Silva-Pinto A, Sarmento A, Santos L, Kara Ý, Yýldýrým F, Zerman A, Güllü Z, Boyacý N, Basarýk Aydogan B, Gaygýsýz Ü, Gönderen K, Arýk G, Turkoglu M, Aydogdu M, Aygencel G, Ülger Z, Gursel G, Boyacý N, Isýkdogan Z, Özdedeoglu Ö, Güllü Z, Badoglu M, Gaygýsýz U, Aydogdu M, Gursel G, Kongpolprom N, Sittipunt C, Eden A, Kokhanovsky Y, Bursztein – De Myttenaere S, Pizov R, Neilans L, MacIntyre N, Radosevich M, Wanta B, Weber V, Meyer T, 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Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].